Effectiveness and acceptability of progestogens in combined oral contraceptives – a systematic reviewReport as inadecuate

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Reproductive Health

, 1:1

First Online: 03 June 2004Received: 28 April 2004Accepted: 03 June 2004DOI: 10.1186-1742-4755-1-1

Cite this article as: Kulier, R., Helmerhorst, F.M., Maitra, N. et al. Reprod Health 2004 1: 1. doi:10.1186-1742-4755-1-1


BackgroundThe progestogen component of oral contraceptives OCs has undergone changes since it was recognized that their chemical structure can influence the spectrum of minor adverse and beneficial effects.

MethodsThe objective of this review was to evaluate currently available low-dose OCs containing ethinylestradiol and different progestogens in terms of contraceptive effectiveness, cycle control, side effects and continuation rates. The Cochrane Controlled Trials Register, MEDLINE and EMBASE databases were searched. Randomized trials reporting clinical outcomes were considered for inclusion and were assessed for methodological quality and validity.

ResultsTwenty–two trials were included in the review. Eighteen were sponsored by pharmaceutical companies and in only 5 there was an attempt for blinding. Most comparisons between different interventions included one to three trials, involving usually less than 500 women. Discontinuation was less with second-generation progestogens compared to first–generation RR 0.79; 95% CI 0.69–0.91. Cycle control appeared to be better with second-compared to first-generation progestogens for both, mono-and triphasic preparations RR 0.69; 95% CI 0.52–0.91 and RR 0.61; 95% CI 0.43–0.85, respectively. Intermenstrual bleeding was less with third- compared to second-generation pills RR 0.71; 95% CI 0.55–0.91.

Contraceptive effectiveness of gestodene GSD was comparable to that of levonorgestrel LNG, and had similar pattern of spotting, breakthrough bleeding and absence of withdrawal bleeding. Drospirenone DRSP was similar compared to desogestrel DSG regarding contraceptive effectiveness, cycle control and side effects.

ConclusionThe third- and second-generation progestogens are preferred over first generation in all indices of acceptability. Current evidence suggests that GSD is comparable to LNG in terms of contraceptive effectiveness and for most cycle control indices. GSD is also comparable to DSG. DRSP is comparable to DSG. Future research should focus on independently conducted well designed randomized trials comparing particularly the third- with second-generation progestogens.

Electronic supplementary materialThe online version of this article doi:10.1186-1742-4755-1-1 contains supplementary material, which is available to authorized users.

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Author: Regina Kulier - Frans M Helmerhorst - Nandita Maitra - A Metin Gülmezoglu

Source: https://link.springer.com/

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