Dose finding in a low-dose 21-day combined oral contraceptive containing gestodene

Suppression of ovarian function by a combined oral contraceptive containing 0.02 mg ethinyl estradiol and 2 mg chlormadinone acetate given in a 24/4-day intake regimen over three cycles

“…These results reflect published data describing rebounds of endogenous E 2 during 7-day hormone-free intervals for 0.02 mg EE formulations (7,24,26) and for 0.03 mg EEcontaining COCs (6,28,29), which were decreased notably by shortening the hormone-free intervals from 7 to 4 days, as also shown for 0.015 mg EE-0.075 mg gestodene (8). A comparable impact of shortening the hormone-free interval on rebound effects in the hormone-free intervals of cycles with 0.02 mg EE-0.075 mg gestodene also has been observed by comparing a 23-day intake regimen with a 21-day intake regimen: rebounds were less pronounced and occurred later under the 23-day intake regimen (10).…”

“…The intensity of ovulation suppression generally is correlated with the progestogen in COCs (24), but no COC currently available Hoogland and Skouby scores of ovarian activity by cycle (per protocol set; absolute and relative frequencies).…”

“…Compared with other low-and ultra-low-dose COCs, less residual ovarian activity was observed under 0.02 mg EE-2 mg chlormadinone acetate given in a 24/4-day intake regimen. Residual ovarian activity with other 0.02 mg EE-containing COCs in a 21-day intake regimen has been reported to be between 21% and 30% (24,26). Follicular development harbors the possible danger of breakthrough ovulations, jeopardizing the reliability of oral contraceptives (10).…”

Hormonal Contraception and Physiology: A Research‐based Theory of Discontinuation Due to Side Effects

“…Of course, not all attempts to reduce steroid dosages have proved equally satisfactory. A study of the use of 20 mcg EE/50 mcg gestodene among 22 English and Austrian women demonstrated that this formulation failed to inhibit ovulation adequately compared with 20 mcg EE/75 mcg gestodene (Lüdicke et al 2001). The question arises, however, whether the lower formulation might have proved more effective among women in less-developed countries.…”

Low-dose Oral Contraceptives in Adolescents: How Low Can You Go?

“…This class of drugs inhibits the hypothalamic-pituitary axis and maintains a constant serum estrogen concentration comparable to the level present in the early follicular phase of the menstrual cycle. 6 Since their introduction into widespread clinical use, the estrogen content in oral contraceptives has continued to decline. The subgroup with the lowest concentration of ethynyl estradiol (currently 20 mg in North America) is favored by many providers as the initial prescription choice for both the adult and adolescent populations.…”