Some trials reported data on cycle control by describing the events per cycles rather than per subjects, or the data were given in graphical form. For the purpose of the review we did not include these data in the review. Generally there appears to be conformity between studies in the definitions of various cycle disturbances.
All trials except three have follow-up confined to the course of the study with the final assessment at the end of the concluding study cycle. Seven studies were conducted over a study duration of twelve months, of which two [ 12 , 20 ] reported 18 pregnancies in participants.
Three studies were conducted over a duration of thirteen to twenty six months; 17 pregnancies were reported in subjects recruited into the two trials reporting on it [ 10 , 26 ]. Two trials were included in this comparison, comparing monophasic gestodene GSD with monophasic levonorgestrel LNG combined with 30 mcg EE [ 14 , 17 ].
No pregnancies were reported in a total of women followed for six cycles. Fewer women had intermenstrual bleeding with gestodene in the one trial reporting on it RR 0. Overall, the results between the 2 groups were similar for the following outcomes: discontinuation RR 0. Two trials used triphasic OCs [ 15 , 24 ]; and one used a monophasic preparation [ 9 ] Overall, women were included in this comparison. Except for the two pregnancies in women receiving norethindrone NE in the Shoupe trial no other pregnancies were observed [ 15 ].
The number of women who had side effects, breakthrough bleeding or discontinued was similar for the comparison groups, for mono-and multiphasic preparations. Six trials compared levonorgestrel LNG or norgestrel NG to norethindrone NE or norethisterone NE ; three monophasic and three triphasic preparations [ 8 , 12 , 20 — 23 ].
The number of women included in this comparison is for the monophasic and for the triphasic preparations. Pregnancies occurred in one of the 2 trials reporting on it [ 12 ] with more pregnancies occurring in the group receiving a first-generation progestogen RR 0.
In the monophasic group, fewer women in the second-generation group discontinued RR: 0. Reported side effects and the number of women who discontinued due to side effects were similar in both groups for monophasic preparations; no data on these outcomes were available for the multiphasic preparations.
Cycle control appeared to be better with second generation progestogens for both, mono-and triphasic preparations RR: 0. Dunson [ 12 ] used iron tablets during the 7 days hormone free interval in one group.
One trial [ 25 ] with women was included in this comparison. Discontinuation and breakthrough bleeding were similar in the 2 groups RR 0. No other data relevant for the review could be extracted. The two groups were similar for the following outcomes: number of pregnancies; women who discontinued side effects and side effects leading to discontinuation. Regarding cycle control, trials were further stratified according to their estrogen dose. The data for cycle disturbances from this trial were therefore not included in the meta-analysis.
This comparison is based on the single study by Affinito [ 18 ], including women. No pregnancies were reported in either group at six months of OC use. Discontinuation, reasons for discontinuation and overall side effects were similar. There is one trial included in this comparison [ 9 ]. No pregnancies were reported in either group after 6 cycles in a total of women. Overall reported side effects were similar in both groups.
Two trials, with a total number women were included [ 15 , 24 ]. Both were described as user failures. Similar results for side effects, discontinuation and cycle disturbances were reported for both groups. This comparison includes women from 2 trials [ 20 , 22 ]. No pregnancies occurred in either group at twelve months of OC use.
This comparison is based on a single trial [ 8 ], including 96 women. There are no data on contraceptive effectiveness. Fewer women had spotting RR 0. One trial with women was included in this comparison [ 12 ]. More pregnancies occurred with norethindrone NE RR 0. Cycle disturbances as a reason for discontinuation were less frequent in the NG group RR 0. Intermenstrual bleeding RR 0. Side effects were similar for both groups. Two trials with women were included in this comparison [ 21 , 23 ].
No data on contraceptive effectiveness were reported. A similar number of women was satisfied with the treatment, reported intermenstrual bleeding and absence of withdrawal bleeding in both groups. Of the 2 trials included in this comparison, one was conducted over twenty six months [ 26 ] and another over thirteen months [ 10 ]. The total number of women randomized was At thirteen months and at 26 months the pregnancy rate was similar in both groups.
A similar number of women in both groups reported side effects and discontinued with the treatment. The aim of this systematic review was to evaluate the acceptability of progestogens used in low-dose oral contraceptives.
In designing the protocol for this review, we have assumed that acceptability indices can be adequately assessed by means of contraceptive effectiveness, cycle control, discontinuation rates and side effects. A clinically relevant difference in effectiveness among the different progestogens was not observed.
Generally, trials with a follow-up period of up to one year or longer showed a failure rate ranging from 0. The overall discontinuation rate amongst different trials varied from 8. Second-generation progestogens had higher discontinuation rates compared to third- and lower compared to first-generation preparations; which may be the reflection of a similar pattern seen with cycle disturbances. The association between cycle disturbances and continuation has been demonstrated before.
Data from longitudinal studies suggest that most of the women discontinuing OCs in the first year of use do so within the first two months and new starters are more likely to discontinue than switchers. Most of the women who discontinued did not want to fall pregnant but continued with less effective contraceptive methods [ 5 ].
Is the estradiol dose the sole important factor or should we consider the estradiol dose in combination with the progestogen type? Each progestogen steroid differs in its estrogenic, progestogenic and androgenic properties [ 31 ]. Therefore, variation in estrogenic potential among progestogens may explain some clinical phenomena such as spotting and breakthrough bleeding. One trial included in this review [ 13 ] used EE 15 mcg in one and EE 20 mcg in the other group.
There was a trend that more women in the 15 mcg group reported breakthrough bleeding RR 1. We were not able to lump data on spotting and breakthrough bleeding per cycle since a woman can experience the spotting during several cycles, but also several events of spotting per cycle.
Clustering of these data might overestimate the outcome and distort the results. The majority of the trials were supported in full or partially by pharmaceutical companies. The methods of allocation concealment are unclear in most studies. Therefore, trials with adequate sample sizes are required to determine the superiority of one method over the other. The included trials in this review did not have large enough sample sizes to detect rare outcomes. These findings are also consistent with those of a trial that found no significant difference in effect on acne between COCs containing desogestrel versus norgestimate.
The study analyzed de-identified information from the medical records of 2, consecutive female patients. All were using hormonal contraception at the time of telephone consultations for acne that took place from March to May Mean age was Levonorgestrel-releasing IUDs were the most commonly used progestin-only contraceptives.
However, at present, there is no data to support one particular birth control pill being more effective than others at treating acne or excess hair growth. People might consider talking to a doctor or healthcare professional about which type of progestin will suit them best. Some people may prefer to use a birth control pill that contains the progestin desogestrel. According to a article, it may help those with hair growth and acne. However, the article also indicates that there is limited evidence to confirm that it is better than other options is limited.
Some of these birth control pills contain the same drugs in identical dosages but have different names. For example, a doctor may prescribe Azurette and Kariva, or Reclipsen and Apri interchangeably because they have the same contents.
Which drug a person gets may depend on a variety of factors, such as their insurance policy or availability of a specific brand. Some people prefer birth control pills that contain the progestin drospirenone because it has diuretic properties , which helps prevent bloating.
It is important to note, that according to the Food and Drug Administration FDA , drospirenone may increase the chance of blood clots. However, ACOG state that the risk is low. According to a study , drospirenone can also help treat premenstrual dysphoric disorder PMDD , which is a severe type of premenstrual syndrome PMS. As before, it is important to note that a doctor may prescribe some brands interchangeably when they contain the same dosages, such as with Loryna and Yaz.
The birth control pills that contain levonorgestrel appear to have lower risks of side effects, such as venous thrombosis, than some of the other progestin options. Doctors consider pills containing levonorgestrel and ethinyl estradiol as first-line, and they are effective as long as a person takes them correctly.
A doctor may prescribe these brands interchangeably, providing they contain the same ingredients and dosages, as in the case of Aviane, Lessina, and Sronyx.
Norethindrone is a progestin that derives from testosterone. Those who take birth control pills containing norethindrone may experience androgenic side effects. People who use birth control pills containing norgestimate or norgestrel may also experience androgenic side effects, such as hair growth and acne.
There are also extended-cycle birth control pills, such as Seasonique , which contain 12 weeks of combined hormones ethinyl estradiol and levonorgestrel and one week of placebo or low dose ethinyl estradiol. Some people prefer extended cycles because they only bleed once every 3 months. Studies show that continuous use is safe for up to 12 months.
According to DailyMed , triphasic birth control pills contain 21 days of active hormonal pills with different doses of estrogen and progestin each week. An example of a triphasic birth control pill is Ortho Tri Cyclen. Each pill contains 35 mcg of ethinyl estradiol, but the dose of norgestimate increases each week. Certainly, the lowest possible dose of ethinyl estradiol is recommended as well. Advantages : Lowest risk of blood clots of all combined oral contraceptives.
Disadvantages : Negative effect on lipids affects serum lipoproteins ; increased incidence of androgenic side effects such as acne. Norgestrel a second-generation progestin is a mixture of both an inactive and active isomer—dextro-norgestrel inactive and levonorgestrel biologically active.
Norgestrel has high progestational and strong antiestrogen effects while also being high in androgenic activity. Advantages : May be helpful in endometriosis prevention. Disadvantages : Acne; weight gain. Desogestrel is a third-generation progestin with high progestational selectivity, minimizing androgenic effects and estrogenic activity. It shows a lower negative impact on metabolism, weight gain, acne, and other side effects typical of older progestins.
It shows positive effects on lipoproteins as seen by a slight rise of HDL cholesterol. Clinical trials show a possibly higher risk of non-fatal venous thrombosis blood clots with desogestrel pills versus those with levonorgestrel. Along with drospirenone, desogestrel appears to have a higher risk of blood clots than other options, especially levonorgestrel, with the highest risk of all combination birth control pills being desogestrel combined with 30 to 40 micrograms of ethinyl estradiol see study below under desogestrel.
Advantages : May help with menstrual cramps; Reduced risk of menstrual migraines; positive effects on lipids; Less weight gain. Disadvantages : Higher risk of blood clots. Norgestimate, a third-generation progestin, has high progestational activity while showing slight estrogenic effects and tends to be less androgenic. It also has minimal effect on serum lipoproteins as well as on carbohydrate metabolism.
The low androgenic effects of norgestimate have resulted in successful treatment of acne. In fact, birth control pills that contain norgestimate are the only ones FDA approved to help reduce acne.
Ortho Tri-cyclen Lo is a brand that provides norgestimate and a mid-level dose of estrogen, so this pill may be helpful in lowering side effects such as nausea and vomiting while not causing an increased incidence of spotting typically associated with low-estrogen pills. Disadvantages : May have a higher rate of headaches; Reduced libido. Drospirenone is the only progestin derived from 17a-spironolactone. It helps suppress the secretion of the hormones that regulate the body's water and electrolytes.
It also has low androgenic activity. Drospirenone and estrogen seem to lessen symptoms associated with mild PMS increased appetite, negative mood, and water retention. Drospirenone may cause higher potassium levels, so women with kidney, liver, or adrenal disease should not use it. The brands YAZ and Beyaz have 24 days of active pills and four days of placebo pills. This combination may cause fewer hormone fluctuations than typical pill packs. Drospirenone has been linked to an increased risk of blood clots in several studies.
A review looked at 17 studies that found the risk of blood clots ranged from no increase to a 3. The conclusion was that based on the best studies, the risk is only slightly increased. Looked in another way, however, some of the same researchers looked at the risk of blood clots in first-time users and restarters of oral contraceptives in over 55, women in another study.
They found that the risk of blood clots was 3.
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