Contraceptive Effect and Safety of Ethinyl Estradiol versus Desogestrel: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

1. Clinical Medical School of West China Hospital, Sichuan University, Chengdu 610041, China2. Chinese Evidence-Based Medicine/Cochrane Centre, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Oral contraceptives; Contraception; Randomized controlled trial; Systematic review

DOI：

10.7507/1672-2531.20080055

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective　 To compare and evaluate the effectiveness and safety of 30ug ethinyl estradiol /150ug desogestrel versus 30ug ethinyl estradiol /75ug gestodene.
Methods　 We searched MEDLINE (1990 to 2007), EMBASE (1990 to 2007), POPLINE (1990 to 2007), Cochrane Central Register of Controlled Trials (Issue 2, 2007), EMBASE (1990 to 2007) and The Cochrane Library (Issue 2, 2007). Four relevant journals were also hand searched. Randomized controlled trials (RCTs) comparing ethinyl estradiol with desogestrel were collected. The quality of the included studies was assessed and data were collected by two reviewers independently. Meta-analyses were performed with The Cochrane Collaboration’s RevMan 4.2.10 software.
Results 　Six studies involving 3,143 patients were included. Meta-analyses found no significant difference in contraceptive effect between 30ug ethinyl estradiol /150ug desogestrel and 30ug ethinyl estradiol /75ug gestodene (P gt;0.05). During six months of follow-up, patients receiving 30ug ethinyl estradiol /150ug desogestrel had a higher incidence of irregular bleeding (RR 1.50, 95%CI 1.27 to 1.78; P lt;0.00001); and a lower incidence of vomiting (RR 0.18, 95%CI 0.04 to 0.78; P=0.02]; but higher incidences of breast tenderness, nervousness, headache, chloasma, edema, dyspareunia and varicose (RR 1.23 to 2.69; 95%CI 1.02 to 6.37, P lt;0.05). No significant differences were noted in discontinuation between 30ug ethinyl estradiol /150ug desogestrel and 30ug ethinyl estradiol /75ug gestodene.
Conclusion　 Ethinyl estradiol was similar to desogestrel in terms of the contraceptive effect, while the use of desogestrel might be associated with less irregular bleeding and other common adverse events. As the existing data have a high risk of bias, the current evidence is insufficient and further high-quality randomized controlled trials are needed.

Citation： PENG Lihua,WANG Li,CAI LinRui,MENG Yue,LI Youping. Contraceptive Effect and Safety of Ethinyl Estradiol versus Desogestrel: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(4): 252-260. doi: 10.7507/1672-2531.20080055 Copy

1.	ACOG Technical Bulletin. Hormonal contraception. International Journal of Gynecology and Obstetrics, 1995, 48: 115-126.
2.	Stone SC. Desogestrel. Clin Obstet Gynecol, 1995, 34(4): 821-828.
3.	Human Reproduction Update, Vol.12, No.2 pp. 169-178, 2006; Advance Access publication November 16, 2005.
4.	Cullberg G, Samsioe G, Andersen RF, et al. Two oral contraceptives, efficacy, serum proteins, and lipid metabolism. A comparative multicentre study on a triphasic and a fixed dose combination. Contraception, 1982, 26(3): 229-243.
5.	Foidart JM, Wuttke W, Bouw GM, et al. A comparative investigation of contraceptive reliability, cycle control and tolerance of two monophasic oral contraceptives containing either drospirenone or desogestrel. Eur J Contracept Reprod Health Care, 2000, 5(2): 124-134.
6.	Huber J, Foidart JM, Wuttke W, et al. Efficacy and tolerability of a monophasic oral contraceptive containing ethinylestradiol and drospirenone. Eur J Contracept Reprod Health Care, 2000, 5(1): 25-34.
7.	Aerlund, Mats Clinical experience of a combined oral contraceptive with very low dose ethinyl estradiol; Proceedings of the Baltic Conference On Obstetrics And Gynecology; Malm Sweden 25-27 May 1995.
8.	Hugh Allen, H. Clinical assessment of a low-dose estrogen low-dose progestogen combined oral contraceptive. Curr Med Res Opin, 1974, 2: 101-108.
9.	Kaplan B. Desogestrel, norgestimate, and gestodene: the newer progestins. Ann Pharmacother, 1995, 29(7-8): 736-742.
10.	WHO Tech Rep Ser 619. Geneva: World Health Organization, 1978: 47.
11.	Halbe HW, de Melo NR, Bahamondes L, et al. Efficacy and acceptability of two monophasic oral contraceptives containing ethinylestradiol and either desogestrel or gestodene. European Journal of Reproductive health, 1998, 3(3): 113-120.
12.	王今锦, 刘搏, 王德静, 等. 左炔诺孕酮三相片在女性避孕中的作用. 中国妇幼保健, 2006, 21: 2842-2843.
13.	Clinical comparison of monophasic oral contraceptive preparations of gestodene/ethinyl estradiol and desogestrel/ethinyl estradiol. Latin American Oral Contraceptive Study Group. Contraception, 1994, 50(3): 201-214.
14.	Koetswang S, Charoenvisal C, Banharnsupawat L, et al. Multicenter trial of two monophasic oral contraceptives containing 30 mcg ethinylestradiol and either desogestrel or gestodene in Thai women. Contraception, 1995, 51(4): 225-229.
15.	Zichella L, Sbrignadello C, Tomassini A, et al. Comparative study on the acceptability of two modern monophasic oral contraceptive preparations: 30 microgram ethinyl estradiol combined with 150 microgram desogestrel or 75 microgram gestodene. Adv Contraception, 1999, 15(3): 191-200.
16.	Benagiano G. Comparison of two monophasic oral contraceptives: gestodene/ethinyl estradiol versus desogestrel/ethinyl estradiol. Int J Fertil, 1989, 34 Suppl: 31-39.
17.	Brill K, Muller C, Schnitker J, et al. The influence of different modern low-dose oral contraceptives on intermenstrual bleeding. Advances in Contraception, 1991, 7: 51-61.
18.	Lexchin J, Bero LA, Djulbegovic B, et al. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ, 2003, 326: 1167-1170.
19.	Rosenberg MJ, Waugh MS. Oral contraceptive discontinuation: a prospective evaluation of frequency and reasons. American Journal of Obstetrics and Gynecology, 1998, 179: 577-582.
20.	Maitra N, Kulier R, Bloemenkamp KWM, et al. Progestogens in combined oral contraceptives for contraception (Cochrane Review). In: The Cochrane Library, Issue 1, 2006.
21.	Gallo MF, Lopez LM, Grimes DA, et al. Combination contraceptives: effects on weight. In: The Cochrane Library, Issue 1, 2006.
22.	Foidart JM, Wuttke W, Bouw GM, et al. Heithecker A comparative investigation of contraceptive reliability, cycle control and tolerance of two monophasic oral contraceptives containing either drospirenone or desogestrel. The European Journal of Contraception and Reproductive Health Care, 2000, 5: 124-134.
23.	Endrikat J, Mijller U, Dijsterberg B. A Twelve-Month Comparative Clinical Investigation of Two Low-Dose Oral contraceptives containing 20 mg ethinylestradiol/75mg gestodene and 30mg ethinylestradiol/75mg gestodene with respect to efficacy,cycle control and tolerance. Contraception, 1997, 55: 131-137.
24.	Bruni V, Croxatto H, De La Cruz J, et al. A comparison of cycle control and effect on well-being of monophasic gestodene-, triphasic gestodene- and monophasic desogestrel-containing oral contraceptives. Gestodene Study Group. Gynecol Endocrinol, 2000, 14: 90-98.
25.	Holt VL, Daling JR, McKnight B, et al. Functional ovarian cysts in relation to the use of monophasic and triphasic oral contraceptives. Obstetrics and Gynecology, 1992, 79: 529-533.
26.	Marchbanks PA, McDonald JA, Wilson HG, et al. Oral contraceptives and the risk of breast cancer. New England Journal of Medicine, 2002, 346: 2025-2032.
27.	Corvol P, Elkik F, Feneant M, et al. Effect of progesterone and progestins on water and salt metabolism. In: CW Bardin,E Milgrom, P Mauvais-Jarvis, editor(s). Progesterone and Progestins. New York: Raven Press, 1983.
28.	Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Lancet, 2001, 357: 1191-1194.

1. ACOG Technical Bulletin. Hormonal contraception. International Journal of Gynecology and Obstetrics, 1995, 48: 115-126.
2. Stone SC. Desogestrel. Clin Obstet Gynecol, 1995, 34(4): 821-828.
3. Human Reproduction Update, Vol.12, No.2 pp. 169-178, 2006; Advance Access publication November 16, 2005.
4. Cullberg G, Samsioe G, Andersen RF, et al. Two oral contraceptives, efficacy, serum proteins, and lipid metabolism. A comparative multicentre study on a triphasic and a fixed dose combination. Contraception, 1982, 26(3): 229-243.
5. Foidart JM, Wuttke W, Bouw GM, et al. A comparative investigation of contraceptive reliability, cycle control and tolerance of two monophasic oral contraceptives containing either drospirenone or desogestrel. Eur J Contracept Reprod Health Care, 2000, 5(2): 124-134.
6. Huber J, Foidart JM, Wuttke W, et al. Efficacy and tolerability of a monophasic oral contraceptive containing ethinylestradiol and drospirenone. Eur J Contracept Reprod Health Care, 2000, 5(1): 25-34.
7. Aerlund, Mats Clinical experience of a combined oral contraceptive with very low dose ethinyl estradiol; Proceedings of the Baltic Conference On Obstetrics And Gynecology; Malm Sweden 25-27 May 1995.
8. Hugh Allen, H. Clinical assessment of a low-dose estrogen low-dose progestogen combined oral contraceptive. Curr Med Res Opin, 1974, 2: 101-108.
9. Kaplan B. Desogestrel, norgestimate, and gestodene: the newer progestins. Ann Pharmacother, 1995, 29(7-8): 736-742.
10. WHO Tech Rep Ser 619. Geneva: World Health Organization, 1978: 47.
11. Halbe HW, de Melo NR, Bahamondes L, et al. Efficacy and acceptability of two monophasic oral contraceptives containing ethinylestradiol and either desogestrel or gestodene. European Journal of Reproductive health, 1998, 3(3): 113-120.
12. 王今锦, 刘搏, 王德静, 等. 左炔诺孕酮三相片在女性避孕中的作用. 中国妇幼保健, 2006, 21: 2842-2843.
13. Clinical comparison of monophasic oral contraceptive preparations of gestodene/ethinyl estradiol and desogestrel/ethinyl estradiol. Latin American Oral Contraceptive Study Group. Contraception, 1994, 50(3): 201-214.
14. Koetswang S, Charoenvisal C, Banharnsupawat L, et al. Multicenter trial of two monophasic oral contraceptives containing 30 mcg ethinylestradiol and either desogestrel or gestodene in Thai women. Contraception, 1995, 51(4): 225-229.
15. Zichella L, Sbrignadello C, Tomassini A, et al. Comparative study on the acceptability of two modern monophasic oral contraceptive preparations: 30 microgram ethinyl estradiol combined with 150 microgram desogestrel or 75 microgram gestodene. Adv Contraception, 1999, 15(3): 191-200.
16. Benagiano G. Comparison of two monophasic oral contraceptives: gestodene/ethinyl estradiol versus desogestrel/ethinyl estradiol. Int J Fertil, 1989, 34 Suppl: 31-39.
17. Brill K, Muller C, Schnitker J, et al. The influence of different modern low-dose oral contraceptives on intermenstrual bleeding. Advances in Contraception, 1991, 7: 51-61.
18. Lexchin J, Bero LA, Djulbegovic B, et al. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ, 2003, 326: 1167-1170.
19. Rosenberg MJ, Waugh MS. Oral contraceptive discontinuation: a prospective evaluation of frequency and reasons. American Journal of Obstetrics and Gynecology, 1998, 179: 577-582.
20. Maitra N, Kulier R, Bloemenkamp KWM, et al. Progestogens in combined oral contraceptives for contraception (Cochrane Review). In: The Cochrane Library, Issue 1, 2006.
21. Gallo MF, Lopez LM, Grimes DA, et al. Combination contraceptives: effects on weight. In: The Cochrane Library, Issue 1, 2006.
22. Foidart JM, Wuttke W, Bouw GM, et al. Heithecker A comparative investigation of contraceptive reliability, cycle control and tolerance of two monophasic oral contraceptives containing either drospirenone or desogestrel. The European Journal of Contraception and Reproductive Health Care, 2000, 5: 124-134.
23. Endrikat J, Mijller U, Dijsterberg B. A Twelve-Month Comparative Clinical Investigation of Two Low-Dose Oral contraceptives containing 20 mg ethinylestradiol/75mg gestodene and 30mg ethinylestradiol/75mg gestodene with respect to efficacy,cycle control and tolerance. Contraception, 1997, 55: 131-137.
24. Bruni V, Croxatto H, De La Cruz J, et al. A comparison of cycle control and effect on well-being of monophasic gestodene-, triphasic gestodene- and monophasic desogestrel-containing oral contraceptives. Gestodene Study Group. Gynecol Endocrinol, 2000, 14: 90-98.
25. Holt VL, Daling JR, McKnight B, et al. Functional ovarian cysts in relation to the use of monophasic and triphasic oral contraceptives. Obstetrics and Gynecology, 1992, 79: 529-533.
26. Marchbanks PA, McDonald JA, Wilson HG, et al. Oral contraceptives and the risk of breast cancer. New England Journal of Medicine, 2002, 346: 2025-2032.
27. Corvol P, Elkik F, Feneant M, et al. Effect of progesterone and progestins on water and salt metabolism. In: CW Bardin,E Milgrom, P Mauvais-Jarvis, editor(s). Progesterone and Progestins. New York: Raven Press, 1983.
28. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Lancet, 2001, 357: 1191-1194.

Chinese Journal of Evidence-Based Medicine

Contraceptive Effect and Safety of Ethinyl Estradiol versus Desogestrel: A Systematic Review

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content