New Drug Combo Shows Promise as Contraceptive Pill

A combination of ulipristal acetate, a drug used as an emergency contraception medication under the brand name Ella, and pain-reliever meloxicam is effective in preventing unwanted pregnancies and could serve as an option in emergency contraception, or birth control, for women.// Peak fertility is the point in a woman’s ovulation cycle at which the risk for pregnancy is greatest due to the high production of eggs in the ovaries, the researchers said in an article published Monday by the journal BMJ Sexual and Reproductive Health.

Findings About Combination

The findings mean the combination might work as an on-demand contraceptive pill for use before or after sex as needed, or as an emergency contraceptive pill, they said.

"There’s no specific reason why emergency contraception pills must be taken after intercourse, as their effect is on preventing ovulation or preventing egg release," study co-author Dr. Erica P. Cahill told UPI in an email.

"The goal is to prevent egg release while sperm is present, so these medications, taken prior to intercourse, may be more effective," said Cahill, an obstetrician, and gynecologist and clinical assistant professor at Stanford Health Care in Palo Alto, Calif.

The days just before ovulation, known as the luteal surge, are the period when disrupting ovulation is the most difficult and when fertilization of the egg is most likely to occur, according to the researchers.

The researchers said that the drug ulipristal acetate disrupts ovulation, but only if it is taken before the luteal surge begins.

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However, drugs like meloxicam, part of a class of non-steroidal, anti-inflammatory drugs called COX-2 inhibitors used in pain medicine, still may be able to disrupt ovulation even after the luteal surge has started, they said.

Cahill and her colleagues tested the combination on 10 healthy women ages 18 to 35 years, all of whom had regular periods, or menstrual cycles.

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Each woman was monitored through two menstrual cycles, including a baseline cycle to identify normal ovulatory patterns and a treatment cycle when participants were given a combined dose of ulipristal acetate and meloxicam — at 30 milligrams each — around the time of the luteal surge, the researchers said.

Participants underwent ultrasound scans and were tested for key hormones to identify their respective luteal surges and whether ovulation had occurred or been disrupted.

They said that of the nine women who completed both cycles, six had ovulation disrupted and eight met the criteria for incomplete ovulation.

As this is a small study, involving only nine participants, additional research is needed to confirm the safety and effectiveness of the drug combination in larger numbers of women are needed, according to the researchers.

Results of the Combination

The researchers said that the combination of ulipristal acetate plus meloxicam can disrupt ovulation when conception risk is highest.

Based on the results of the study, the combination drug "is a good candidate for evaluation as a peri-coital or on-demand method" of birth control, according to Cahill.

The findings also suggest that adding meloxicam to ulipristal acetate may boost the latter’s effectiveness as emergency contraception, she and her colleagues said.

"Our study was a small exploratory study demonstrating biologic feasibility, so we cannot recommend the use of this in place of other methods," Cahill said.

"However, for people using ulipristal acetate as one-time emergency contraception, it is reasonable" — in consultation with a physician — "to take it in a peri-coital fashion, or within 24 hours prior to intercourse to up to five days after intercourse, and to add meloxicam," she said.

Source-Medindia