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Progestogens in Contraception

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Progestogens in Obstetrics and Gynecology
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Abstract

Progestogens are the basic active agent of hormonal contraception. Three modes of contraceptive action can be distinguished.

  1. (a)

    A strong antigonadotropic action leading to ovulation inhibition.

  2. (b)

    Thickening of the cervical mucus to inhibit sperm penetration.

  3. (c)

    Desynchronisation of the endometrial changes necessary for implantation.

Progestogens are either used in combined hormonal contraceptives or as progestogen only contraceptives

According to the time of their introduction into the market progestogens in combined hormonal contraceptives are described as first, second, third and fourth generation progestogens.

According to the structure different derivatives from testosterone, progesterone and spironolactone are available.

The differences in the molecular structure determine pharmacodynamic and pharmacokinetic differential effects which contribute to tolerability and additional beneficial or therapeutic effects.

Progestogen only contraceptives are available as daily oral preparations, monthly injections, implants (2–3 years), and Intrauterine Systems (IUS).

The long acting progestogens are highly effective in typical use and have a very low risk profile.

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References

  1. Djerassi C. Steroid research at Syntex: “the pill” and cortisone. Steroids. 1992;57:631–41.

    Article  CAS  Google Scholar 

  2. Schindler AE, Campagnoli C, Druckmann R, Huber J, Pasqualini JR, Schweppe KW, Thijssen JH. Classification and pharmacology of progestins. Maturitas. 2008;61:171–80.

    Article  Google Scholar 

  3. BfArM Red Letter Jenapharm Dec 2018 frauengesundheit@jenapharm.de.

    Google Scholar 

  4. WHO Medical eligibility criteria for contraceptive use. 5th edition 2015.

    Google Scholar 

  5. Kuhl H. Pharmacology of progestogens. J Reproduktionsmed Endokrinol. 2011;8:157–76.

    CAS  Google Scholar 

  6. Lidegaard O, Lokkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ. 2009;339:b2890.

    Article  Google Scholar 

  7. Van Hylckama VA, Helmerhorst FM, Vandenbroucke JP, Doggen CJ, Rosendaal FR. The venous thrombotic risk of oral contraceptives, effects of estrogen dose and progestagen type: results of the MEGA case-control study. BMJ. 2009;339:b2921.

    Article  Google Scholar 

  8. Jick SS, Hernandez RK. Risk of non-fatal venous thromboembolism in women using oral contraceptives containing drospirenone compared with women using oral contraceptives containing levonorgestrel: case-control study using United States claims data. BMJ. 2011;340:d2151.

    Article  Google Scholar 

  9. Parkin L, Sharples K, Hernandez RK, Jick SS. Risk of venous thromboembolism in users of oral contraceptives containing drospirenone or levonorgestrel: nested case-control study based on UK General Practice Research Database. BMJ. 2011;340:d2139.

    Article  Google Scholar 

  10. Lidegaard Ø, Nielsen LH, Skovlund CW, Skjeldestad FE, Løkkegaard E. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and estrogen doses: Danish cohort study 2001–9. BMJ. 2011;343:d6423.

    Article  Google Scholar 

  11. Heinemann LAJ, Dinger JC. Range of published estimates of venous thromboembolism incidence in young women. Contraception. 2007;75:328–36.

    Article  Google Scholar 

  12. Dinger JC, Heinemann LAJ, Kuhl-Habich D. The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance study on Oral Contraceptivesbased on 142,475 women-years of observation. Contraception. 2007;75:344–54.

    Article  CAS  Google Scholar 

  13. Seeger JD, Loughlin J, Eng PM, et al. Risk of thromboembolism in women taking ethinylestradiol/drospirenone and other oral contraceptives. Obstet Gynecol. 2007;110:587–93.

    Article  CAS  Google Scholar 

  14. Lidegaard O, Nielsen LH, Skovlund CW, Lokkegaard E. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001–10. BMJ. 2012;344:e2990.

    Article  Google Scholar 

  15. Lidegaard O, Milsom I, Geirssons RT, Skjeldestrad FE. Hormonal contraception and venous thromboembolism. Acta Obstet Gynecol Scand. 2012;91:769–78.

    Article  Google Scholar 

  16. Dinger J. Oral contraceptives and venous thromboembolism: old questions revisited. J Fam Plann Reprod Health Care. 2009;35:211–3.

    Article  Google Scholar 

  17. Shapiro S, Dinger J. Risk of venous thromboembolism among users of oral contraceptives: a review of two recently published studies. J Fam Plann Reprod Health Care. 2010;36(1):33–8.

    Article  Google Scholar 

  18. Heinemann K, Heinemann LAJ. Comparative risks of venous thromboembolism among users of oral contraceptives containing drospirenone and levonorgestrel. J Fam Plann Reprod Health Care. 2011;37:132–5.

    Article  Google Scholar 

  19. Seaman HE, De Vries CS, Farmer RD. The risk of venous thromboembolism in women prescribed cyproterone acetate in combination with ethinyl estradiol: a nested cohort analysis and case-control study. Hum Reprod. 2003;18:522.

    Article  CAS  Google Scholar 

  20. Vasilakis-Scaramozza C, Jick H. Risk of venous thromboembolism with cyproterone or levonorgestrel contraceptives. Lancet. 2001;358:1427.

    Article  CAS  Google Scholar 

  21. Lidegaard Ø. Absolute and attributable risk of venous thromboembolism in women on combined cyproterone acetate and ethinylestradiol. J Obstet Gynaecol Can. 2003;25:575.

    Article  Google Scholar 

  22. FDA Office of Surveillance and Epidemiology. Combined Hormonal Contraceptives (CHCs) and the risk of cardiovascular disease endpoints. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM277384.pdf. Accessed 03 Feb 2012.

  23. US Food and Drug Administration. Birth control pills containing Drospirenone: label change-products may be associated with a higher risk for blood clots. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm299605.htm. Accessed 17 Apr 2012.

  24. European Medicines Agency. PhVWP Monthly report on safety concerns, guidelines and general matters, January 2012 - Issue number: 1201. http://www.ema.europa.eu/docs/en_GB/document_library/Report/2012/01/WC500121387.pdf. Accessed 17 Apr 2012.

  25. PRAC referral assessment report. Procedure under Article 31 of Directive 2001/83/EC resulting from pharmacovigilance data. Combined hormonal contraceptives containing medicinal products INN: chlormadinone, desogestrel, dienogest, drospirenone, etonogestrel, gestodene, nomegestrol, norelgestromin or norgestimate. Procedure number: EMEA/H/A-31/1356. 15 October 2013.

    Google Scholar 

  26. Tepper NK, Whiteman MK, Marchbanks PA, et al. Progestin-only contraception and thromboembolism: a systematic review. Contraception. 2016;94:678–700.

    Article  CAS  Google Scholar 

  27. Vu Q, Micks E, McCoy E, et al. Efficacy and safety of long-acting reversible contraception in women with cardiovascular conditions. Am J Cardiol. 2016;117:302–4.

    Article  Google Scholar 

  28. Faculty of Sexual & Reproductive Healthcare (FSRH). Progestogen-only pills. 2015. http://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-pop-mar-2015/.

  29. Curtis KM, Martins SL. Progestogen-only contraception and bone mineral density: a systematic review. Contraception. 2006;73:470–87.

    Article  CAS  Google Scholar 

  30. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 121: long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2011;118:184–96.

    Article  Google Scholar 

  31. National Institute for Health and Care Excellence (NICE). Long-acting reversible contraception (update). 2014. https://www.nice.org.uk/guidance/cg30.

  32. Faculty of Sexual & Reproductive Healthcare (FSRH). Progestogen-only injectable contraception. 2014. http://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-injectables-dec-2014/.

  33. Kaunitz AM, Arias R, McClung M. Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception. 2008;77:67–76.

    Article  CAS  Google Scholar 

  34. Beatty MN, Blumenthal PD. The levonorgestrel-releasing intrauterine system: safety, efficacy, and patient acceptability. Ther Clin Risk Manag. 2009;5:561–74.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Soini T, Hurskainen R, Grenman S, et al. Levonorgestrel-releasing intrauterine system and the risk of breast cancer: a nationwide cohort study. Acta Oncol. 2016;55:188–92.

    Article  CAS  Google Scholar 

  36. Backman T, Rauramo I, Jaakkola K, et al. Use of the levonorgestrel-releasing intrauterine system and breast cancer. Obstet Gynecol. 2005;106:813–1.

    Article  Google Scholar 

  37. Dinger J, Bardenheuer K, Minh TD. Levonorgestrel-releasing and copper intrauterine devices and the risk of breast cancer. Contraception. 2011;83:211–7.

    Article  CAS  Google Scholar 

  38. Soini T, Hurskainen R, Grenman S, Maenpaa J, Paavonen J, Pukkala E. Cancer risk in women using the levonorgestrel-releasing intrauterine system in Finland. Obstet Gynecol. 2014;124:292–9.

    Article  CAS  Google Scholar 

  39. Mørch L, Skovlund C, Hannaford P, et al. Contemporary contraception and the risk of breast cancer. N Engl J Med. 2017;377:2228–39.

    Article  Google Scholar 

  40. Skovlund CW, Mørch LS, Kessing LV, et al. Association of hormonal contraception with depression. JAMA Psychiat. 2016;73:1154–62.

    Article  Google Scholar 

  41. Bitzer J, Rapkin A, Soares CN. Managing the risks of mood symptoms with LNG-IUS: a clinical perspective. Eur J Contracept Reprod Health Care. 2018;23(5):321–5.

    Article  CAS  Google Scholar 

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Correspondence to Johannes Bitzer .

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Bitzer, J. (2021). Progestogens in Contraception. In: Carp, H.J. (eds) Progestogens in Obstetrics and Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-030-52508-8_8

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  • DOI: https://doi.org/10.1007/978-3-030-52508-8_8

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