La contraccezione ormonale oggi

Riassunto La contraccezione ormonale è stata negli anni profondamente modificata nei suoi costituenti, dosaggi e regimi di somministrazione. È oggi possibile disporre di preparati che, accanto a un effetto contraccettivo ottimale, possono essere usati a scopo terapeutico per la cura di numerose patologie benigne (acne, dismenorrea grave, dolore pelvico, metrorragie, ecc.). Tra i vantaggi non contraccettivi sicuramente di rilievo è la protezione che la pillola contraccettiva esercita nei confronti del tumore dell’ovaio, endometrio e colon retto. A fronte di questi effetti positivi, i preparati ormonali attualmente disponibili risultano nel complesso privi di gravi effetti collaterali. Luso di basse dosi di etinilestradiolo e di progestinici privi di attività androgenica ha portato infatti alla riduzione fino annullamento di effetti collaterali da sempre legati alla contraccezione estro-progestinica come la patologia cardiovascolare. Bibliografia Skouby SO. Contraceptive use and behavior in the 21st century: a comprehensive study across five European countries. Eur J Contracept Reprod Health Care 9: 57, 2004. I World Health Organization. Improving access to quality care in family planning: medical eligibility criteria for contraceptive use. WHO, Geneva, 1996, p 13. Wiegratz I, Kuhl H. Metabolic and clinical effects of progestogens. Eur J Contracept Reprod Health Care 11: 153, 2006. Kaplan B. Desogestrel, norgestimate, and gestodene: the newer progestins. Ann Pharmacother 29: 736, 1995. Fruzzetti F, Lello S, Lazzarini V, Fratta S, Orrù M, Sorge R, Minerba L, Ricci C, Genazzani AR, Melis GB, Paoletti AM. The oral contraceptive containing 30 microg of ethinylestradiol plus 3 mg of drospirenone is able to antagonize the increase of extracellular water occurring in healthy young women during the luteal phase of the menstrual cycle: an observational study. Contraception 75: 199, 2007. Sitruk-Ware R. New progestagens for contraceptive use. Hum Reprod Update 12: 169, 2006. Roumen FJ, Apter D, Moulders TM, Dieben TO. Efficacy, tolerabiliy, and acceptability of a novel contraceptive vaginal ring releasing etonorgestrel and ethinyl oestradiol. Human Reprod 16: 469, 2001. Bjarnadottir RI, Tuppurainen M, Killick SR. Comparison of cycle control with a combined contraceptive vaginal ring and oral levonorgestrel/ethinyloestradiol. Am J Obstet Gynecol 186: 389, 2002. Audet MC, Moreau K, Koltun WD, Waldbaum AS, Shangold G, Fisher AC, Creasy GW; ORTHO EVRA/EVRA 004 Study Group. Evaluation of contraceptive efficacy and cycle control of a transdermal contraceptive patch vs an oral contraceptive: a randomized controlled trial. JAMA 285: 2347, 2001. Poindexter A, The emerging use of the 20-mcg oral contraceptive. Fertil Steril 75: 457, 2001. Endrikat J, Short M. A 12-month comparative investigation of reliability, cycle control and tolerance with low-dose oral contraceptives containing 20 mcg ethinylestradiol and either 75 mcg gestodene or 150 mcg desogestrel. In: Lopes R, Killick SR (Eds.) The new option in low dose oral contraception — expanding the choice. The Parthenon Publishing Group, New York, 1995, p 37. Gestodene Study Group 324. Cycle control, safety and efficacy of a 24-day regimen on gestodene 60 mcg/ethinyl oestradiol 15 mcg and a 21-day regimen of desogestrel 150 mcg/ethinyl oestradiol 20 mcg. Eur J Contr Reprod Health Care 4(Suppl 2): 17, 1999. Fruzzetti F, Genazzani AR, Ricci C, De Negri F, Bersi C, Carmassi F. A 12-month clinical investigation with a 24-day regimen containing 15 mcg ethinylestradiol plus 60 mcg gestodene with respect to haemostasis and cycle control. Contraception 63: 303, 2001. Gallo MF, Grimes DA, Schulz KF, Helmerhorst FM. Combination estrogen-progestin contraceptives and body weight: systematic review of randomized controlled trials. Obstet Gynecol 103: 359, 2004. Baillargeon JP, McClish DK, Essah PA, Nestler JE. Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a metaanalysis. J Clin Endocrinol Metab 90: 3863, 2005. Venous thromboembolic disease and combined oral contraceptives: results of an international, multicenter, case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Lancet 346: 1575, 1995. Suissa S, Blais L, Spitzer WO, Cusson J, Lewis M, Heinemann L. First time use of newer oral contraceptives and the risk of venous thromboembolism. Contraception 56: 141, 1997. Dinger JC, Heinemann LA, Kühl-Habich D. The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance Study on oral contraceptives based on 142, 475 women-years of observation. Contraception 75: 344, 2007. The ESHRE Capri Workshop Group. Noncontraceptive health benefits of combined oral contraception. Hum Reprod Update 11: 513, 2005. Gambacciani M, Cappagli B, Lazzarini V, Ciaponi M, Fruzzetti F, Genazzani AR. Longitudinal evaluation of perimenopausal bone loss: effects of different low dose oral contraceptive preparations on bone mineral density Maturitas 54: 176, 2006. Collaborative Group on Epidemiological Studies of Ovarian Cancer, Beral V, Doll R, Hermon C, Peto R, Reeves G. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet 371: 303, 2008. Royar J, Becher H, Chang-Claude J. Low-dose oral contraceptives: protective effect on ovarian cancer risk. Int J Cancer 95: 370, 2001. Deligeoroglou E, Michailidis E, Creatsas G. Oral contraceptives and reproductive system cancer. Ann N Y Acad Sci 997: 199, 2003. International Collaboration of Epidemiological Studies of Cervical Cancer, Appleby P, Beral V, Berrington de González A, Colin D, Franceschi S, Goodhill A, Green J, Peto J, Plummer M, Sweetland S. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet 370: 1609, 2007. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. Lancet 347: 1713, 1996. Kahlenborn C, Modugno F, Potter DM, Severs WB. Oral contraceptive use as a risk factor for premenopausal breast cancer: a meta-analysis. Mayo Clin Proc 81: 1290, 2006. Haile RW, Thomas DC, McGuire V, Felberg A, John EM, Milne RL, Hopper JL, Jenkins MA, Levine AJ, Daly MM, Buys SS, Senie RT, Andrulis IL, Knight JA, Godwin AK, Southey M, McCredie MR, Giles GG, Andrews L, Tucker K, Miron A, Apicella C, Tesoriero A, Bane A, Pike MC; kConFab Investigators; Ontario Cancer Genetics Network Investigators, Whittemore AS. BRCA1 and BRCA2 mutation carriers, oral contraceptive use, and breast cancer before age 50. Cancer Epidemiol Biomarkers Prev 15: 1863, 2006. Author information Authors and Affiliations Additional information Al momento della stesura del testo non erano ancora disponibili sul mercato pillole con estrogeni naturali. Un ulteriore aggiornamento sarà oggetto di appofondimento in uno dei prossimi fascicoli. Rights and permissions About this article Cite this article Fruzzetti, F., Perini, D. & Lazzarini, V. La contraccezione ormonale oggi. L’Endocrinologo 10, 159–166 (2009). https://doi.org/10.1007/BF03344673 Published: Issue date: DOI: https://doi.org/10.1007/BF03344673