Why Maintain the Availability of Levonorgestrel to the UK Public - Essay Example

Topic: WHY MAINTAIN THE AVAILABILITY OF LEVONORGESTREL (LEVONELLE 1500) TO THE UK PUBLIC AS IT IS CURRENTLY? Introduction Levonorgestrel is a tablet used by women to reduce chances of getting pregnant. It is an emergency contraceptive that can be used within 72 hours of unprotected sex or if ones usual contraceptive method has failed (Guillebaud, p102). It is also referred to as ‘the morning-after pill’ because it is taken after unprotected sex and can protect about 84% of unwanted pregnancies. Studies have indicated that each levonelle1500 tablet contains an active ingredient of artificial progesterone female sex hormone in addition to 142.5mg lactose (p420). This essay explores the maintenance of levonelle1500 availability to the UK public as it is currently. Pharmacological history of Levonelle1500 The use of synthetic estrogens as a post-coital contraceptive was discovered by Dr. John McLean Morris in 1966 according to study findings by Waller and McPherson (p45). At the time, a few different drugs were also scrutinised in researches conducted in the USA and Netherlands to establish a more active dose of estrogens that was to produce a most viable drug. It wasn’t before the early 70s when the first progesterone post-coital was developed by a Mr Yuzpe A as noted by Wertheimer (p73). The drug was further investigated and eventually recommended for use in 1975. Observations by Trussell and Lisa (p89) indicate that post coital contraceptive became a standard course of treatment in 1980 but was only recommended for use in the UK in 2004. To date, morning-after pills are shown to have worked a greater deal in reducing pregnancies compared to other means according to study findings by Raymond and Trussell (p37). Mode of action of Levonelle1500 and its safety Post-coital is an oral contraceptive pill that is used to prevent conception in cases where other means of pregnancy control have failed due to some mishaps. For instance, a woman might have forgotten to take birth control pills or even a condom bursting during sexual intercourse. It is important to note that post-coital contraception does not protect sexually transmitted diseases (Bosch et al, p1090; Dunn et al, p795 and Tanis et al, p1790). For this reason, post-coital contraceptive pills are used where Levonorgestrel is used as a medicine in emergency hormonal contraception, menorrhagia and prevention of endometrial hyperplasia (Nichols et al, p660). Depending on the condition being treated and the particular preparation used, these pills are identified by labelling clearly on the packages. Experts explain that levonorgestrel works by preventing ovulation, hindering fertilisation and altering the lining of the uterus (Guillebaud, p286). Normally, a mature ovum is released from the ovary through the fallopian tube during a process known as ovulation. Hormone progesterone is then released from the ovary to prevent further ovulation under normal circumstances (p300). When levonorgestrel is taken into the body, it causes the body to sense that an ovulation has occurred and consequently no more eggs are released (Gemzell-Danielsson and Marions, p68). It does this by providing a high level of synthetic progesterone which prevents the ovaries from releasing more eggs as observed by Cooper (p12). Additionally, it increases the thickness of the natural mucus in the cervix which prevents penetration of sperms from the vagina to the oviducts through the uterus (p32). Since fertilisation takes place in the oviducts, then it means that if an egg was present will not get a chance to meet with the sperm (Ellison, p1046). Similarly, Levonorgestrel is known to prevent the thickening of the lining of the uterus effectively preventing implantation from occurring. Research shows that a fertilised egg takes a maximum of three days to reach the uterus, just enough time for levonorgestrel which can only be effective if used within 72 hours after the unprotected sex (Hannaford and Webb, p365). The current levonorgestrel contains only one tablet which replaced the two tablets in the former levonelle-2. Haugan et al (p291) argue that this one tablet for levonelle1500 has double strength and it is supposed to be taken at once within 12 to 72 hours of unprotected sex. This reduces the inconveniences which were associated with the former levonelle-2 product which had a safety window of only 12 hours (Lyall, p528). If appropriately used, the current levonorgestrel can prevent pregnancies up to 85%. Its safety levels have been lauded by both users and manufacturers except a few isolated cases of health complications (n.d). Why do only 1 or 2 pharmaceutical companies hold the licence to this drug? Levonorstrel is currently used in UK and is referred to as levonelle-one step or levonelle1500 (Miller and Hughes, p655). This tablet contains female type hormone called levonorgestrel which is one of the ingredients of several types of contraceptives. Claims by Lippman et al (p1360) indicate that levonelle1500 tablets were recommended for use by the Food and Drugs Regulations schedule 1272. Although this post-coital pill was recommended for use in the UK in 2004, it became available early this year according to study findings by Raymond and Trussell (p105). In addition to this, the UK government is in an attempt to limit the availability of the drug to prevent its misuse by the youth and consequently reduce the rate of promiscuity in the country. Numerous studies have shown that countries that have allowed rampart use of the drug has led to increased the rates of promiscuity because there is no fear of unwanted pregnancies amongst the perpetrators (Anthony, p334). These two reasons among many others have made only two pharmaceutical companies to hold the licence to the drug. Apart from the foregoing, research has demonstrated that levonorgestrel effectiveness is still under investigation and should therefore be handled with utmost care. In a recent research for the effectiveness of the pill was based on trials done in two women in UK as reported by Schwarz (p14). The two were introduced post coital contraceptives between 0 to 72 hours after unprotected sexual intercourse or contraceptive failure. The outcome showed that pregnancy was vulnerable to around 1.5% in both cases (p16). Based on these results, statisticians and epidemiologists are really concerned about the efficiency of the levonelle1500 as reported by Wilson, H et al (p2030). Moreover, findings have illustrated that the high cost of the pill in addition to its availability only in prescription has further restricted its licensing to pharmaceutical companies in UK and other countries like France, Netherlands, German and Belgium. Side effects of levonorgestrel There are no notable side effects of levonelle1500 that have been identified so far. But Gainer et al (p120) observes that the pill may cause nausea and vaginal bleeding that is not related to the normal menses in some women. Thus if a woman vomits three hours of taking levonorgestrel, it should be assumed that its intended purpose is lost and therefore retake another tablet after having sought pharmaceutical assistance (Nichols et al, 663). There are also other assumed side effects apart from vomiting that include feeble headache, tummy ache, breast tenderness and dizziness. Jeremy (p38) observes that these side effects are not common to all individuals but only a few with certain body complications like porphyries and severe liver diseases (). Additionally, “levonorgestrel is not recommended for people with diseases like small bowels that interfere with digestion, people who previously had ectopic pregnancy and people with history of inflamed fallopian tubes” (Lyall, p518). A point of caution is that levonelle1500 cannot work properly to a person who is using other medicines to treat diseases such as epilepsy, tuberculosis, HIV infection and fungal infections (Waller and McPherson, p26). World Health Organisation advice: recommended dosage World Health Organisation advices that levonorgestrel should not be used regularly because it is not a contraceptive. It is only recommended for emergency cases because it can affect the menstrual cycle if used improperly. This conclusion arose from a pilot study conducted by a World Bank and World Health Organisation special program on human reproduction in 2004 to test the effectiveness of levonorgestrel as an emergency contraceptive (Guillebaud, p100). The World Health Organisation and other professionals contend that morning-early pills are medically safe for use because they do not affect the health of the user in any way. Levonorgestrel is therefore recommended to be used within a span of five days continuously after unprotected sex that might have occurred as a “result of rape, use of an expired condom that might have broken in the process or women who might have been induced to sex under influence of drunks or alcoholic drinks” (Guillebaud, p203). For this reason, it is not to use levonorgestrel regularly like other contraceptives methods of preventing pregnancy. It can only be used as an emergency the morning-after unprotected sex to protect one from conceiving. Impact of Education on teenagers about Levonelle1500 In the recent past, the morning-after pills have had a very new look. Researchers have demonstrated that the increased availability of levonorgestrel has reduced reported cases of abortion, thus gaining more credit over other medicines (Cooper, p38). Abortion has adverse effects on the victims and the discovery of levonorgestrel has been a big relief in the field of reproductive health. Published works by Gainer et al (p13) show that levonorgestrel has an exciting potentiality in reproductive health because it is based on modern day technology of using the ingredient ulipristal acetate which binds to the progesterone receptor for effect (Guillebaud, p417). Its usage varies from country to country but universally as an emergency contraception. Its defining characteristic is that it requires no physical assessment and its dosage is uniform to all women. Work cited Anthony, A., et al. “Retraction of an interpretation”. 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