Early research published online in the journal BMJ Sexual & Reproductive Health reveals a new drug combination is a “promising candidate” for on-demand contraception.

The combination of the COX-2 inhibitor meloxicam, a type of non-steroidal anti-inflammatory drug, and the emergency contraceptive pill ulipristal acetate appears to be highly successful at preventing ovulation at the time in the cycle when the chance of conception is greatest, known as peak fertility.

The luteal surge, which occurs shortly before ovulation, is when it’s most difficult to disrupt ovulation and when fertilization of the egg is most likely.

Ovulation is disrupted by ulipristal acetate, but only if it is given before the luteal surge begins. COX-2 inhibitors, on the other hand, may be able to prevent ovulation even after the luteal surge has begun.

The researchers intended to see if the combination of both medications worked at peak fertility, in the hopes of finding a promising lead candidate for an on-demand contraceptive pill that could be used before or after sex as needed, or as an emergency contraceptive pill.

The study comprised ten healthy women between the ages of 18 and 35 who all had regular periods.

Each woman was followed for two menstrual cycles: one to determine typical ovulatory patterns and another to administer a combined dosage of ulipristal acetate 30 mg and meloxicam 30 mg around the time of the luteal surge.

Ultrasound scans and critical hormones were used to determine whether the luteal surge had occurred or if ovulation had been disrupted. Nine women were included in the final analysis after completing both the baseline and treatment cycles.

In the therapy cycle, ovulation was interrupted in six women. The majority of the women (89 percent, 8) satisfied some of the criteria for incomplete ovulation. According to the researchers, treatment cycles were roughly 3 days longer, which is very crucial for women who may also be using fertility awareness measures.

They emphasize that because this is exploratory research with just 9 women, more studies on safety and effectiveness in larger groups of women are needed.

The findings are encouraging, they say, because they show that ulipristal acetate + meloxicam can prevent ovulation when the risk of pregnancy is greatest, making it “a good candidate for consideration as a pericoital oral contraceptive.”

They add: “When we compare ovulation disruption rates in our study with the previous studies on which our protocol is based, the combination of [ulipristal acetate] and meloxicam disrupted ovulation at each phase of the fertile window more than any other medication previously studied.” 

According to the researchers, adding meloxicam to ulipristal acetate may improve the latter’s efficiency as an emergency contraceptive.

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