Endocrine Abstracts (2008) 16 ME3

Contraception in the new millennium

George Mastorakos


Endocrine Unit, Athens University Medical School, Aretaieion Hospital, Athens, Greece.


The control of fertility constitutes a global health issue, because overpopulation and unintended pregnancy have both major personal and societal impact. Oral contraceptives (OCs) have been the gold standard for contraception since their introduction in 1960. They are used for both their contraceptive and noncontraceptive benefits. Hormonal contraceptives are made of either oestrogen-progestin combinations or progestins alone. Attempts have been made to use other classes of steroids for contraception such as the so-called selective progesterone receptor modulators (SPRM). Hormonal contraceptives can be employed through different routes (intramuscularly, intranasally, intrauterus, intravaginally, orally, subcutaneously, and transdermally). The newest developments in contraception include low and ultra-low doses of estrogen, the use of less-androgenic 19 nor-testosterone progestins, and the nonsteroidal progestin drospirenone, a new minipill (progestin-only preparation) containing desogestrel, the contraceptive transdermal patch, the vaginal estrogen-progestin ring, the levonorgestrel intrauterine system and several subcutaneously implanted systems (contraceptive ‘rods’ and ‘capsules’). Although the traditional dosing regimen, 21 active pills and 7 placebo pills, (21/7), reduces many symptoms women suffer with spontaneous cycles and hormone withdrawal symptoms. New contraceptives are available that increase the time between hormone-free intervals. Extended cycle contraception is a safe and acceptable form of contraception and may be more efficacious than cyclic regimens. Most extended cycle regimens result in fewer scheduled bleeding episodes, as well as in fewer problems with bloating, menstrual symptoms and dysmenorrhea. Women usually experience more unscheduled spotting and bleeding in the initial cycles, but those problems decrease with longer use. Some women have medical conditions that make extended cycle contraception a preferred method. Counseling women about all their contraceptive options and the variety of ways that OCs can be taken may increase women’s commitment on the selected therapy. Finally, the recently observed enhancement of our knowledge related to the basic processes of reproduction, as well as the genomic and proteomic revolutions provide new targets for contraceptive development.

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