title: Suppression of follicular rupture with meloxicam, a cyclooxygenase-2 inhibitor: potential for emergency contraception.
abstract: BACKGROUND
  There is evidence that cyclooxygenase-2 (COX-2) inhibitors can prevent or delay follicular rupture. COX-2 inhibitors, such as meloxicam, may offer advantages over emergency contraception with levonorgestrel, such as extending the therapeutic window for up to 24 h. We assessed the effect of meloxicam administered in the late follicular phase upon ovulation in women.
  
  
  METHODS
  This was a single center, double blind, crossover study designed to assess the effects in 27 eligible women (18-40 years old, surgically sterilized with regular menstrual cycles) of meloxicam, 15 or 30 mg/day, administered orally for five consecutive days during the late follicular phase, starting when the leading follicle reached 18 mm diameter. Volunteers underwent two treatment cycles separated by one resting cycle, with randomization to dose sequence. Main outcomes were follicular rupture; serum LH, progesterone and estradiol (E2) levels; and incidence of adverse events.
  
  
  RESULTS
  Twenty-two volunteers completed the study. There were no differences between meloxicam doses in menstrual cycle length. Dysfunctional ovulation was observed in 11/22 (50%) cycles treated with 15 mg/day and 20/22 (90.9%) cycles with 30 mg/day (P = 0.0068). All women had normal luteal phase progesterone levels; mean maximal values +/- SEM were 42 +/- 4.1 and 46.8 +/- 2.6 nmol/l for 15 and 30 mg/day groups, respectively. There were no serious adverse events, and no changes in LH and E2 levels or in cycle length.
  
  
  CONCLUSIONS
  Meloxicam 30 mg given for five consecutive days in the late follicular phase is safe, effective and may be an alternative form of emergency contraception.
authors.affiliation: Instituto Chileno de Medicina Reproductiva (ICMER), José Victorino Lastarria 29, Apt. 101, Santiago, Chile. cjesam@icmer.org
authors.forename: Cristián
authors.initials: C
authors.lastname: Jesam
authors.forename: Ana María
authors.initials: AM
authors.lastname: Salvatierra
authors.forename: Jill L
authors.initials: JL
authors.lastname: Schwartz
authors.forename: Horacio B
authors.initials: HB
authors.lastname: Croxatto
mesh_terms: D000293:Adolescent; D000328:Adult; D044363:Contraception, Postcoital; D018592:Cross-Over Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000494:pharmacology*; D004311:Double-Blind Method; D004958:Estradiol / Q000097:blood; D005260:Female; D005498:Follicular Phase / Q000187:drug effects; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D000077239:Meloxicam; D006080:Ovarian Follicle / Q000187:drug effects* / Q000502:physiology; D010060:Ovulation / Q000187:drug effects*; D011374:Progesterone / Q000097:blood; D013843:Thiazines / Q000009:adverse effects / Q000494:pharmacology*; D013844:Thiazoles / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D013843:Thiazines; D013844:Thiazoles; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D000077239:Meloxicam