Haemostatic and metabolic impact of estradiol pills and drospirenone-containing ethinylestradiol pills vs. levonorgestrel-containing ethinylestradiol pills: A literature review

Abstract

E2/NOMAC exhibits less haemostatic and metabolic impact than EE/LNG and other COCs, suggesting that it may be a promising candidate to reduce residual VTE risk associated with COC use. Confirmation from a well-powered prospective clinical trial is, however, needed.

Estradiol in hormonal contraception: real evolution or just same old wine in a new bottle?

“…Hormonal contraceptives were originally designed to avoid unintended pregnancies giving the least possible side effects: with the important limitations of this observational study [16,17], its promising results indicate that the most serious and feared side effects during CHCs use (such as VTEs and other cardiovascular events) could be at least halved with the use of E2V/DNG, being associated with an almost doubled contraceptive efficacy. These results should be theoretically similar or even better for E2 and NOMAc [14], although population data are still lacking. If these results will be confirmed, these preparations could sign a real evolution in CHC technology over the next few years.…”

“…Theoretically, products containing E2 should be associated with less cardiovascular events in comparison to those containing EE [8]: indeed, the impact of these new preparations on secondary minor metabolic end-points, such as lipid and glucose metabolism [9][10][11][12][13], the hemostatic system [9,10,14] and blood pressure [15] seems milder than that caused by EE-based ones. However, population data were missing.…”

FSRH Guideline (January 2019, amended October 2023) Combined Hormonal Contraception

“…Theoretically, estradiol COC could have improved safety profiles compared to formulations containing EE or mestranol due to reduced thrombotic and metabolic effects 5. This has not yet been established: although limited evidence suggests that estradiol COC is safe to use and highly effective in preventing unintended pregnancy,6 further research will be required to assess the safety profile of estradiol COC relative to that of EE COC.…”

Oral Contraceptives and Venous Thromboembolism: Focus on Testing that May Enable Prediction and Assessment of the Risk

“…2). 12,53,58,63,64,69,76,94,98,99,134 Correlations between the increase of nAPCsr and the risk of VTE have been demonstrated in different studies suggesting its high potential for prediction of the risk of VTE both in the presence and absence of FV Leiden mutation. [135][136][137] In addition, the increase of nAPCsr is also associated with the VTE risk observed in epidemiological studies (►Fig.…”