A revolution in contraception: new vaginal ring with progesterone and with segesterone acetate/ethinylestradiol, and combined oral contraception with estetrol

Abstract

Contraception is an essential component of birth control. The purpose of contraception is to prevent fertilization or implantation of a fertilized egg. Perfect contraception should be safe, effective, reversible, easy to use, widely available, and available at low/reasonable price. The choice of contra-ceptive method depends on many factors, the most important being the patient’s wishes and acceptance. In the case of women with severe or chronic illnesses, or at high risk of adverse events, contraception should be carefully considered and the most appropriate method should be selected. Hormonal contraception is the use of progestogens only or progestogens in combination with estrogens. The mechanism of the contraceptive effect of hormonal agents is complex, and it comprises the effect of preparations on the process of ovarian follicle maturation and ovulation, and their impact on the uterine mucosa, cervical mucus, and possibly on the contractility of the fallopian tubes. Combined hormonal preparations vary greatly, both in their routes of administration and in their administration schedules. Oral contraceptive pills differ primarily in the type of progestogen used and in the ethinylestradiol dose. A new vaginal ring with progesterone was developed for post-partum contraception. Segesterone acetate in combination with ethinylestradiol is becoming available in some parts of the world. Other novel options include combined oral contraception with estetrol and drospirenone. In the following review, the advantages and disadvantages of the above methods of contraception are presented in order to familiarize readers with the latest methods of birth control.