Oestrogen component of COCs: have we finally found a replacement for ethinyl estradiol?

Abstract

Purpose of reviewCombined oral contraceptive pills are among the most widely used contraceptive methods globally. Despite their popularity, the potential risks and side effects can lead to both high discontinuation rates and adverse outcomes including thromboembolic events. The quest for a safer alternative to the traditional ethinyl estradiol/progestin combination has led to the use of newer oestrogens. Ethinyl oestradiol alternatives will be reviewed including the newest option, estetrol, as it enters clinical use. Recent findingsOestradiol, when combined with a progestin with strong endometrial activity, is a viable alternative to ethinyl estradiol in the form of oestradiol valerate and estradiol, which have been available since 2008 and 2011, respectively. Estetrol is the newest oestrogen available and is found naturally in the foetal liver. Estetrol was approved for use in 2021. All three of these alternatives have high contraceptive efficacy, similar if not improved cycle control and decreased impact on haemostatic factors as compared to ethinyl estradiol.

Reversible interventions for menstrual management in adolescents and young adults with gender incongruence

“…In the United States, the vast majority of these medications use the synthetic estrogen EE, although there are some emerging options that use either estradiol valerate or esterol. 45 For the purposes of this article, as the vast majority of CHCs use EE, the risks and benefits of CHCs will be discussed with respect to this specific compound.…”

“…In a gender-related context, the absence of estrogen in progestin-only methods of suppression may be seen as a benefit not only in terms of safety profile, as no synthetic progestin carries the same clot risk as ethinyl estradiol (EE), the most widely used synthetic estrogen in contraceptive methods in the United States. 45 Effective menstrual suppression with progestins may be achieved with pills, [46][47][48] subcutaneous injection, 49 intramuscular injection, 50 and intrauterine devices. 51 Drospirenone 4 mg oral tabs is a relatively new progestin-only contraceptive pill that may offer more reliable contraception than norethindrone, but its use as a menstrual suppressant has not been studied, and its anti-androgenic effect may limit its use in TGD individuals.…”

Bioinformatic Study of Ziziphus Jujuba (Rhamnaceae) in Preventing the Growth of Breast Cancer

“…The main risk factors for breast cancer are hormonal and genetic conditions (family history) [5] Hormonal factors can be influenced by several things, including age at menarche, age at first pregnancy, parity, history of breastfeeding, infertility and long-term use of hormonal contraception [6,7]. Early menache or first menstruation at a relatively young age (less than 12 years) is associated with an increased risk of cancer with an OR = 1.5 [8] Based on the evaluation results, the latest evidence relating to diet and cancer, some recommendations to prevent cancer include a diet with organic types of food, balanced and varied nutrition, and a diet to maintain a normal body mass index and an active lifestyle [9,10,11].…”

Editorial: Updates in contraception and abortion care: reviews from both the clinical and social science sides of the aisle

“…Thus, the answer to their provocative review title, ''Have we finally found a replacement for ethinyl estradiol? '', might well be yes [2].…”

“…In another clinically focused and forward looking review, Voedisch and Fok provide an assessment of the current state of the estrogen art and conclude that alternatives to ethinyl estradiol, particularly the newest option of estetrol, show promise in providing comparable contraceptive efficacy with potentially lower risk of side effects and thromboembolic events. Thus, the answer to their provocative review title, “Have we finally found a replacement for ethinyl estradiol?”, might well be yes [2].…”