A new method for estimating the effectiveness of emergency contraception that accounts for variation in timing of ovulation and previous cycle length.
OBJECTIVE
To develop a new method for estimating the effectiveness of emergency contraception (EC) by using information about previous menstrual cycle length, accounting for the variation in the day of ovulation within the menstrual cycle, and comparing the validity of the new and previous methods.


METHODS
Secondary analysis of a data set with a biological marker of ovulation and its distribution in the cycle. Based on a sample of cycles with known length and a known biological marker of ovulation, we simulated trials of predetermined EC effectiveness and then calculated estimates of EC effectiveness based on old and new methods.


RESULTS
Under some conditions, all methods produced biased estimates of effectiveness with simulated trials, especially when the actual effectiveness was low. The systematic bias was minimized with the new method. The new method was robust with regard to the distribution of the day of intercourse in women presenting for EC.


CONCLUSIONS
Future studies of EC effectiveness should consider both the uncertainty in predicting the day of ovulation and previous cycle length. Our estimates of daily fecundity should be replicated with other data sets.
Mikolajczyk
Rafael T
RT
Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany. rmikolajczyk@uni-bielefeld.de
Stanford
Joseph B
JB
D044363:Contraception, Postcoital / Q000379:methods* / Q000706:statistics & numerical data; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008597:Menstrual Cycle; D010060:Ovulation; D013997:Time Factors