Skip to main content
SpringerLink
Log in

Hormonelle Kontrazeption mit östradiolhaltigen Kombinationspräparaten

Hormonal contraception with estradiol-containing combined preparations

  • Leitthema
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Entwicklung östradiolhaltiger Kontrazeptiva

Erste Weiterentwicklungen der Pille zielten auf die Dosisreduktion des Östrogen- und Gestagenanteils sowie die Entwicklung neuer Gestagene unter Erhalt der kontrazeptiven Sicherheit. Sicherlich die relevanteste Neuheit der letzten Jahre war die Einführung einer hormonellen Kontrazeption mit natürlichem Östradiol. Der Ersatz von Ethinylöstradiol durch natürliches Östradiol lässt eine weitere Verbesserung der Sicherheit und Verträglichkeit der hormonellen Kontrazeption erwarten. Hauptproblem der Entwicklung hormoneller Kontrazeptiva mit natürlichem Östradiol war ein inakzeptables Blutungsverhalten.

Aktuell verfügbare Präparate

Aktuell stehen zwei Präparate mit dem natürlichen Östrogen zur Verfügung: Östradiolvalerat/Dienogest (Qlaira®) als 4-Phasen-Regime und Östradiol/Nomegestrolacetat (Zoely®) als monophasisches Regime. Beide Präparate bieten eine hohe kontrazeptive Sicherheit sowie eine gute Zykluskontrolle und Verträglichkeit. Qlaira® ist das einzige orale hormonelle Kontrazeptivum, das zur Behandlung starker Regelblutungen ohne organische Ursache bei Frauen, die eine Verhütung wünschen, zugelassen ist.

Ausblick

Weitere Studien und insbesondere die Anwendung in der Praxis müssen zeigen, inwieweit der Ersatz von Ethinylöstradiol durch natürliche Östrogene die Sicherheit für Anwenderinnen erhöht.

Abstract

Development of contraceptives containing estradiol

Since the introduction of the pill, most research has dealt with dose reductions and alterations to the progestin component. One of the most recent developments in contraceptives has been the successful introduction of estradiol into combined oral contraceptives. The use of estradiol instead of ethinyl estradiol may result in better safety and tolerability. Previous attempts were unsuccessful because of irregular bleeding and unacceptable cycle control.

Currently available contraceptives

Two oral hormonal contraceptives with the “physiologic estrogen” are available now: estradiol valerate/dienogest (Qlaira®) in a four-phase regime and estradiol/nomegestrol acetate (Zoely®) in a monophasic regime. Both combinations are highly effective oral contraceptives with good cycle control and are safe and well tolerated. Qlaira® is the only oral hormonal contraceptive that is approved for the treatment of heavy menstrual bleeding with no recognizable cause in women who desire contraception.

Conclusion

Further studies need to be performed to determine whether clinically significant differences in safety exist in the replacement of ethinyl estradiol by natural estrogens.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Literatur

  1. Bundeszentrale für gesundheitliche Aufklärung (BzgA) (2007) BzgA: Verhütungsverhalten Erwachsener 2007 – Ergebnisse einer Repräsentativbefragung 20- bis 44-Jähriger. http://www.bzga.de/botmed_13317100.html

  2. Astedt B, Jeppsson S, Liedholm P et al (1979) Clinical trial of a new oral contraceptive pill containing the natural oestrogen 17 beta-oestradiol. Br J Obstet Gynaecol 86:732–736

    Article  PubMed  CAS  Google Scholar 

  3. Kivinen S, Saure A (1996) Efficacy and tolerability of a combined oral contraceptive containing 17β-estradiol and desogestrel. Eur J Contracept Reprod Health Care 1:183

    Google Scholar 

  4. Serup J, Bostofte E, Larsen S et al (1979) Natural oestrogens for oral contraception. Lancet 2:471–472

    Article  PubMed  CAS  Google Scholar 

  5. Hirvonen E, Allonen H, Anttila M et al (1995) Oral contraceptive containing natural estradiol for premenopausal women. Maturitas 21:27–32

    Article  PubMed  CAS  Google Scholar 

  6. Koetsawang S, Mandlekar AV, Krishna UR et al (1980) A randomized, double-blind study of two combined oral contraceptives containing the same progestogen, but different estrogens. World Health Organization Task Force on Oral Contraception. Contraception 21:445–459

    Article  Google Scholar 

  7. Bitzer J, Simon JA (2011) Current issues and available options in combined hormonal contraception. Contraception 84:342–356

    Article  PubMed  CAS  Google Scholar 

  8. Fruzzetti F, Trémollieres F, Bitzer J (2012) An overview of the development of combined oral contraceptives containing estradiol: focus on estradiol valerate/dienogest. Gynecol Endocrinol 28:400–408

    Article  PubMed  CAS  Google Scholar 

  9. Wenzl R, Bennink HC, Beek A van et al (1993) Ovulation inhibition with a combined oral contraceptive containing 1 mg micronized 17 beta-estradiol. Fertil Steril 60:616–619

    PubMed  CAS  Google Scholar 

  10. Kuhnz W, Blode H, Zimmerman H (1999) Pharmacokinetics of exogenous natural and synthetic estrogens and antiestrogens. In: Oettel M, Schillinger E (Hrsg) Handbook of experimental pharmacology. Springer, Berlin, S 261–322

  11. Guengerich FP (1990) Metabolism of 17 alpha-ethynylestradiol in humans. Life Sci 47:1981–1988

    Article  PubMed  CAS  Google Scholar 

  12. Fotherby K (1996) Bioavailability of orally administered sex steroids used in oral contraception and hormone replacement therapy. Contraception 54:59–69

    Article  PubMed  CAS  Google Scholar 

  13. Düsterberg B, Nishino Y (1982) Pharmacokinetic and pharmacological features of oestradiol valerate. Maturitas 4:315–324

    Article  PubMed  Google Scholar 

  14. Timmer CJ, Geurts TB (1999) Bioequivalence assessment of three different estradiol formulations in postmenopausal women in an open, randomized, single-dose, 3-way cross-over study. Eur J Drug Metab Pharmacokinet 24:47–53

    Article  PubMed  CAS  Google Scholar 

  15. Zeun S, Lu M, Uddin A et al (2009) Pharmacokinetics of an oral contraceptive containing oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care 14:221–232

    Article  PubMed  CAS  Google Scholar 

  16. Ahrendt H-J, Makalova D, Parke S et al (2009) Bleeding pattern and cycle control with an estradiol-based oral contraceptive: a seven-cycle, randomized comparative trial of estradiol valerate/dienogest and ethinylestradiol/levonorgestrel. Contraception 80:436–444

    Article  PubMed  CAS  Google Scholar 

  17. Fraser IS, Parke S, Mellinger U et al (2001) Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of estradiol valerate and dienogest. Eur J Contracept Reprod Health Care 16:258–269

    Article  Google Scholar 

  18. Fraser IS, Römer T, Parke S et al (2011) Effective treatment of heavy and/or prolonged menstrual bleeding with an oral contraceptive containing estradiol valerate and dienogest: a randomized, double-blind phase III trial. Hum Reprod 26:2698–2708

    Article  PubMed  CAS  Google Scholar 

  19. Jensen JT, Parke S, Mellinger U et al (2011) Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial. Obstet Gynecol 117:777–787

    Article  PubMed  CAS  Google Scholar 

  20. Bitzer J, Parke S, Roemer T, Serrani M (2011) Endometrial safety of an oral contraceptive containing estradiol valerate and Dienogest. Int J Womens Health 3:127–132

    PubMed  CAS  Google Scholar 

  21. Nelson A, Parke S, Makalova D et al (2013) Efficacy and bleeding profile of a combined oral contraceptive containing oestradiol valerate/dienogest: a pooled analysis of three studies conducted in North America and Europe. Eur J Contracept Reprod Health Care 18:264–273

    Article  PubMed  CAS  Google Scholar 

  22. Palacios S, Wildt L, Parke S et al (2010) Efficacy and safety of a novel oral contraceptive based on oestradiol (oestradiol valerate/dienogest): a Phase III trial. Eur J Obstet Gynecol Reprod Biol 149:57–62

    Article  PubMed  CAS  Google Scholar 

  23. Junge W, Mellinger U, Parke S, Serrani M (2011) Metabolic and haemostatic effects of estradiol valerate/dienogest, a novel oral contraceptive a randomized, open-label, single-centre study. Clin Drug Investig 31:573–584

    Article  PubMed  CAS  Google Scholar 

  24. Klipping C, Duijkers I, Parke S et al (2011) Hemostatic effects of a novel estradiol-based oral contraceptive: an open-label, randomized, crossover study of estradiol valerate/dienogest versus ethinylestradiol/levonorgestrel. Drugs R D 11:159–170

    Article  PubMed  Google Scholar 

  25. Mueck AO, Sitruk-Ware R (2011) Nomegestrol acetate, a novel progestogen for oral contraception. Steroids 76:531–539

    Article  PubMed  CAS  Google Scholar 

  26. Christin-Maitre S, Serfaty D, Chabbert-Buffet N et al (2011) Comparison of a 24-day and a 21-day pill regimen for the novel combined oral contraceptive, nomegestrol acetate and 17b-estradiol (NOMAC/E2): a double-blind, randomized study. Hum Reprod 26:1338–1347

    Article  PubMed  CAS  Google Scholar 

  27. Mansour D, Verhoeven C, Sommer W et al (2011) Efficacy and tolerability of a monophasic combined oral contraceptive containing nomegestrol acetate and 17β-oestradiol in a 24/4 regimen, in comparison to an oral contraceptive containing ethinylestradiol and drospirenone in a 21/7 regimen. Eur J Contracept Reprod Health Care 16:430–443

    Article  PubMed  CAS  Google Scholar 

  28. Westhoff C, Kaunitz AM, Korver T et al (2012) Efficacy, safety, and tolerability of a monophasic oral contraceptive containing nomegestrol acetate and 17β-estradiol: a randomized controlled trial. Obstet Gynecol 119:989–999

    Article  PubMed  CAS  Google Scholar 

  29. Sørdal T, Grob P, Verhoeven C (2012) Effects on bone mineral density of a monophasic combined oral contraceptive containing nomegestrol acetate/17β-estradiol in comparison to levonorgestrel/ethinylestradiol. Acta Obstet Gynecol Scand 91:1279–1285

    Article  PubMed  Google Scholar 

  30. Ågren UM, Anttila M, Mäenpää-Liukko K et al (2011) Effects of a monophasic combined oral contraceptive containing nomegestrol acetate and 17β-oestradiol compared with one containing levonorgestrel and ethinylestradiol on haemostasis, lipids and carbohydrate metabolism. Eur J Contracept Reprod Health Care 16:444–457

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Foth verweist auf Beratungstätigkeiten für sowie Vortragshonorare und Reisekostenerstattungen durch folgende Firmen: Ferring, MSD, Merck Serono, Jenapharm, Bayer-Schering, Dr. Kade Pharma GmbH und MSLGroup Germany GmbH. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. MVZ PAN Institut für Endokrinologie und Reproduktionsmedizin, Zeppelinstr. 1, 50667, Köln, Deutschland

    D. Foth

  2. Evangelisches Krankenhaus Köln-Weyertal gGmbH, Köln, Deutschland

    T. Römer

  3. Praxis für Frauenheilkunde, Klinische Forschung und Weiterbildung, Magdeburg, Deutschland

    H.-J. Ahrendt

Authors
  1. D. Foth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Römer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H.-J. Ahrendt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Foth.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Foth, D., Römer, T. & Ahrendt, HJ. Hormonelle Kontrazeption mit östradiolhaltigen Kombinationspräparaten. Gynäkologische Endokrinologie 11, 162–167 (2013). https://doi.org/10.1007/s10304-012-0530-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10304-012-0530-6

Schlüsselwörter

Keywords

Search

Navigation