Priority 15 from the Contraception PSP

UNCERTAINTY: Are there health risks for women who take emergency contraception repeatedly? (JLA PSP Priority 15)
Overall ranking	15
JLA question ID	0049/15
Explanatory note	In England about 330 thousand prescriptions for emergency EC were issued in 2013-14, only 1 in 3 of these were from community sexual health services, only 19/20 women using oral method. Prescriptions for EC have been falling since it was made available to buy over the counter in 2001, but there are no central data on how many women buy EC at pharmacies. Most studies in the systematic review were old (they used Levonorgestrel EC which is less effective than Ulipristal acetate (UPA) EC) and many reports were not complete. However, the data had moderate quality because of the many women in these studies, the low pregnancy rates, and the consistent results. We do not know for sure whether using levonorgestrel repeatedly around the time of sex is a good and safe method of birth control. More high-quality research is needed to answer the question.
Evidence	Repeated use of pre‐ and postcoital hormonal contraception for prevention of pregnancy. Vera Halpern, Elizabeth G Raymond, Laureen M Lopez. CDSR September 2014
Health Research Classification System category	Reproductive Health and Childbirth

Extra information provided by this PSP
Original uncertainty examples	“How often you can take EHC and how often is safe to take” (HCP) ~ “Any risks to frequency of using emergency contraception in itself (not associated risks eg stds or risk of failure if used twice in cycle) “ (Patient)“
Submitted by	Healthcare Professionals x 3~Patients x 1~Both x 0

PSP information
PSP unique ID	0049
PSP name	Contraception
Total number of uncertainties identified by this PSP.	57 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	21 April 2017