Latest developments in the field of contraception
“In the last few years, research in the field of female contraception has not led to any significant renewal. The new proposals can be divided into two categories, in addition to sub-cutaneous implants and intra-muscular injections:
- new combined contraceptives (estro-progestogenic);
- the new emergency contraception”.
1. The new combined estro-progestogenic contraceptives
“The objective of new combined contraceptives is to try and diminish negative side effects and to provide a better control of the cycle”.
Oral contraceptives :
“The novelty in this field is the appearance, since the 90’s, of so called ‘third generation’ contraceptives, which are a combination of estrogens in low doses (15-35 micrograms ethinylestradiol) and of powerful progestins derived from levonorgestrel (desogestrel, gestodene, norgestimate). These progestogens being more powerful than those previously used, lower doses can be used, which makes it possible to obtain a lesser androgenic effect. The following combinations are available:
- 30 micrograms ethinylestradiol combined with gestoden or desogestrel (Varnoline, Minulet, Triminulet, Phaeva);
- 20 micrograms ethinylestradiol combined with desogestrel (Cycleane, Mercilon, Harmonet);
- 15 micrograms ethinylestradiol combined with gestoden (Melodia, Minesse)”.
“These third-generation pills are efficient and, in this regard, are comparable to previous high-dose combined pills (Pearl index 0.05%-0.01%, against 0.01% for high-dose pills). In general terms, they should have been better tolerated (with less nausea, vomiting, mastodynia, acne, weight gain), but in fact there is no difference in this regard with older generation, high-dose pills. When pills contain 30 micrograms or more of ethinylestradiol, there is an increased risk of venous thromboembolic accident”.
“Pills containing 15 micrograms of ethylenestradiol combined with 60 micrograms of gestoden: Minesse and Melodia. These pills have a good contraceptive efficiency (Pearl index 0.24%) due to the progestin’s powerfulness. They have less side effects (mastodynia, nausea, vomiting). Their abortive effect is certainly superior to that of high-dose pills”.
“Another novelty, more recent, is the extended-cycle contraceptive, Yasmine, which makes it possible to menstruate only four times per year: it is a combination of progestogen (3 mg drospirenone) and ethinylestradiol (30 micrograms). It has a good contraceptive efficiency (Pearl index 0.57%) and is supposed to cause less acne and weight gain. However, Yasmine has side effects that are linked to the ethinylestradiol it contains, and exposes the woman to thromboembolism”.
“Bayer’s QLaira first appeared in September 2009 in France. This pill uses a ‘natural’ estrogen, estradiol valerate, which releases estradiol (identical to the estrogen naturally produced in the female body) in the organism, and a progestin, dienogest, which is the only one that can be combined with estradiol valerate. This pill should have a better tolerance than the traditional pill, less effects on the liver, fewer vascular accidents and fewer risks of thromboembolic complications. However, only its use over several years will enable us to see if it really reduces side effects”.
Transdermal contraceptives
“Evra is the first combined estrogen-progestin patch that uses the transdermal channel in contraception. Its contraceptive efficiency is relatively good (Pearl index 0.70-1.24%). It has the same unpleasant and adverse side effects as the traditional pill. However, 17 deaths by thromboembolism have been associated with its use and in January 2008 the US FDA issued a warning about it, emphasizing the fact that women using the patch had a greater risk of developing a venous thromboembolism than women using the contraceptive pill”.
Transvaginal contraceptives
“First used in the US in 2002, the Nuvaring is a combined hormonal contraceptive in the form of a vaginal ring. This flexible, transparent vaginal ring, of a 54mm external diameter, releases an average daily dose of 120 mg of etonogestrel (a progestin) and a low dose of ethinylestradiol (15mg). It is inserted into the vagina and left there for a three week period without interruption, then removed for one week, during which the menstruation takes place. It is as efficient as combined oral contraception (Pearl index: 0.4-0.65%). It is tolerated well but, as a combined (estrogen-progestogen) contraceptive, it has the same side effects and risks (thromboembolic) as the combined high-dose pill. Users have a preference for the ring over the patch”.
2. The new emergency contraception
“The new EllaOne pill (ulipristal acetate) is a selective progesterone receptor modulator, comparable to mifepristone (RY 486, ‘Myfegine’) in its pharmacological action, as it blocks the action of progesterone by fixing itself to its receptors; its action is thus either contraceptive (by inhibiting ovulation), or interceptive (by preventing nidation), or contragestive (by provoking the death of the implanted embryo), depending on the moment of the female cycle when it is taken. Its effectiveness in preventing pregnancy is higher and longer than that of levonorgestrel, as it supposedly prevents pregnancies after a potentially fertilizing intercourse, up to 73 and even 120 hours after intercourse. It is to be feared that this product, which will be sold in drugstores as Norlevo is, will be used to carry out hidden abortions during the first months of pregnancy. From an ethical viewpoint, it is clearly an abortive product and should not be prescribed by a Christian doctor”.