Adverse Effects of Hormonal contraception

In the Rosa Sabatini early 1980s, the third generation oral contraceptives were developed in an attempt to decrease the risk of cardiovascular disease (CVD) and to decrease androgenic side-effects such as weight gain, acne and adverse changes in metabolism of lipoproteins. 

Although   the   major   disadvantage   of   third   generation   COCs, according with the majority of authors,  is the increased risk of vascular effects (5,6).

Anyway,  the   third-generation   19-nortestosterone   derivatives (gestodene, desogestrel, norgestimate), allowed the reduction of the COCs steroid doses.

In the last decade,  with the aim to decrease the adverse effects-  COCs related and to enhance the user’s compliance, besides the dose reduction, other approaches have been performed such as the improvement in previous methods, the development of new steroids and the characterization of new schedules of administration.

Currently,  new available options of non-daily hormonal contraception,  utilizing classic or alternative routes of administration,  are present on the market.

Today the long-acting contraceptives constitute an important option in the family planning services of several countries. 

We remember the long-lasting action (5 years)  levonorgestrel-releasing intrauterine device (IUD) (20μg/day),  the monthly injectable Lunelle (25 mg medroxyprogesterone cypionate +  5 mg estradiol), the monthly   intravaginal   ring   containing   15μg   ethinylestradiol   and   120   μg etonogestrel,  the weekly transdermal patch releasing 20 μg ethinylestradiol and 150 μg norelgestromin (active metabolite of norgestimate)  over 24 hours,  the subdermal implant (Implanon) containing 68 mg of etonogestrel. In addition,it is important to remember the new generation of oral antiandrogenic progestins as drospirenone and clormadinone acetate-containing COCs. 

In the mean time, extended or continuous regimens were experienced introducing the new idea of contraception without menstruation.

These new means of administration obtained legitimacy   through   their   use   in   treating   endometriosis,  dysmenorrhea,and menstrual-symptoms ; however, some women without problems likewise, prefer to avoid their periods.  Eventual long-time adverse effects related to these new regimens are hitherto unknown. 

From the experience of the post-menopausal women,  long-term taking hormonal replacement therapy,  a possible deleterious effect   time-related   might   be   hypothesized (7)

Therefore   until   now,  no contraceptive exists without some adverse effect.  Besides,  little is known about the relationship between the safety of hormonal contraceptives and the risk of breast cancer among BRCA 1/2 mutation carriers (8,9)

Currently,  the large variety of the hormonal contraceptive preparations,  the different doses and the different formulations, the different routes of administration, and the right of all women to avoid an unwilling pregnancy, created a complex scenario.

Moreover, many teenagers are sexually active at earlier ages than in the past, before they are cognitively   able   to   develop   a   responsible   sexual   behavior (10)

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