Modern hormonal contraceptives are highly reliable in terms of protection against unplanned pregnancy. They are also reversible, i.e. a woman can become pregnant once she stops taking her contraceptive.
Being able to make a conscious decision on whether and when to have children has decisively strengthened women's role in society. Thanks to modern hormonal contraceptives, couples today can better plan their families and experience sexuality with the security in knowing that pregnancy is prevented.
Different methods – individual prescription
Hormonal contraceptives contain hormones whose effect is similar to the sex steroids estrogen and progesterone produced by a woman’s body. There are various forms of hormonal contraceptives available. They include oral contraceptives ("the pill”), the intrauterine system (IUS), the patch, the vaginal ring, implants and injectables.
All forms of hormonal contraceptives have to be individually prescribed – usually by a gynecologist. When choosing a method, important criteria such as a woman's age, her medical history and condition, her current situation in life, her personal preferences, as well as her expectations of the contraceptive method have to be considered.
When people talk about oral contraceptives, or the "pill”, they usually mean the combined pill which contains an estrogen and a progestin. The progestin exerts the actual contraceptive effect while the estrogen maintains a regular menstrual cycle. The combined pill is the most commonly used form of hormonal contraception.
More information on oral contraceptives
Drospirenone-containing combined pills
Combined pills are available with various types of progestins. Some progestins have certain effects in addition to contraception, for example the progestin drospirenone, which closely resembles the natural progesterone produced by a woman’s body. Thanks to its properties, drospirenone counteracts estrogen-induced water retention and its related symptoms. Drospirenone-containing pills are the most widely prescribed hormonal contraceptives in the world today.
A low-dose drospirenone-containing pill with a new administration regimen is available in major markets worldwide. In this regimen, hormone-containing tablets are taken for 24 days, followed by only 4 days of tablets with no active ingredient. Due to the special properties of drospirenone and the advantages of the new administration regimen, the product reduces the typical hormonal fluctuations and potentially related symptoms which often occur with the conventional 21/7 pill. (The conventional 21/7 regimen consist of 21 days of active pills, followed by a 7-day pill-free interval.) The pill has been approved in several countries throughout the world, including the U.S., for three indications: oral contraception, the treatment of moderate acne, and the treatment of emotional and physical symptoms of Premenstrual Dysphoric Disorder (PMDD), the most severe form of premenstrual syndrome (PMS).
In addition there are the first birth control pills that also provide a daily dose of folate, a B vitamin. It is well established that folates play an important role during the first weeks of pregnancy. Folate is an essential nutrient that many women of childbearing age lack. A well-established body of evidence supports folate supplementation as a means to reduce the incidence of neural tube defects – or birth defects of the brain and spinal cord. Folate supplementation is particularly important at least one month before and three months after conception. Women who discontinue their pill or do not take them correctly may become pregnant before seeking preconception counseling from their healthcare provider, and combining an oral contraceptive with folate targets to reduce the risk of neural tube defects. These combined oral contraceptives have been developed in two regimens - 24/4 (consisting of 24 days of hormone-containing tablet with folate followed by four days of folate only) and 21/7 (consisting of 21 days of hormone-containing tablets with folate followed by seven days of folate only.). They are approved in the US and several other countries in the world.
Furthermore a low-dose drospirenone-containing pill with a flexible extended regimen is being offered. This provides the option of ‘personal period planning’. The number and timing of periods can be chosen within the limits permitted by the approved dosing regimen. The new dosing regimen involves a daily intake for a minimum period of 24 days and up to a maximum period of 120 days. During day 25 to 120, a 4-day tablet-free interval individually can be scheduled which triggers the period. This offers the option of flexibly reducing the number of periods to three per year. An innovative digital tablet dispenser supports the new regimen and reminds when to take the pill.
The combined pill based on estradiol
Over the past 50 years, many new progestins have been developed for use in oral contraceptives, but the estrogen component remained the same – ethinylestradiol. However, a new oral contraceptive has been available since May 2009. Its estrogen component differs from that of virtually all other oral contraceptives. This pill contains estradiol valerate which is immediately metabolized to estradiol, the same estrogen as produced by the female body.
This pill combines estradiol valerate with the progestin dienogest in a novel dosing regimen in which the estrogen component is gradually reduced and the progestin component gradually increased over a total of 26 days (the tablets for 2 days contain no active substance). The aim of this dosing regimen is to achieve a balance between the estrogen and progestin components and to ensure reliable contraceptive protection and good cycle control in harmony with the woman's body.
Contraception using the intrauterine systems
The intrauterine system (IUS) consists of a flexible plastic T-shaped frame surrounded by a hormone cylinder which gradually releases a constant, small quantity of the hormone levonorgestrel (LNG). The IUS is placed directly into the womb by a clinician and can remain there up to three or to five years depending on the inserted IUS. The presence of the IUS is not felt. It can be easily removed by a clinician at any time when the woman plans to have a child.
The contraceptive effect provided by the IUS differs from that of oral contraceptives. The female hormonal cycle and the ovulation process remain virtually unchanged. The mode of action is based to a large extent on the local effects of the hormone. The IUS causes the viscosity of the cervical mucous to increase, and the cervix thus becomes impenetrable to sperms, which are then unable to reach the uterus.
Advice for patients
Every body reacts differently to medicines. Therefore it is impossible to tell which medicine works best for you. Please consult your physician.