Advantages and challenges of oestrogen-free hormonal contraception

Abstract

Background:

Not all women tolerate hormonal contraceptives containing oestrogens.

Methods:

The authors selected and evaluated relevant publications on the advantages and challenges of oestrogen-containing and oestrogen-free oral contraceptives obtained from the MEDLINE and Google databases from January 2000 to January 2010. In addition, the reference lists from the obtained publications as well as the authors’ clinical experience served as additional sources of information. Emphasis was placed on the common adverse effects and risks associated with oestrogen replacement as well as on the noncontraceptive benefits of combined oral contraceptive pills and progestogen-only pills in the management of menstrual cycle–dependent problems.

Findings:

Progestogen-only pills have the potential to abolish many of the common adverse effects associated with oestrogen plus progestogen oral contraceptives and can be used to treat various menstrual cycle–dependent problems. However, only a limited number of clinical comparative studies are available. Progestogen-only pills are associated with a more irregular bleeding pattern than contraceptive pills containing oestrogens, especially during the first few months of therapy. As this is not permanent, adequate counselling is essential in order to prevent unnecessary discontinuation of treatment.

Conclusions:

Progestogen-only pills offer an effective, convenient, and readily reversible method of contraception that is suitable for women with contraindications for oestrogens.

Key words:

• Contraceptive
• Dysmenorrhoea
• Premenstrual syndrome
• Progesterone-only pill

Transparency

Declaration of funding

Schering-Plough Corporation, a division of Merck & Co. USA, funded this review.

Declaration of financial/other relationships

H.-J.A. has disclosed that he has been a consultant for Schering-Plough, Bayer, Jenapharm, Procter & Gamble and HRA Pharma. K.J.B. has disclosed that he has been a consultant for Bayer and Jenapharm. D.A. reports no conflict of interest.

Some peer reviewers receive honoraria from CMRO for their review work. The peer reviewers of this paper have disclosed that they have no relevant financial relationships.

Acknowledgement

The authors thank Malcolm Darkes, PhD, and Alex Loeb, PhD, of Evidence Scientific Solutions (Philadelphia, PA, USA) for editorial assistance. This assistance was funded by Schering-Plough Corporation, a division of Merck & Co. USA.

H.-J.A. contributed substantially to the concept and design of this manuscript as well as the interpretation of the data. He critically revised the text for important intellectual content. K.J.B. made substantial contributions to the concept of the study and the interpretation of the data in the revised version of the manuscript. D.A. made substantial contributions to the statistical analyses and the interpretation of the results in the revised version of the manuscript. All authors gave final approval of the version to be published.