Human Reproduction Archives
Human Reproduction Archives
EDITORIAL Contraception

Hormonal contraception: Is it time to abandon estrogen?

Mariane Nunes de Nadai, Edson Santos Ferreira-Filho, Jarbas Magalhães, Jaqueline Neves Lubianca, Isabel Cristina Esposito Sorpreso, Edmund Chada Baracat, José Maria Soares-Júnior

Downloads: 1
Views: 348


The efficacy of the contraceptive methods is high, and contraceptive effect is mainly due to progestogen, since it promotes inhibition of ovulation, thickening of the cervical mucus, and reduction in tubal motility. Therefore, one must reflect on the role of estrogen – is it time to abandon it? In this paper, we discuss the role of estrogen and progestogen in contraception, bleeding profile and non-contraceptive benefits.


Hormonal contraception; Estrogens; Progestins


1. Brandão ER, Cabral CS. Da gravidez imprevista à contracepção: aportes para um debate. Cad Saude Publica. 2017;33(2):e00211216. PMid:28300974. 

2. Peipert JF, Madden T, Allsworth JE, Secura GM. Preventing unintended pregnancies by providing no-cost contraception. Obstet Gynecol. 2012;120(6):1291-7. PMid:23168752. 

3. Brynhildsen J. Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks. Ther Adv Drug Saf. 2014;5(5):201-13. PMid:25360241. 

4. United Nations. Department of Economic and Social Affairs. Population Division. World contraceptive use. New York: United Nations; 2018. 

5. Ponce de Leon RG, Ewerling F, Serruya SJ, Silveira MF, Sanhueza A, Moazzam A, et al. Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries. Lancet Glob Health. 2019;7(2):e227-35. PMid:30683240. 

6. David PS, Kling JM. Spotlight on the noncontraceptive benefits of contraceptives. J Womens Health. 2020;29(7):887-8. http:// PMid:32379995. 

7. Schindler AE. Non-contraceptive benefits of oral hormonal contraceptives. Int J Endocrinol Metab. 2013;11(1):41-7. PMid:23853619. 

8. Schrager S, Larson M, Carlson J, Ledford K, Ehrenthal DB. Beyond birth control: noncontraceptive benefits of hormonal methods and their key role in the general medical care of women. J Womens Health. 2020;29(7):937-43. jwh.2019.7731. PMid:32155101.

9. Shulman LP. The state of hormonal contraception today: benefits and risks of hormonal contraceptives: combined estrogen and progestin contraceptives. Am J Obstet Gynecol. 2011;205(4, Suppl):S9-13. PMid:21961825. 

10. World Health Organization. Family planning: a global handbook for providers [Internet]. Geneva: WHO; 2018 [cited 2023 Mar 12]. 460 p. Available from: 

11. Bellizzi S, Mannava P, Nagai M, Sobel HL. Reasons for discontinuation of contraception among women with a current unintended pregnancy in 36 low and middle-income countries. Contraception. 2020;101(1):26-33. contraception.2019.09.006. PMid:31655068. 

12. Teal S, Edelman A. Contraception selection, effectiveness, and adverse effects: a review. JAMA. 2021;326(24):2507-18. http:// PMid:34962522. 

13. Madden T, Secura GM, Nease RF, Politi MC, Peipert JF. The role of contraceptive attributes in women’s contraceptive decision making. Am J Obstet Gynecol. 2015;213(1):46.e1-6. PMid:25644443. 

14. Regidor PA. Clinical relevance in present day hormonal contraception. Horm Mol Biol Clin Investig. 2019;37(1):20180030. http:// PMid:30367791. 

15. Grimes DA, Lopez LM, O’Brien PA, Raymond EG. Progestin-only pills for contraception. Cochrane Database Syst Rev. 2013;(11):CD007541. PMid:24226383. 

16. World Health Organization. Medical eligibility criteria for contraceptive use [Internet]. 5th ed. Geneva: WHO; 2015 [cited 2018 Oct 9]. Available from: 

17. Palacios S, Colli E, Regidor PA. Multicenter, phase III trials on the contraceptive efficacy, tolerability and safety of a new drospirenone-only pill. Acta Obstet Gynecol Scand. 2019;98(12):1549-57. PMid:31321765. 

18. Regidor PA, Colli E, Schindler AE. Drospirenone as estrogen-free pill and hemostasis: coagulatory study results comparing a novel 4 mg formulation in a 24 + 4 cycle with desogestrel 75 μg per day. Gynecol Endocrinol. 2016;32(9):749-51. http://dx.doi. org/10.3109/09513590.2016.1161743. PMid:27028425. 

19. Tepper NK, Whiteman MK, Marchbanks PA, James AH, Curtis KM. Progestin-only contraception and thromboembolism: a systematic review. Contraception. 2016;94(6):678-700. PMid:27153743. 

20. Dragoman MV, Tepper NK, Fu R, Curtis KM, Chou R, Gaffield ME. A systematic review and meta-analysis of venous thrombosis risk among users of combined oral contraception. Int J Gynaecol Obstet. 2018;141(3):287-94. PMid:29388678. 

21. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397-404. contraception.2011.01.021. PMid:21477680. 

22. Brown EJ, Deshmukh P, Antell K. Contraception update: oral contraception. FP Essent. 2017;462:11-9. PMid:29172411. 

23. Secura G. Long-acting reversible contraception: a practical solution to reduce unintended pregnancy. Minerva Ginecol. 2013;65(3):271-7. PMid:23689169. 

24. Vieira CS. Long-acting reversible contraceptives: an important approach to reduce unintended pregnancies. Rev Bras Ginecol Obstet. 2016;38(5):207-9. PMid:27213515. 

25. Belsey EM, Machines D, d’Arcangues C. The analysis of vaginal bleeding patterns induced by fertility regulating methods. Contraception. 1986;34(3):253-60. PMid:3539509. 

26. Mansour D, Korver T, Marintcheva-Petrova M, Fraser IS. The effects of Implanon® on menstrual bleeding patterns. Eur J Contracept Reprod Health Care. 2008;13(Suppl 1):13-28. PMid:18330814. 

27. Smith OPM, Critchley HOD. Progestogen only contraception and endometrial break through bleeding. Angiogenesis. 2005;8(2):117- 26. PMid:16211361. 

28. Korver T. A double-blind study comparing the contraceptive efficacy, acceptability and safety of two progestogen-only pills containing desogestrel 75 μg/day or levonorgestrel 30 μg/day: Collaborative Study Group on the Desogestrel-containing Progestogen-only Pill. Eur J Contracept Reprod Health Care. 1998;3(4):169-78. PMid:10036599. 

29. Mansour D, Bahamondes L, Critchley H, Darney P, Fraser IS. The management of unacceptable bleeding patterns in etonogestrel-releasing contraceptive implant users. Contraception. 2011;83(3):202-10. PMid:21310280. 

30. Zigler RE, McNicholas C. Unscheduled vaginal bleeding with progestin-only contraceptive use. Am J Obstet Gynecol. 2017;216(5):443- 50. PMid:27988268. 

31. Ahrendt H-J, Adolf D, Buhling KJ. Advantages and challenges of oestrogen-free hormonal contraception. Curr Med Res Opin. 2010;26(8):1947-55. PMid:20569066. 

32. Anttila L, Kunz M, Marr J. Bleeding pattern with drospirenone 3 mg+ethinyl estradiol 20 mcg 24/4 combined oral contraceptive compared with desogestrel 150 mcg+ethinyl estradiol 20 mcg 21/7 combined oral contraceptive. Contraception. 2009;80(5):445- 51. PMid:19835718. 

33. Oddsson K, Leifels-Fischer B, Wiel-Masson D, Melo NR, Benedetto C, Verhoeven CHJ, et al. Superior cycle control with a contraceptive vaginal ring compared with an oral contraceptive containing 30 microg ethinylestradiol and 150 microg levonorgestrel: a randomized trial. Hum Reprod. 2005;20(2):557-62. PMid:15539438.

34. Quereux C, Gabriel R. Bénéfices non contraceptifs de la contraception orale. Gynécol Obstét Fertil. 2003;31(12):1047-51. http:// PMid:14680788. 

35. Bahamondes L, Bahamondes MV, Shulman LP. Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods. Hum Reprod Update. 2015;21(5):640-51. PMid:26037216. 

36. Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev. 2012;(2):CD006586. PMid:22336820. 

37. Maia Jr HJ, Casoy J. Non-contraceptive health benefits of oral contraceptives. Eur J Contracept Reprod Health Care. 2008;13(1):17- 24. PMid:17963179. 

38. Amiri M, Nahidi F, Bidhendi-Yarandi R, Khalili D, Tohidi M, Tehrani FR. A comparison of the effects of oral contraceptives on the clinical and biochemical manifestations of polycystic ovary syndrome: a crossover randomized controlled trial. Hum Reprod. 2020;35(1):175-86. PMid:31916574. 

39. Taub RL, Jensen JT. Advances in contraception: new options for postpartum women. Expert Opin Pharmacother. 2017;18(7):677- 88. PMid:28375776. 

40. James AH, Tapson VF, Goldhaber SZ. Thrombosis during pregnancy and the postpartum period. Am J Obstet Gynecol. 2005;193(1):216-9. PMid:16021082. 

41. Dinger J, Minh TD, Heinemann K. Impact of estrogen type on cardiovascular safety of combined oral contraceptives. Contraception. 2016;94(4):328-39. PMid:27343748. 

42. Reed S, Koro C, DiBello J, Becker K, Bauerfeind A, Franke C, et al. Prospective controlled cohort study on the safety of a monophasic oral contraceptive containing nomegestrol acetate (2.5mg) and 17β-oestradiol (1.5mg) (PRO-E2 study): risk of venous and arterial thromboembolism. Eur J Contracept Reprod Health Care. 2021;26(6):439-46. 10. PMid:34644228. 

43. Gérard C, Arnal JF, Jost M, Douxfils J, Lenfant F, Fontaine C, et al. Profile of estetrol, a promising native estrogen for oral contraception and the relief of climacteric symptoms of menopause. Expert Rev Clin Pharmacol. 2022;15(2):121-37. 0/17512433.2022.2054413. PMid:35306927. 

44. Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012;380(9837):149-56. http://dx.doi. org/10.1016/S0140-6736(12)60609-6. PMid:22784533.

Submitted date:

Accepted date:

64e7540fa9539553571e4043 hra Articles
Links & Downloads

Hum Reprod Arch

Share this page
Page Sections