title: Haemostatic and metabolic impact of estradiol pills and drospirenone-containing ethinylestradiol pills vs. levonorgestrel-containing ethinylestradiol pills: A literature review.
abstract: OBJECTIVE
  Since its introduction 50 years ago, the contraceptive pill has continuously evolved to decrease the risk of venous thromboembolism (VTE) associated with its use. An increased risk of VTE still remains, however. Other concerns, such as effects on lipid and carbohydrate metabolism, have also been reported. In this study we compared two reference combined oral contraceptives (COCs) containing ethinylestradiol (EE)/levonorgestrel (LNG) and EE/drospirenone (DRSP) with COCs containing estradiol (E2) (estradiol valerate [E2V]/dienogest [DNG] and E2/nomegestrol acetate [NOMAC]). They were evaluated according to their influence on recognised haemostatic and metabolic markers.
  
  
  METHODS
  A literature search of the MEDLINE/PubMed database was conducted for head-to-head studies. EE/LNG was chosen as the comparator pill.
  
  
  RESULTS
  The haemostatic impact of E2 pills and EE/LNG has been extensively compared, in contrast to that of EE/DRSP and EE/LNG. Changes in haemostatic and metabolic marker levels between EE/LNG and E2V/DNG were generally not statistically significant. E2/NOMAC showed statistically significantly favourable results on haemostatic markers and had a neutral effect on carbohydrate and lipid metabolism when compared with EE/LNG.
  
  
  CONCLUSIONS
  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.
authors.affiliation: a * Department of Obstetrics and Gynaecology , Araba University Hospital , Vitoria-Gasteiz , Spain.
authors.forename: Iñaki
authors.initials: I
authors.lastname: Lete
authors.affiliation: b Department of Obstetrics and Gynecology , APHP Tenon Hospital, Pierre and Marie Curie University , Paris , France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Chabbert-Buffet
authors.affiliation: c 169, boulevard Haussmann, Paris , France.
authors.forename: Christian
authors.initials: C
authors.lastname: Jamin
authors.affiliation: d Gynecology Unit, Madonna delle Grazie Clinic , Velletri, Rome , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Lello
authors.affiliation: e Department of Obstetrics and Gynecology , Infanta Sofia University Hospital , San Sebastián de los Reyes, Madrid , Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Lobo
authors.affiliation: f Research Center for Reproductive Medicine and Unit of Gynecologic Endocrinology and Menopause, IRCCS Policlinico San Matteo, Department of Clinical , Surgical, Diagnostic and Pediatric Sciences, University of Pavia , Pavia , Italy.
authors.forename: Rossella E
authors.initials: RE
authors.lastname: Nappi
authors.affiliation: g Department of Obstetrics and Gynecology , Citadelle Hospital, University of Liège , Liège , Belgium.
authors.forename: Axelle
authors.initials: A
authors.lastname: Pintiaux
mesh_terms: D000736:Androstenes / Q000494:pharmacology; D050260:Carbohydrate Metabolism / Q000187:drug effects*; D003277:Contraceptives, Oral, Combined / Q000494:pharmacology*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000031:analogs & derivatives / Q000494:pharmacology; D004967:Estrogens / Q000494:pharmacology; D004997:Ethinyl Estradiol / Q000494:pharmacology; D005260:Female; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D016912:Levonorgestrel / Q000494:pharmacology; D050356:Lipid Metabolism / Q000187:drug effects*; D008535:Megestrol / Q000031:analogs & derivatives / Q000494:pharmacology; D009277:Nandrolone / Q000031:analogs & derivatives / Q000494:pharmacology; D054556:Venous Thromboembolism / Q000139:chemically induced
chemical_list: D000736:Androstenes; D003277:Contraceptives, Oral, Combined; D004338:Drug Combinations; D004967:Estrogens; C534342:drospirenone and ethinyl estradiol combination; C454300:estradiol valerate-dienogest; C072593:ethinyl estradiol, levonorgestrel drug combination; C047637:nomegestrol; D004997:Ethinyl Estradiol; D004958:Estradiol; D016912:Levonorgestrel; D009277:Nandrolone; D008535:Megestrol
keywords: Combined oral contraceptive; Estradiol; Ethinylestradiol; Haemostatic markers; Markers of lipid and carbohydrate metabolism; Progestin; Venous thromboembolism