Praktické lekárnictvo 3/2011

Trends in hormonal contraception

Currently, a wide range of methods and formulations of hormonal contraception are commercially available which are similarly reliable, safe and tolerated. Thus, there are efforts to develop formulations with additional beneficial properties. The reduction in the dose of the oestrogen component has stopped at 15 µg of ethinylestradiol, a predominant oestrogen component until recently. Not long ago, an alternative in the form of natural estradiol, or estradiol valerate, was introduced in a combined oral contraceptive (COC). Poor cycle control, the limiting factor thus far, has been overcome by the combination with new gestagens. In the gestagen component, recent gestagens have virtually no negative metabolic effects (zero androgenic potential) and some gestagens exhibit additional beneficial properties (e. g., antimineralocorticoid activity of drospirenone). Other gestagens in the phase of clinical trials include nestorone (similar to natural progesterone) and ulipristal, a progesterone receptor modulator. Among depot forms of hormonal contraception, the vaginal route of administration has been preferred to the transdermal one recently. The most recent trials have again confirmed a protective effect of the use of COC on endometrial, ovarian and colorectal cancer while not confirming an increased risk of breast cancer. The selection of an optimal method or formulation is in the hands of gynaecologists while carefully observing the contraindications and considering all possible benefits, including the utilization of noncontraceptive beneficial properties.

Keywords: ethinylestradiol, 17β-estradiol, gestagens.