Hormonal contraception – Related resources

Cochrane reviews

• Progestin-only contraceptives do not have a significant effect on weight .
• Desogestrel and levonorgestrel progestin-only pill may have similar efficacy for contraception .
• Combined oral contraceptives may not affect bone mineral density or biochemical markers of bone turnover, but data on fracture risk is missing .
• Audiovisual aids or clear categories of risks seem to be more effective in communicating contraceptive effectiveness compared with oral presentations or numbers, although the evidence is limited .
• There is insufficient evidence of the effectiveness of immediate start of hormonal contraceptives compared to start during next menses .
• Oral contraceptives containing drospirenone seem to have some effect on severe premenstrual symptoms compared to placebo in short term, but the evidence is limited .
• There is no clinically relevant difference in contraceptive effectiveness among the different progestogens used in combined oral contraceptives. Third- and second-generation progestogens are generally better accepted than first-generation preparations. Gestodene may cause less intermenstrual bleeding than levonorgestrel .
• Oral contraceptives taken continuously for more than 28 days appear similar to traditional cyclic oral contraceptives as judged by bleeding, discontinuation rates, and reported satisfaction .
• Intensified counselling may improve adherence and continuation of hormonal contraception .
• Biphasic and triphasic oral contraceptives seem to have comparable effects, but there is insufficient evidence from controlled trials .
• There is insufficient evidence from controlled trials on the effects of combined hormonal versus progestin-only contraception during lactation .
• Combination injectable contraception results in fewer bleeding disruptions and lower discontinuation rates for bleeding reasons than progestin-only injectable contraception. Discontinuation for other reasons is more likely .
• Combined oral contraceptives with 20 mcg estrogen appear to have similar efficacy as those with >20 mcg estrogen. Bleeding pattern disruption are more common with low-dose estrogen .
• Triphasic OCs appear to have similar contraceptive effectiveness as monophasic OCs but the evidence is insufficient to determine any differences in bleeding patterns or discontinuation rates .
• Interventions promoting condom use for dual protection might not be effective for preventing pregnancy or sexually transmitted infections .

Other evidence summaries

• Desogestrel and gestodene may have a small favourable effect on HDL and LDL .
• An association between oral contraceptive use and venous thromboembolism (VTE) exists, but the reported risk is probably exaggerated. The users of non-third-generation OCs have a less than 3-fold increase in risk for VTE compared to nonusers: the risk for VTE is possibly higher in users of third-generation OCs. An association between hormone replacement therapy and VTE (a two-fold increase in risk) may also exist .
• Risk of ischaemic strokes is increased in current contraceptive users. However, the absolute increase in stroke risk is expected to be very small since the incidence of stroke is very low in this population .
• Risk of venous thromboembolism appears to be approximately twofold in users of third generation OC compared with users of second generation products .

Other Internet resources

• WHO: Family planning
• WHO: Sexual and reproductive health

Literature

• Parkin L, Skegg DC, Wilson M, Herbison GP, Paul C. Oral contraceptives and fatal pulmonary embolism. Lancet 2000 Jun 17;355(9221):2133-4.
• Farley TM, Meirik O, Chang CL, Poulter NR. Combined oral contraceptives, smoking, and cardiovascular risk. J Epidemiol Community Health 1998 Dec;52(12):775-85.