Abstract
Third-generation oral contraceptives are an association of low-dose ethinyl estradiol and potent testosterone-derived progestins, developed in order to improve general and vascular tolerance. They are highly efficient and well tolerated by most users. Their extensive use has provided different key information: oral contraceptives (as well as non-oral ethinyl estradiol-containing contraceptives) can be used in women under the age of 35 years with well-controlled metabolic risk factors and high familial risk of breast cancer. On the other hand, ethinyl-estradiol containing contraceptives are not indicated in women with a high risk of deep venous thrombosis, or noncontrolled metabolic and vascular risk factors (including being over the age of 35 years or cigarette smoking), or with a history of breast cancer. Progestin-only contraception is not well tolerated owing to bleeding. Future hormonal contraception for women with a high vascular risk may contain nontestosterone-derived progestins and 17β estradiol, or antiprogestins.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
Notes
As discussed in the text these contraindications have been re-evaluated and reduced during the 45 years of experience of oral contraceptives, with the improvement of their tolerance profile. However, reduction in ethinyl estrogen doses and development of third-generation progestins did not solve the problem of high vascular risk.