Trends in Hormonal Contraception

Abstract

Despite the availability of a wide range of formulations of hormonal contraception (similarly reliable, safe and tolerated), there are still efforts to develop formulations with additional favourable properties and noncontraceptive benefits. After achieving the minimum dose of the synthetic oestrogen component (15 (mu)g) of ethinylestradiol, a predominant oestrogen component until recently, an alternative in the form of natural estradiol, or estradiol valerate, was introduced in combined oral contraception (COC) not long ago. 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.