Horm Mol Biol Clin Investig. 2020 Jan 10;42(2):149-151. doi: 10.1515/hmbci-2019-0042.

Progestogen-only pills: which progestogen would be ideal.

Hormone molecular biology and clinical investigation

Christian Egarter

PMID: 31922955 DOI: 10.1515/hmbci-2019-0042

Abstract

Compared with nonuse, combined hormonal contraceptives containing estrogen and a progestogen are associated with a roughly 2- to 3-fold increased risk of venous and a 2-fold increased risk of arterial thromboembolism, including stroke and acute myocardial infarction. These events are, however, overall rare among women of reproductive age. Historically, progestin-only pills were not thought to be linked with any thromboembolic risk increase. Therefore, these preparations may be valuable options in women who are ineligible to take combined hormonal contraceptives. Until recently, only progestogens with partial androgenic activities were available. As demonstrated in animal studies, more modern progestogens such as drospirenone with its anti-mineralocorticoid effects may be associated with even more favorable aspects, which have to be clinically demonstrated, however, in future studies.

© 2020 Walter de Gruyter GmbH, Berlin/Boston.

Keywords: desogestrel; drospirenone; levonorgestrel; norethindrone; progestogen-only-pill

References

1. Burke Anne E. The state of hormonal contraception today: benefits and risks of hormonal contraceptives: progestin-only contraceptives. American Journal of Obstetrics and Gynecology 2011;205:S14–7. - PubMed
2. Schindler Adolf Adolf E, Campagnoli Carlo, Druckmann René, Huber Johannes, Pasqualini Jorge R, Schweppe Karl W, Thijssen Jos HH, et al. Classification and pharmacology of progestins. Maturitas. 2003;46:7–16. - PubMed
3. McCann MF, Potter LS. Progestin-only oral contraception: a comprehensive review. Contraception. 1994;50:S1–195. - PubMed
4. Practice Committee of the American Society for Reproductive Medicine. Hormonal contraception: recent advances and controversies. Fertil Steril. 2008;90:S103–13. - PubMed
5. Sheth A, Jain U, Sharma S, Adatia A, Patankar S, Andolsek L, et al. A randomized, double-blind study of two combined and two progestogen-only oral contraceptives. Contraception. 1982;25:243–52. - PubMed
6. Trussell James. Contraceptive failure in the United States. Contraception. 2011;83:397–404. - PubMed
7. Grimes David A, Lopez Laureen M, O'Brien Paul, Raymond Elizabeth G. Progestin-only pills for contraception. Cochrane Database of Systematic Reviews. 2009. https://doi.org/10.1002/14651858.CD007541. - PubMed
8. Kapp Nathalie, Curtis Kathryn, Nanda Kavita. Progestogen-only contraceptive use among breastfeeding women: a systematic review. Contraception. 2010;82:17–37. - PubMed
9. World Health Organization. Medical eligibility criteria for contraceptive use. 5th ed. WHO Library Cataloguing-in-Publication Data; 2015. ISBN: 9789241549158. - PubMed
10. Glisic Marija, Shahzad Sara, Tsoli Stergiani, Chadni Mahmuda, Asllanaj Eralda, Rojas Lyda Z, Brown Elizabeth, Chowdhury Rajiv, Muka Taulant, Franco Oscar H, et al. Association between progestin-only contraceptive use and cardiometabolic outcomes: A systematic review and meta-analysis. European Journal of Preventive Cardiology 2018;25:1042–52. - PubMed
11. Tepper Naomi Naomi K, Whiteman Maura K, Marchbanks Polly A, James Andra H, Curtis Kathryn M. Progestin-only contraception and thromboembolism: A systematic review. Contraception. 2016;94:678–700. - PubMed
12. Africander Donita, Verhoog Nicolette, Hapgood Janet P. Molecular mechanisms of steroid receptor-mediated actions by synthetic progestins used in HRT and contraception. Steroids. 2011;76:636–52. - PubMed
13. Armani Andrea, Cinti F, Marzolla V, Morgan J, Cranston GA, Antelmi A, et al. Mineralocorticoid receptor antagonism induces browning of white adipose tissue through impairment of autophagy and prevents adipocyte dysfunction in high-fat-diet-fed mice. The FASEB Journal. 2014;28:3745–57. - PubMed

Publication Types

• Journal Article
• Review