Hormonal Contraceptives: Pharmacology Tailored to Women's Health
June 2016
in “
Human Reproduction Update
”
ethinylestradiol natural estradiol progestins anti-androgenic properties acne hirsutism extended-cycle COCs menstruation frequency metabolic effects cardiovascular risk biomarkers glucose intolerance glycosylated hemoglobin insulin therapy venous thromboembolism VTE myocardial infarction stroke breast cancer cervical cancer hyperandrogenism dysmenorrhea premenstrual tension perimenopausal women EE estradiol birth control pills anti-androgenic acne treatment hair growth extended-cycle birth control menstrual cycle metabolism heart health blood sugar HbA1c insulin blood clots heart attack high androgen levels painful periods PMS menopause
TLDR New hormonal contraceptives are safer, have fewer side effects, and offer health benefits for women.
The document from June 15, 2016, reviews advancements in hormonal contraceptives (OCs) and their tailored benefits for women's health. It covers a systematic literature search of papers published between January 2000 and July 2014, highlighting the evolution of OCs with lower doses of ethinylestradiol (EE) to reduce side effects and the introduction of natural estradiol. New progestins with anti-androgenic properties have been developed to help conditions like acne and mild hirsutism. Extended-cycle COCs have been designed to reduce menstruation frequency and side effects. The paper also discusses the metabolic effects of COCs, their impact on cardiovascular risk biomarkers, and the reduced risk of glucose intolerance with modern low-dose formulations. It notes that COCs do not affect glycosylated hemoglobin levels or insulin therapy in diabetic premenopausal women and that certain combinations of progestin and estrogen have less impact on metabolic and clotting parameters. The risk of venous thromboembolism (VTE) is highest in the first three months of COC use and varies with estrogen dose and progestin type. Modern COCs with less than 50 µg of estrogen do not increase the risk of myocardial infarction or stroke in healthy, non-smoking women, and the risk of breast and cervical cancer associated with COC use is either low or disappears after cessation. The document also addresses the therapeutic roles of COCs for conditions like hyperandrogenism, dysmenorrhea, and premenstrual tension, and their safety and benefits for perimenopausal women. It emphasizes the importance of personalized contraceptive counseling and the need for individualized choices to improve compliance and reduce discontinuation due to side effects.
