PDF herunterladen
Semin Reprod Med 2010; 28(2): 140-146
DOI: 10.1055/s-0030-1248139
© Thieme Medical Publishers

Recent Innovations in Oral Contraception

Miriam Cremer1 , Scarlett Phan-Weston2 , Adam Jacobs1
  • 1Department of OB/GYN, The Mount Sinai Medical Center, New York, New York
  • 2Smith College, Northampton, Massachusetts
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
13. April 2010 (online)

    Lizenzen und Reprints

ABSTRACT

Traditional forms of oral contraception contain 21 days of hormone-containing pills and 7 days of placebo during the hormone-free interval (HFI). Since 2003, the Food and Drug Administration has approved 24/4, 84/7, and 365-day regimens. These regimens shorten the HFI in an attempt to decrease bleeding and menstrual-associated side effects. Safety and efficacy of these regimens is comparable with traditional 21/7 dosing. Extended regimens are associated with high patient satisfaction. Bleeding patterns are similar or shorter in women using extended regimens, along with improvement in menstrual symptoms. One of the new formulations contains the new progestin drospirenone, which has antimineralocorticoid and antiandrogenic properties. This review summarizes the data about new formulations of oral contraception available in the United Sates and also provides a summary of the current literature on drospirenone.

KEYWORDS

24/4 - 84/7 - Lybrel - drospirenone - extended regimen

REFERENCES

  • 1 Mosher W D, Martinez G M, Chandra A, Abma J C, Willson S J. Use of contraception and use of family planning services in the United States: 1982–2002.  Adv Data. 2004;  (350) 1-36
    PubMedGoogle Scholar
  • 2 Loudon N B, Foxwell M, Potts D M, Guild A L, Short R V. Acceptability of an oral contraceptive that reduces the frequency of menstruation: the tri-cycle pill regimen.  BMJ. 1977;  2(6085) 487-490
    CrossrefPubMedGoogle Scholar
  • 3 Edelman A, Gallo M F, Nichols M D, Jensen J T, Schulz K F, Grimes D A. Continuous versus cyclic use of combined oral contraceptives for contraception: systematic Cochrane review of randomized controlled trials.  Hum Reprod. 2006;  21(3) 573-578
    CrossrefPubMedGoogle Scholar
  • 4 Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Nelson AL, Willard Cates J, Stewart F, Kowal D Contraceptive Technology 19th ed. New York, NY; Ardent Media 2007
    PubMedGoogle Scholar
  • 5 Facts on Contraceptive Use . 2008. Guttmacher Institute.  Available at: http://.www.guttmacher.org/pubs/fb_contr_use.html Accessed September 15, 2009; 
    PubMedGoogle Scholar
  • 6 Baerwald A R, Pierson R A. Ovarian follicular development during the use of oral contraception: a review.  J Obstet Gynaecol Can. 2004;  26(1) 19-24
    PubMedGoogle Scholar
  • 7 Killick S R, Fitzgerald C, Davis A. Ovarian activity in women taking an oral contraceptive containing 20 microg ethinyl estradiol and 150 microg desogestrel: effects of low estrogen doses during the hormone-free interval.  Am J Obstet Gynecol. 1998;  179(1) S18-S24
    CrossrefPubMedGoogle Scholar
  • 8 Schlaff W D, Lynch A M, Hughes H D, Cedars M I, Smith D L. Manipulation of the pill-free interval in oral contraceptive pill users: the effect on follicular suppression.  Am J Obstet Gynecol. 2004;  190(4) 943-951
    CrossrefPubMedGoogle Scholar
  • 9 Sullivan H, Furniss H, Spona J, Elstein M. Effect of 21-day and 24-day oral contraceptive regimens containing gestodene (60 microg) and ethinyl estradiol (15 microg) on ovarian activity.  Fertil Steril. 1999;  72(1) 115-120
    CrossrefPubMedGoogle Scholar
  • 10 Nakajima S T, Archer D F, Ellman H. Efficacy and safety of a new 24-day oral contraceptive regimen of norethindrone acetate 1 mg/ethinyl estradiol 20 micro g (Loestrin 24 Fe).  Contraception. 2007;  75(1) 16-22
    CrossrefPubMedGoogle Scholar
  • 11 Bachmann G, Sulak P J, Sampson-Landers C, Benda N, Marr J. Efficacy and safety of a low-dose 24-day combined oral contraceptive containing 20 micrograms ethinylestradiol and 3 mg drospirenone.  Contraception. 2004;  70(3) 191-198
    CrossrefPubMedGoogle Scholar
  • 12 Rosenberg M J, Meyers A, Roy V. Efficacy, cycle control, and side effects of low- and lower-dose oral contraceptives: a randomized trial of 20 micrograms and 35 micrograms estrogen preparations.  Contraception. 1999;  60(6) 321-329
    CrossrefPubMedGoogle Scholar
  • 13 Sulak P J, Carl J, Gopalakrishnan I, Coffee A, Kuehl T J. Outcomes of extended oral contraceptive regimens with a shortened hormone-free interval to manage breakthrough bleeding.  Contraception. 2004;  70(4) 281-287
    CrossrefPubMedGoogle Scholar
  • 14 Brown C S, Ling F W, Andersen R N, Farmer R G, Arheart K L. Efficacy of depot leuprolide in premenstrual syndrome: effect of symptom severity and type in a controlled trial.  Obstet Gynecol. 1994;  84(5) 779-786
    PubMedGoogle Scholar
  • 15 Hahn P M, Van Vugt D A, Reid R L. A randomized, placebo-controlled, crossover trial of danazol for the treatment of premenstrual syndrome.  Psychoneuroendocrinology. 1995;  20(2) 193-209
    CrossrefPubMedGoogle Scholar
  • 16 Yonkers K A, Brown C, Pearlstein T B, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder.  Obstet Gynecol. 2005;  106(3) 492-501
    CrossrefPubMedGoogle Scholar
  • 17 Pearlstein T B, Bachmann G A, Zacur H A, Yonkers K A. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation.  Contraception. 2005;  72(6) 414-421
    CrossrefPubMedGoogle Scholar
  • 18 Yaz drospirenone and ethinyl estradiol tablets. Prescribing information. Wayne, NJ; Bayer HealthCare Pharmaceuticals Inc.; 2007 Available at: http://berlex.bayerhealthcare.com/html/products/pops/fhc9.html?WT.mc_id=www.berlex.com Accessed September 2009
    Google Scholar
  • 19 Maloney J M, Dietze Jr P, Watson D et al.. Treatment of acne using a 3-milligram drospirenone/20-microgram ethinyl estradiol oral contraceptive administered in a 24/4 regimen: a randomized controlled trial.  Obstet Gynecol. 2008;  112(4) 773-781
    CrossrefPubMedGoogle Scholar
  • 20 Lucky A W, Koltun W, Thiboutot D et al.. A combined oral contraceptive containing 3-mg drospirenone/20-microg ethinyl estradiol in the treatment of acne vulgaris: a randomized, double-blind, placebo-controlled study evaluating lesion counts and participant self-assessment.  Cutis. 2008;  82(2) 143-150
    PubMedGoogle Scholar
  • 21 Anderson F D, Hait H. A multicenter, randomized study of an extended cycle oral contraceptive.  Contraception. 2003;  68(2) 89-96
    CrossrefPubMedGoogle Scholar
  • 22 Anderson F D, Gibbons W, Portman D. Long-term safety of an extended-cycle oral contraceptive (Seasonale): a 2-year multicenter open-label extension trial.  Am J Obstet Gynecol. 2006;  195(1) 92-96
    CrossrefPubMedGoogle Scholar
  • 23 Anderson F D, Gibbons W, Portman D. Safety and efficacy of an extended-regimen oral contraceptive utilizing continuous low-dose ethinyl estradiol.  Contraception. 2006;  73(3) 229-234
    CrossrefPubMedGoogle Scholar
  • 24 Kaunitz A M, Portman D J, Hait H, Reape K Z. Adding low-dose estrogen to the hormone-free interval: impact on bleeding patterns in users of a 91-day extended regimen oral contraceptive.  Contraception. 2009;  79(5) 350-355
    CrossrefPubMedGoogle Scholar
  • 25 Anderson F D, Feldman R, Reape K Z. Endometrial effects of a 91-day extended-regimen oral contraceptive with low-dose estrogen in place of placebo.  Contraception. 2008;  77(2) 91-96
    CrossrefPubMedGoogle Scholar
  • 26 Anderson F D, Hait H, Hsiu J, Thompson-Graves A L, Wilborn W H, Williams R F. Endometrial microstructure after long-term use of a 91-day extended-cycle oral contraceptive regimen.  Contraception. 2005;  71(1) 55-59
    CrossrefPubMedGoogle Scholar
  • 27 den Tonkelaar I, Oddens B J. Preferred frequency and characteristics of menstrual bleeding in relation to reproductive status, oral contraceptive use, and hormone replacement therapy use.  Contraception. 1999;  59(6) 357-362
    CrossrefPubMedGoogle Scholar
  • 28 Andrist L C, Arias R D, Nucatola D et al.. Women's and providers' attitudes toward menstrual suppression with extended use of oral contraceptives.  Contraception. 2004;  70(5) 359-363
    CrossrefPubMedGoogle Scholar
  • 29 Lybrel package insert .2007. Wyeth. Available at: http://www.lybrel.com/patient_package-insert Accessed September 15, 2009
    PubMedGoogle Scholar
  • 30 Archer D F, Jensen J T, Johnson J V, Borisute H, Grubb G S, Constantine G D. Evaluation of a continuous regimen of levonorgestrel/ethinyl estradiol: phase 3 study results.  Contraception. 2006;  74(6) 439-445
    CrossrefPubMedGoogle Scholar
  • 31 Teichmann A, Emerich C, Greven D et al.. Continuous, daily levonorgestrel/ethinyl estradiol vs. 21-day, cyclic levonorgestrel/ethinyl estradiol: efficacy, safety and bleeding in a randomized, open-label trial.  Contraception. 2009;  80(6) 504-511
    CrossrefPubMedGoogle Scholar
  • 32 Miller L, Hughes J P. Continuous combination oral contraceptive pills to eliminate withdrawal bleeding: a randomized trial.  Obstet Gynecol. 2003;  101(4) 653-661
    CrossrefPubMedGoogle Scholar
  • 33 Mishell Jr D R. Family planning. In: Katz VL, Lobo RA, Lentz G, Gershenson D Comprehensive Gynecology. 5th ed. St. Louis, MO; Mosby 2007: 275-325
    PubMedGoogle Scholar
  • 34 Mishell Jr D R. YAZ and the novel progestin drospirenone.  J Reprod Med. 2008;  53(9, suppl) 721-728
    PubMedGoogle Scholar
  • 35 Loughlin J, Seeger J D, Eng P M et al.. Risk of hyperkalemia in women taking ethinylestradiol/drospirenone and other oral contraceptives.  Contraception. 2008;  78(5) 377-383
    CrossrefPubMedGoogle Scholar
  • 36 Heinemann L A, Lewis M A, Assmann A, Thiel C. Case-control studies on venous thromboembolism: bias due to design? A methodological study on venous thromboembolism and steroid hormone use.  Contraception. 2002;  65(3) 207-214
    CrossrefPubMedGoogle Scholar
  • 37 Dinger J C, Heinemann L A, Kühl-Habich D. The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance Study on oral contraceptives based on 142,475 women-years of observation.  Contraception. 2007;  75(5) 344-354
    CrossrefPubMedGoogle Scholar
  • 38 Seeger J D, Loughlin J, Eng P M, Clifford C R, Cutone J, Walker A M. Risk of thromboembolism in women taking ethinylestradiol/drospirenone and other oral contraceptives.  Obstet Gynecol. 2007;  110(3) 587-593
    CrossrefPubMedGoogle Scholar
  • 39 Batukan C, Muderris I I, Ozcelik B, Ozturk A. Comparison of two oral contraceptives containing either drospirenone or cyproterone acetate in the treatment of hirsutism.  Gynecol Endocrinol. 2007;  23(1) 38-44
    CrossrefPubMedGoogle Scholar
  • 40 Gregoriou O, Papadias K, Konidaris S et al.. Treatment of hirsutism with combined pill containing drospirenone.  Gynecol Endocrinol. 2008;  24(4) 220-223
    CrossrefPubMedGoogle Scholar
  • 41 Pehlivanov B, Mitkov M. Efficacy of an oral contraceptive containing drospirenone in the treatment of women with polycystic ovary syndrome.  Eur J Contracept Reprod Health Care. 2007;  12(1) 30-35
    CrossrefPubMedGoogle Scholar

Miriam CremerM.D. M.P.H. 

Assistant Professor, Department of OB/GYN, The Mount Sinai Medical Center

One Gustave, L. Levy Place, Box 1170, New York, NY 10029-6574

eMail: mlcremer@hotmail.com