Abstract
Background: In clinical trials and non-interventional studies encompassing >50 000 women, the monophasic, low-dose combined oral contraceptive (OC) chlormadinone acetate 2 mg/ethinylestradiol 0.03 mg (CMA/EE) has been shown to have various non-contraceptive benefits, as well as contraceptive efficacy and good tolerability. However, there is a paucity of data on use of this OC in young women.
Objective: To investigate the relevance of, and changes in, cycle disorders, dysmenorrhoea and skin problems in addition to the efficacy and tolerability of CMA/EE in young women.
Methods: In this prospective, observational, non-interventional, multicentre study (TeeNIS [Teenager in Non-Interventional Study 2mg CMA/0.03mgEE]), young women (≤20 years of age) were administered CMA/EE (Belara®) once daily for 21 days (one blister strip), followed by either a 7-day pill-free interval (conventional cycle regimen; 89.3%) or a pill-free interval after two blister strips or more (extended cycle regimen; 3.7%), over a 6-month treatment period. Data on the mode of administration were missing for 7.1% of patients. The study included a safety population of 7462 patients (the efficacy population consisted of 6885 patients) from 886 gynaecological centres throughout Germany.
Results: Compared with baseline, CMA/EE intake resulted in significant reductions in the numbers of patients with cycle disorders, i.e. spotting (−46%), breakthrough bleeding (−64%), heavy bleeding (−95%) and absence of any bleeding (secondary amenorrhoea; −76%) [all p≤ 0.001], and with dysmenorrhoea (−56%) [p≤ 0.001]. Similarly, there was a significant decrease in the number of patients who used analgesics (−75%), had dysmenorrhoea-associated symptoms (back pain [−69%], headache [−70%], nausea/vomiting [−85%], diarrhoea [−80%], mood swings [−75%] or absence from school/job due to dysmenorrhoea [−92%]), or were restricted in their leisure/sporting activities because of dysmenorrhoea (−83%) [all p ≤ 0.001]. Another major benefit of CMA/EE was a significant reduction in the number of patients with skin problems (acne and acne-prone skin) [−55%; p≤ 0.001]. In parallel, the number of patients who needed dermatological treatment (−67%; p≤ 0.001) and concealer cosmetics (−55%; p≤ 0.001) was significantly reduced, and significantly fewer patients felt that their self-esteem was restricted due to skin problems (−67%; p≤ 0.001). There were no relevant weight changes during the observation period; mean bodyweight remained virtually constant (mean weight change <1 kg). At final assessment, physicians’ expectations were either ‘completely fulfilled’ or ‘exceeded’ with regard to cycle stability, regular bleeding, dysmenorrhoea, effects on weight, and skin problems in 78–95% of patients. CMA/EE provided high contraceptive efficacy with an unadjusted Pearl index of 0.25, calculated from 41 601 cycles of exposure; seven out of eight pregnancies were attributable to user failure, thus resulting in an adjusted Pearl index of 0.03. The tolerability of CMA/EE was excellent, with no unexpected adverse effects.
Conclusions: This observational, non-interventional study in young women showed that CMA/EE had a significantly beneficial effect on cycle disorders, dysmenorrhoea and skin disorders, and confirmed the good efficacy and tolerability of this combined OC.
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References
Mosher WD, Martinez GM, Chandra A, et al. Use of contraception and use of family planning services in the United States: 1982–2002. Adv Data 2004; (350): 1-36
Hickey M, Balen A. Menstrual disorders in adolescence: investigation and management. Hum Reprod Update 2003; 9: 493–504
Slap GB. Menstrual disorders in adolescence. Best Pract Res Clin Obstet Gynaecol 2003; 17: 75–92
Klein JR, Litt IF. Epidemiology of adolescent dysmenorrhoea. Pediatrics 1981; 68: 661–4
Ziv A, Boulet JR, Slap GB. Utilization of physician offices by adolescents in the United States. Pediatrics 1999; 104: 35–42
Neinstein LS. Menstrual problems in adolescents. Med Clin North Am 1990; 74: 1181–203
Bergfeld WF. The evaluation and management of acne: economic considerations. J Am Acad Dermatol 1995; 32: S52–6
Zahradnik HP, Goldberg J, Andreas JO. Efficacy and safety of the new antiandrogenic oral contraceptive Belara®. Contraception 1998; 57: 103–9
Worret I, Arp W, Zahradnik HP, et al. Acne resolution rates: results of a single-blind, randomised, controlled, parallel phase III trial with EE/CMA (Belara®) and EE/LNG (Microgynon®). Dermatology 2001; 203: 38–44
Schramm G, Steffens D. Contraceptive efficacy and tolerability of chlormadinone acetate 2 mg/ethinylestradiol 0.03 mg (Belara®). Clin Drug Investig 2002; 22: 221–31
Schramm G, Steffens D. A 12-month evaluation of the CMA-containing oral contraceptive Belara®: efficacy, tolerability and anti-androgenic properties. Contraception 2003; 67: 305–12
Zahradnik HP. Belara® — a reliable oral contraceptive with additional benefits for health and efficacy in dysmenorrhoea. Eur JContracept Reprod Health Care 2005; 10Suppl. 1:12–8
Kerscher M, Reuther T, Bayrhammer J, et al. Effect of an oral contraceptive containing chlormadinone and ethinyl-estradiol on acne-prone skin of women of different age groups. Clin Drug Investig 2008; 28(11): 703–11
Schramm G, Heckes B. Switching hormonal contraceptives to a chlormadinone acetate-containing oral contraceptive: the Contraceptive Switch Study. Contraception 2007; 76: 84–90
Feige A, Rempen A, Würfel W, et al. Frauenheilkunde: Fortpflanzungsmedizin Geburtsmedizin Onkologie Psychosomatik (Gebundene Ausgabe). In: Geisthövel F, editor. Munich: Elsevier GmbH, 2005
Runnebaum B, Rabe T. Gynäkologische Endokrinologie. Berlin: Springer-Verlag, 1994: 413
Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Nelson AL, et al., editors. Contraceptive technology. 19th rev ed. New York: Ardent Media, 2007
Spona J, Binder N, Höschen K, et al. Contraceptive efficacy and safety of a low-dose oral contraceptive (0.03 mg ethinyl oestradiol and 2 mg chlormadinone acetate) Belara, over three medication cycles. Eur J Contracept Reprod Health Care 2008; 13: 39–48
Vandenbroucke JP, van der Meer FJ, Helmerhorst FM, et al. Factor V Leiden: should we screen oral contraceptive users and pregnant women? BMJ 1996; 313: 1127–30
Cardiovascular disease and steroid hormone contraception: report of a WHO scientific group. WHO Tech Rep Ser 1998; 877: 1–89
Schramm G, Heckes B. The COSS-study: switching hormonal contraceptives to a combined oral contraceptive containing chlormadinone acetate (2 mg) and ethinyl estradiol (0.03 mg) [poster no. P029]. 9th Congress of the European Society of Contraception, 2006 Mar 3–6; Istanbul
Feldman W, Hodgson C, Corber S, et al. Health concerns and health-related behaviours of adolescents. CMAJ 1986; 134:489–93
Hamani Y, Sciaki-Tamir Y, Deri-Hasid R, et al. Misconceptions about oral contraception pills among adolescents and physicians. Hum Reprod 2007; 22: 3078–83
Gallo MF, Nanda K, Grimes DA, et al. 20 mg versus >20 µg estrogen combined oral contraceptives for contraception. Cochrane Database Syst Rev 2008; 4: CD003989
Zahradnik HP, Hanjalic-Beck A, Groth K. Nonsteroidal anti-inflammatory drugs and hormonal contraceptives for pain relief from dysmenorrhea: a review. Contraception. In press
Proctor M, Farquhar C. Dysmenorrhoea. Clin Evid 2002; 7: 1639–53
French L. Dysmenorrhea. Am Fam Physician 2005; 71(2): 285–91
Bock K, Heskamp ML, Schramm G. Convincing effect of CMA on dysmenorrhoea and other cycle-related disorders [in German]. Gyne 2008; 8: 219–25
Tan HH. Topical antibacterial treatments for acne vulgaris: comparative review and guide to selection. Am J Clin Dermatol 2004; 5: 79–84
Kerscher M. Hormonal contraception-prospects and limitations in dermatocosmetic indications [in German]. Gynäkol Endokrinol 2009; 7: 17–24
Druckmann R. Profile of the progesterone derivative chlormadinone acetate: pharmacodynamic properties and therapeutic applications. Contraception 2009;79(4): 272–81
Acknowledgements
This study was conducted and sponsored by Grünenthal GmbH, Germany. The authors would like to thank all of the 886 participating investigators. GAKS and M-LSH are employees of Grünenthal GmbH, Germany. SA has no conflicts of interest that are directly relevant to the content of this study.
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Anthuber, S., Schramm, G.A. & Heskamp, ML.S. Six-Month Evaluation of the Benefits of the Low-Dose Combined Oral Contraceptive Chlormadinone Acetate 2 mg/Ethinylestradiol 0.03 mg in Young Women. Clin. Drug Investig. 30, 211–220 (2010). https://doi.org/10.2165/11532910-000000000-00000
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DOI: https://doi.org/10.2165/11532910-000000000-00000