The clinical relevance of having more than one estrogen in combined hormonal contraception to address the needs of women

IF 3.9 2区医学 Q1 OBSTETRICS & GYNECOLOGY Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-02-01 DOI:10.1016/j.bpobgyn.2024.102571

Caroline Frisendahl , Helena Kopp Kallner , Kristina Gemzell-Danielsson

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Abstract

This chapter examines the potential of natural estrogens, particularly estradiol and estetrol, in combined hormonal contraceptive pills as alternatives to the widely used synthetic ethinyl estradiol. Current evidence highlights the promise of these natural estrogens in providing effective contraception with improved safety profiles and maintained tolerability.

What we know

Estradiol and estetrol exhibit favorable safety and efficacy profiles compared to ethinyl estradiol.

What we think we know

Initial studies suggest that estetrol combined with drosperinone provide effective contraception with a predictable bleeding patternand reduced risk for venous thromboembolism compared to ethinyl estradiol containing pills. Such risk may also be further mitigated by non-oral administration of estradiol.

What we do not know

Long-term efficacy and safety data are needed to confirm the benefits of natural estrogens and their impact on diverse populations and comorbid conditions. By addressing these gaps, future research can enhance our understanding of natural estrogens in hormonal contraception, ultimately refining their use in clinical practice.

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在联合激素避孕中使用一种以上雌激素以满足妇女需要的临床意义。

本章探讨了天然雌激素的潜力，特别是雌二醇和雌二醇，在联合激素避孕药中作为广泛使用的合成乙基雌二醇的替代品。目前的证据强调了这些天然雌激素在提供有效避孕方面的前景，它们具有更好的安全性和耐受性。我们所知道的：与乙炔雌二醇相比，雌二醇和雌二醇表现出良好的安全性和有效性。我们认为我们知道什么：初步研究表明，与含有乙炔雌二醇的药片相比，雌二醇与drosperinone联合使用可以有效避孕，可预测出血模式，并降低静脉血栓栓塞的风险。这种风险也可以通过非口服雌二醇进一步减轻。我们不知道的是：需要长期疗效和安全性数据来证实天然雌激素的益处及其对不同人群和合并症的影响。通过解决这些差距，未来的研究可以增强我们对激素避孕中天然雌激素的理解，最终完善其在临床实践中的应用。

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来源期刊

Best Practice & Research Clinical Obstetrics & Gynaecology 医学-妇产科学

CiteScore

9.40

自引率

1.80%

发文量

113

审稿时长

54 days

期刊介绍： In practical paperback format, each 200 page topic-based issue of Best Practice & Research Clinical Obstetrics & Gynaecology will provide a comprehensive review of current clinical practice and thinking within the specialties of obstetrics and gynaecology. All chapters take the form of practical, evidence-based reviews that seek to address key clinical issues of diagnosis, treatment and patient management. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. Management will be described in practical terms so that it can be applied to the individual patient.

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