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Oral contraceptives: opt for tried-and-tested combinations rather than latest-generation pill

Levonorgestrel- or norethisterone-based combinations of oestrogen and progestogen are the first-choice oral contraceptives, because of their more favourable risk-benefit balance.

Now that the French national health insurance system has begun reimbursing "3rd-generation" combined oestrogen/progestogen contraceptives, it bears pointing out that the oral contraceptives of reference are those that contain low doses of ethinylestradiol (oestrogen) combined with levonorgestrel or norethisterone (progestogens).

The 3rd-generation combined oestrogen/progestogen oral contraceptives contain more recent progestogens such as gestodene and desogestrel. They have not proved any more effective than the first-choice contraceptives. On the other hand, they carry a greater venous and arterial risk (venous thromboembolism, pulmonary embolism etc.).

The reimbursement of two generic 3rd-generation oral contraceptive drugs is being presented in France as offering women a choice between the different types of reimbursable contraceptives.

But above all it should be remembered that levonorgestrel- or norethisterone-based products are still the combined oral contraceptives of choice because they have a more favourable risk-benefit balance.

©Prescrire May 2010

Source: "Encore des contraceptifs oraux dits de "3e génération" remboursables" Rev Prescrire 2010; 30 (318): 256.