Dear Editor,

Thank you for your interesting editorial "A simple way to find a simple answer to a simple question" the Hong Kong Practitioner September 2001 issue about emergency contraception.

Why, however, are we not discussing and using the safer, more effective, with fewer side-effects post-coital contraception Levonorgestrol following the 1998 WHO paper?¹

Levonorgestrol 750mg (alone) is given twice with a 12-hour interval, preferrably as early as possible, within the first 72 hours after intercourse.

It is the drug of first choice in many countries e.g.: the UK,² both by prescription and by pharmacy license. In fact the Hong Kong Family Planning Association are soon to trial its self-administered use in Hong Kong.³

Perhaps it is time for Hong Kong to have formal post-coital packs as are available overseas e.g. Levonelle 2 (Levonorgestrol 750mg 2) which would help to simplify and clarify instructions for both patients and doctors in the use of emergency contraception.

Authors' Reply
R W M Chow 周偉文

Dear Editor,

Thank you for forwarding Dr Bryden's letter on the editorial "A simple way to find a simple answer to a simple question" in the September 2001 issue of the Hong Kong Practitioner.

The editorial in question is no more than an attempt to promote the spirit of inquiry among non-academic, practising family doctors. It was never meant to be a comprehensive discussion paper on the broader topic of emergency contraception and should not be viewed as such. The use of this topic as a specific example to make a point is purely incidental. It is for this reason that other methods of emergency contraception such as Levonorgestrol and emergency IUD insertion, were not discussed.

In fact I did come across the use of Levonorgestrol as a superior form of emergency contraception when I conducted the search back in March 2001. I had originally listed this as one of my learning points in my first draft. During subsequent revision, however, it appeared that this lone piece of information did not add anything to the subject matter and was thus dropped in the final manuscript. My understanding is that, at that time, most available formulations contained only a very small dose of the drug. As a result, patients had to swallow a large number of tablets, which is undersirable. As Dr Bryden has correctly pointed out, things are changing.¹

As a family doctor, I often caution myself not to become so obsessed with pills and dosages that the need of the patient is overlooked. Request for emergency contraception represents a failure in planned contraception for whatever reasons. Drugs which are safer, more effective, with fewer side-effects and in convenient packaging will certainly help the patient. However, the family physician has much to offer the patient in helping her to cope with her own emotional reactions of embarrassment, anxiety and fear. Indeed, these clinical encounters may be the only times when patients are open to be counselled on issues like contraception, safe sex, sexually transmitted diseases, gynaecological examination and Pap smear, etc. We would have failed ourselves and our patients if such golden opportunities were not seized and put into good use. Let us hope that no elixir will ever even come close to replacing the family doctor. Armed with a trusting doctor-and-patient relationship, the family physician is also at a very favourable position to provide counselling in this area. In this regard, I have found the information at the Family Planning Association of Hong Kong homepage very useful.²