Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Aug 1;2013(8):CD003989.
doi: 10.1002/14651858.CD003989.pub5.

20 µg versus >20 µg estrogen combined oral contraceptives for contraception

Maria F Gallo  1 , Kavita Nanda, David A Grimes, Laureen M Lopez, Kenneth F Schulz
Affiliations
Meta-Analysis

20 µg versus >20 µg estrogen combined oral contraceptives for contraception

Maria F Gallo et al. Cochrane Database Syst Rev. .

Abstract

Background: Concern about estrogen-related adverse effects has led to progressive reductions in the estrogen dose in combination oral contraceptives (COCs). However, reducing the amount of estrogen to improve safety could result in decreased contraceptive effectiveness and unacceptable changes in bleeding patterns.

Objectives: To test the hypothesis that COCs containing ≤ 20 μg ethinyl estradiol (EE) perform similarly as those containing > 20 μg in terms of contraceptive effectiveness, bleeding patterns, discontinuation, and side effects.

Search methods: In July 2013, we searched CENTRAL, MEDLINE, and POPLINE, and examined references of potentially eligible trials. We also searched for recent clinical trials using ClinicalTrials.gov and ICTRP. No new trials met the inclusion criteria. Previous searches included EMBASE. For the initial review, we wrote to oral contraceptive manufacturers to identify trials.

Selection criteria: English-language reports of randomized controlled trials were eligible that compare a COC containing ≤ 20 μg EE with a COC containing > 20 μg EE. We excluded studies where the interventions were designed to be administered for less than three consecutive cycles or to be used primarily as treatment for non-contraceptive conditions. Trials had to report on contraceptive effectiveness, bleeding patterns, trial discontinuation due to bleeding-related reasons or other side effects, or side effects to be included in the review.

Data collection and analysis: One author evaluated all titles and abstracts from literature searches to determine whether they met the inclusion criteria. Two authors independently extracted data from studies identified for inclusion. We wrote to the researchers when additional information was needed. Data were entered and analyzed with RevMan.

Main results: No differences were found in contraceptive effectiveness for the 13 COC pairs for which this outcome was reported. Compared to the higher-estrogen pills, several COCs containing 20 μg EE resulted in higher rates of early trial discontinuation (overall and due to adverse events such as irregular bleeding) as well as increased risk of bleeding disturbances (both amenorrhea or infrequent bleeding and irregular, prolonged, frequent bleeding, or breakthrough bleeding or spotting).

Authors' conclusions: While COCs containing 20 μg EE may be theoretically safer, this review did not focus on the rare events required to assess this hypothesis. Data from existing randomized controlled trials are inadequate to detect possible differences in contraceptive effectiveness. Low-dose estrogen COCs resulted in higher rates of bleeding pattern disruptions. However, most trials compared COCs containing different progestin types, and changes in bleeding patterns could be related to progestin type as well as estrogen dose. Higher follow-up rates are essential for meaningful interpretation of results.

PubMed Disclaimer

Conflict of interest statement

DA Grimes has consulted with the pharmaceutical companies Bayer Healthcare Pharmaceuticals and Merck & Co, Inc.

Figures

1.1
1.1. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 1 Pregnancy per woman.
1.2
1.2. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 2 Discontinuation ‐ overall.
1.3
1.3. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 3 Discontinuation ‐ mood changes.
1.4
1.4. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 4 Discontinuation ‐ irregular bleeding.
1.5
1.5. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 5 Discontinuation ‐ nausea.
1.6
1.6. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 6 Amenorrhea ‐ cycle 3.
1.7
1.7. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 7 Amenorrhea ‐ cycle 6.
1.8
1.8. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 8 Irregular bleeding ‐ cycle 3.
1.9
1.9. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 9 Duration of irregular bleeding in days ‐ cycle 3.
1.10
1.10. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 10 Duration of irregular bleeding in days ‐ cycle 6.
1.11
1.11. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 11 Dizziness.
1.12
1.12. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 12 Dysmenorrhea.
1.13
1.13. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 13 Headache.
1.14
1.14. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 14 Increased weight.
1.15
1.15. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 15 Irregular bleeding.
1.16
1.16. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 16 Mood change.
1.17
1.17. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 17 Nausea, diarrhea, vomiting.
1.18
1.18. Analysis
Comparison 1 EE 20 µg and desogestrel 150 µg versus EE 30 µg and desogestrel 150 µg, Outcome 18 Prolonged withdrawal bleeding.
2.1
2.1. Analysis
Comparison 2 EE 20 µg and desogestrel 150 µg versus EE 50 µg and desogestrel 125 µg, Outcome 1 Breakthough bleeding ‐ cycles 1 to 3.
2.2
2.2. Analysis
Comparison 2 EE 20 µg and desogestrel 150 µg versus EE 50 µg and desogestrel 125 µg, Outcome 2 Breakthrough spotting ‐ cycles 1 to 3.
2.3
2.3. Analysis
Comparison 2 EE 20 µg and desogestrel 150 µg versus EE 50 µg and desogestrel 125 µg, Outcome 3 Acne.
2.4
2.4. Analysis
Comparison 2 EE 20 µg and desogestrel 150 µg versus EE 50 µg and desogestrel 125 µg, Outcome 4 Breast tenderness.
2.5
2.5. Analysis
Comparison 2 EE 20 µg and desogestrel 150 µg versus EE 50 µg and desogestrel 125 µg, Outcome 5 Headache.
2.6
2.6. Analysis
Comparison 2 EE 20 µg and desogestrel 150 µg versus EE 50 µg and desogestrel 125 µg, Outcome 6 Weight gain.
3.1
3.1. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 1 Pregnancy per woman.
3.2
3.2. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 2 Discontinuation ‐ overall.
3.3
3.3. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 3 Discontinuation ‐ abdominal pain.
3.4
3.4. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 4 Discontinuation ‐ adverse event.
3.5
3.5. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 5 Discontinuation ‐ breast tension.
3.6
3.6. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 6 Discontinuation ‐ colpitis.
3.7
3.7. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 7 Discontinuation ‐ depressive mood.
3.8
3.8. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 8 Discontinuation ‐ dizziness.
3.9
3.9. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 9 Discontinuation ‐ headache.
3.10
3.10. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 10 Discontinuation ‐ hypertension.
3.11
3.11. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 11 Discontinuation ‐ hypomenorrhea.
3.12
3.12. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 12 Discontinuation ‐ intermenstrual bleeding.
3.13
3.13. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 13 Discontinuation ‐ menorrhagia.
3.14
3.14. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 14 Discontinuation ‐ menstrual disorder.
3.15
3.15. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 15 Discontinuation ‐ metrorrhagia.
3.16
3.16. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 16 Discontinuation ‐ nausea.
3.17
3.17. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 17 Discontinuation ‐ nervousness.
3.18
3.18. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 18 Discontinuation ‐ pruritus.
3.19
3.19. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 19 Discontinuation ‐ vomiting.
3.20
3.20. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 20 Irregular bleeding ‐ cycle 3.
3.21
3.21. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 21 Irregular bleeding ‐ cycle 6.
3.22
3.22. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 22 Amenorrhea ‐ cycle 3.
3.23
3.23. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 23 Amenorrhea ‐ cycle 6.
3.24
3.24. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 24 Abdominal pain.
3.25
3.25. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 25 Acne.
3.26
3.26. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 26 Breast pain.
3.27
3.27. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 27 Decreased libido.
3.28
3.28. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 28 Depression.
3.29
3.29. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 29 Dizziness.
3.30
3.30. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 30 Dysmenorrhea.
3.31
3.31. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 31 Emotional lability.
3.32
3.32. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 32 Flatulence.
3.33
3.33. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 33 Headache.
3.34
3.34. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 34 Menstrual disorder.
3.35
3.35. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 35 Metrorrhagia.
3.36
3.36. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 36 Migraine.
3.37
3.37. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 37 Nausea.
3.38
3.38. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 38 Pain.
3.39
3.39. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 39 Vaginal moniliasis.
3.40
3.40. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 40 Vomiting.
3.41
3.41. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 41 Weight gain.
3.42
3.42. Analysis
Comparison 3 EE 20 µg and desogestrel 150 µg versus EE 30 µg and gestodene 75 µg, Outcome 42 Weight gain in kg.
4.1
4.1. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 1 Pregnancy per woman.
4.2
4.2. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 2 Discontinuation ‐ overall.
4.3
4.3. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 3 Discontinuation ‐ adverse reaction.
4.4
4.4. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 4 Discontinuation ‐ metrorrhagia.
4.5
4.5. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 5 Abdominal pain.
4.6
4.6. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 6 Acne.
4.7
4.7. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 7 Breast pain.
4.8
4.8. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 8 Decreased libido.
4.9
4.9. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 9 Depression.
4.10
4.10. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 10 Dizziness.
4.11
4.11. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 11 Dysmenorrhea.
4.12
4.12. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 12 Emotional lability.
4.13
4.13. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 13 Flatulence.
4.14
4.14. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 14 Headache.
4.15
4.15. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 15 Menstrual disorder.
4.16
4.16. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 16 Metrorrhagia.
4.17
4.17. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 17 Migraine.
4.18
4.18. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 18 Nausea.
4.19
4.19. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 19 Pain.
4.20
4.20. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 20 Vaginal moniliasis.
4.21
4.21. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 21 Vomiting.
4.22
4.22. Analysis
Comparison 4 EE 20 µg and desogestrel 150 µg versus EE 30‐40‐30 µg and gestodene 50‐70‐100 µg, Outcome 22 Weight gain.
5.1
5.1. Analysis
Comparison 5 EE 20 µg and desogestrel 150 µg versus EE 35 µg and norgestimate 180‐215‐250 µg, Outcome 1 Pregnancy per woman.
6.1
6.1. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 1 Pregnancy per woman.
6.2
6.2. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 2 Discontinuation ‐ overall.
6.3
6.3. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 3 Discontinuation ‐ adverse event.
6.4
6.4. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 4 Discontinuation ‐ intermenstrual bleeding.
6.5
6.5. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 5 Discontinuation ‐ metrorrhagia.
6.6
6.6. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 6 Breakthrough bleeding ‐ cycle 3.
6.7
6.7. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 7 Breakthrough bleeding ‐ cycle 6.
6.8
6.8. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 8 Spotting ‐ cycle 3.
6.9
6.9. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 9 Spotting ‐ cycle 6.
6.10
6.10. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 10 Acne.
6.11
6.11. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 11 Breast tension or tenderness.
6.12
6.12. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 12 Change in libido.
6.13
6.13. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 13 Chloasma.
6.14
6.14. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 14 Depressive moods.
6.15
6.15. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 15 Diarrhea.
6.16
6.16. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 16 Dizziness.
6.17
6.17. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 17 Edema.
6.18
6.18. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 18 Headache.
6.19
6.19. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 19 Nausea.
6.20
6.20. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 20 Nausea and vomiting.
6.21
6.21. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 21 Nervousness.
6.22
6.22. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 22 Varicose conditions.
6.23
6.23. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 23 Vomiting.
6.24
6.24. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 24 Weight gain >2 kg.
6.25
6.25. Analysis
Comparison 6 EE 20 µg and gestodene 75 µg versus EE 30 µg and gestodene 75 µg, Outcome 25 Weight gain in kg.
7.1
7.1. Analysis
Comparison 7 EE 20 µg and gestodene 75 µg (23‐day) versus EE 30 µg and gestodene 75 µg (21‐day), Outcome 1 Pregnancy per woman.
7.2
7.2. Analysis
Comparison 7 EE 20 µg and gestodene 75 µg (23‐day) versus EE 30 µg and gestodene 75 µg (21‐day), Outcome 2 Intracyclic bleeding ‐ cycle 1 and at least once during cycles 2 to 6.
8.1
8.1. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 1 Pregnancy per woman.
8.2
8.2. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 2 Discontinuation ‐ overall.
8.3
8.3. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 3 Discontinuation ‐ adverse events.
8.4
8.4. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 4 Discontinuation ‐ breakthrough bleeding.
8.5
8.5. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 5 Discontinuation ‐ headache.
8.6
8.6. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 6 Discontinuation ‐ nausea or vomiting.
8.7
8.7. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 7 Intermenstrual bleeding ‐ cycle 3.
8.8
8.8. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 8 Amenorrhea ‐ cycle 3.
8.9
8.9. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 9 Breast pain.
8.10
8.10. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 10 Dysmenorrhea.
8.11
8.11. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 11 Headache.
8.12
8.12. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 12 Nausea.
8.13
8.13. Analysis
Comparison 8 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norethindrone 500‐750‐1000 µg, Outcome 13 Vomiting.
9.1
9.1. Analysis
Comparison 9 EE 20 µg and levonorgestrel 100 µg versus EE 35 µg and norgestimate 180‐215‐250 µg, Outcome 1 Pregnancy per woman.
10.1
10.1. Analysis
Comparison 10 EE 20 µg and norethindrone acetate 1 mg versus EE 30 µg and levonorgestrel 150 µg, Outcome 1 Pregnancy per woman.
10.2
10.2. Analysis
Comparison 10 EE 20 µg and norethindrone acetate 1 mg versus EE 30 µg and levonorgestrel 150 µg, Outcome 2 Discontinuation ‐ bleeding.
10.3
10.3. Analysis
Comparison 10 EE 20 µg and norethindrone acetate 1 mg versus EE 30 µg and levonorgestrel 150 µg, Outcome 3 Frequent bleeding ‐ cycles 1 to 3.
10.4
10.4. Analysis
Comparison 10 EE 20 µg and norethindrone acetate 1 mg versus EE 30 µg and levonorgestrel 150 µg, Outcome 4 Infrequent bleeding ‐ cycles 1 to 3.
10.5
10.5. Analysis
Comparison 10 EE 20 µg and norethindrone acetate 1 mg versus EE 30 µg and levonorgestrel 150 µg, Outcome 5 Irregular bleeding ‐ cycles 1 to 3.
10.6
10.6. Analysis
Comparison 10 EE 20 µg and norethindrone acetate 1 mg versus EE 30 µg and levonorgestrel 150 µg, Outcome 6 Prolonged bleeding ‐ cycles 1 to 3.
11.1
11.1. Analysis
Comparison 11 EE 20 µg and norethindrone acetate 1 mg versus EE 50 µg and levonorgestrel 150 µg, Outcome 1 Frequent bleeding ‐ cycles 1 to 3.
11.2
11.2. Analysis
Comparison 11 EE 20 µg and norethindrone acetate 1 mg versus EE 50 µg and levonorgestrel 150 µg, Outcome 2 Infrequent bleeding ‐ cycles 1 to 3.
11.3
11.3. Analysis
Comparison 11 EE 20 µg and norethindrone acetate 1 mg versus EE 50 µg and levonorgestrel 150 µg, Outcome 3 Irregular bleeding ‐ cycles 1 to 3.
11.4
11.4. Analysis
Comparison 11 EE 20 µg and norethindrone acetate 1 mg versus EE 50 µg and levonorgestrel 150 µg, Outcome 4 Prolonged bleeding ‐ cycles 1 to 3.
12.1
12.1. Analysis
Comparison 12 EE 20 µg and norethindrone acetate 1 mg versus EE 30 µg and norethindrone acetate 1.5 mg, Outcome 1 Duration of breakthrough bleeding or spotting in days ‐ cycle 3.
12.2
12.2. Analysis
Comparison 12 EE 20 µg and norethindrone acetate 1 mg versus EE 30 µg and norethindrone acetate 1.5 mg, Outcome 2 Amenorrhea ‐ cycle 3.
13.1
13.1. Analysis
Comparison 13 EE 20 µg and norethindrone acetate 1 mg versus EE 50 µg and norethindrone acetate 1 mg, Outcome 1 Duration of breakthrough bleeding or spotting in days ‐ cycle 3.
13.2
13.2. Analysis
Comparison 13 EE 20 µg and norethindrone acetate 1 mg versus EE 50 µg and norethindrone acetate 1 mg, Outcome 2 Amenorrhea ‐ cycle 3.
13.3
13.3. Analysis
Comparison 13 EE 20 µg and norethindrone acetate 1 mg versus EE 50 µg and norethindrone acetate 1 mg, Outcome 3 Frequent bleeding ‐ cycles 1 to 3.
13.4
13.4. Analysis
Comparison 13 EE 20 µg and norethindrone acetate 1 mg versus EE 50 µg and norethindrone acetate 1 mg, Outcome 4 Infrequent bleeding ‐ cycles 1 to 3.
13.5
13.5. Analysis
Comparison 13 EE 20 µg and norethindrone acetate 1 mg versus EE 50 µg and norethindrone acetate 1 mg, Outcome 5 Irregular bleeding ‐ cycles 1 to 3.
13.6
13.6. Analysis
Comparison 13 EE 20 µg and norethindrone acetate 1 mg versus EE 50 µg and norethindrone acetate 1 mg, Outcome 6 Prolonged bleeding ‐ cycles 1 to 3.
14.1
14.1. Analysis
Comparison 14 EE 20 µg and norethindrone acetate 1 mg versus EE 20‐30‐50 µg and norethindrone acetate 1‐1.5‐1 mg, Outcome 1 Duration of bleeding or spotting in days ‐ cycle 3.
14.2
14.2. Analysis
Comparison 14 EE 20 µg and norethindrone acetate 1 mg versus EE 20‐30‐50 µg and norethindrone acetate 1‐1.5‐1 mg, Outcome 2 Amenorrhea ‐ cycle 3.
15.1
15.1. Analysis
Comparison 15 EE 20 µg and norethindrone acetate 1 mg versus EE 35 µg and norethindrone acetate 400 µg, Outcome 1 Frequent bleeding ‐ cycles 1 to 3.
15.2
15.2. Analysis
Comparison 15 EE 20 µg and norethindrone acetate 1 mg versus EE 35 µg and norethindrone acetate 400 µg, Outcome 2 Infrequent bleeding ‐ cycles 1 to 3.
15.3
15.3. Analysis
Comparison 15 EE 20 µg and norethindrone acetate 1 mg versus EE 35 µg and norethindrone acetate 400 µg, Outcome 3 Irregular bleeding ‐ cycles 1 to 3.
15.4
15.4. Analysis
Comparison 15 EE 20 µg and norethindrone acetate 1 mg versus EE 35 µg and norethindrone acetate 400 µg, Outcome 4 Prolonged bleeding ‐ cycles 1 to 3.
16.1
16.1. Analysis
Comparison 16 EE 20 µg and norethindrone acetate 1 mg versus mestranol 50 µg and norethindrone 1 mg, Outcome 1 Frequent bleeding ‐ cycles 1 to 3.
16.2
16.2. Analysis
Comparison 16 EE 20 µg and norethindrone acetate 1 mg versus mestranol 50 µg and norethindrone 1 mg, Outcome 2 Infrequent bleeding ‐ cycles 1 to 3.
16.3
16.3. Analysis
Comparison 16 EE 20 µg and norethindrone acetate 1 mg versus mestranol 50 µg and norethindrone 1 mg, Outcome 3 Irregular bleeding ‐ cycles 1 to 3.
16.4
16.4. Analysis
Comparison 16 EE 20 µg and norethindrone acetate 1 mg versus mestranol 50 µg and norethindrone 1 mg, Outcome 4 Prolonged bleeding ‐ cycles 1 to 3.
17.1
17.1. Analysis
Comparison 17 EE 20 µg and norethindrone acetate 1 mg versus EE 25 µg and norgestimate 180‐215‐250 µg, Outcome 1 Pregnancy per woman.
17.2
17.2. Analysis
Comparison 17 EE 20 µg and norethindrone acetate 1 mg versus EE 25 µg and norgestimate 180‐215‐250 µg, Outcome 2 Discontinuation ‐ overall.
17.3
17.3. Analysis
Comparison 17 EE 20 µg and norethindrone acetate 1 mg versus EE 25 µg and norgestimate 180‐215‐250 µg, Outcome 3 Discontinuation ‐ adverse events.
17.4
17.4. Analysis
Comparison 17 EE 20 µg and norethindrone acetate 1 mg versus EE 25 µg and norgestimate 180‐215‐250 µg, Outcome 4 Breakthrough bleeding ‐ cycle 3.
17.5
17.5. Analysis
Comparison 17 EE 20 µg and norethindrone acetate 1 mg versus EE 25 µg and norgestimate 180‐215‐250 µg, Outcome 5 Breakthrough bleeding ‐ cycle 6.
17.6
17.6. Analysis
Comparison 17 EE 20 µg and norethindrone acetate 1 mg versus EE 25 µg and norgestimate 180‐215‐250 µg, Outcome 6 Breakthrough bleeding or spotting ‐ cycle 3.
17.7
17.7. Analysis
Comparison 17 EE 20 µg and norethindrone acetate 1 mg versus EE 25 µg and norgestimate 180‐215‐250 µg, Outcome 7 Breakthrough bleeding or spotting ‐ cycle 6.
17.8
17.8. Analysis
Comparison 17 EE 20 µg and norethindrone acetate 1 mg versus EE 25 µg and norgestimate 180‐215‐250 µg, Outcome 8 Unscheduled bleeding ‐ cycle 3.
17.9
17.9. Analysis
Comparison 17 EE 20 µg and norethindrone acetate 1 mg versus EE 25 µg and norgestimate 180‐215‐250 µg, Outcome 9 Unscheduled bleeding ‐ cycle 6.
17.10
17.10. Analysis
Comparison 17 EE 20 µg and norethindrone acetate 1 mg versus EE 25 µg and norgestimate 180‐215‐250 µg, Outcome 10 Weight loss, maintenance, or gain <5% ‐ cycle 6.
18.1
18.1. Analysis
Comparison 18 EE 20 µg and drospirenone 3 mg versus EE 30 µg and drospirenone 3 mg, Outcome 1 Pregnancy per woman.
19.1
19.1. Analysis
Comparison 19 EE 20 µg and drospirenone 3 mg versus EE 25 µg and norgestimate 180‐215‐250 µg, Outcome 1 Unscheduled bleeding days ‐ cycle 3.
20.1
20.1. Analysis
Comparison 20 EE 20 µg and levonorgestrel 100 µg versus EE 30 µg and levonorgestrel 150 µg, Outcome 1 Pregnancy per woman.
20.2
20.2. Analysis
Comparison 20 EE 20 µg and levonorgestrel 100 µg versus EE 30 µg and levonorgestrel 150 µg, Outcome 2 Adverse events.
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Akerlund 1993 {published data only}
    1. Akerlund M. Clinical experience of a combined oral contraceptive with very low dose ethinyl estradiol. Acta Obstetricia et Gynecologica Scandinavica 1997;164(Suppl):63‐5. - PubMed
    1. Akerlund M, Rode A, Westergaard J. Comparative profiles of reliability, cycle control and side effects of two oral contraceptive formulations containing 150 µg desogestrel and either 30 µg or 20 µg ethinyl oestradiol. British Journal of Obstetrics and Gynaecology 1993;100(9):832‐8. - PubMed
Appel 1987 {published data only}
    1. Appel TB, Kambi AA, Birdsall C, Christenson DA, Clark DO, DeKoning JR, et al. A comparison of a new graduated estrogen formulation with three constant‐dosed oral contraceptives. Contraception 1987;35(6):523‐32. - PubMed
Basdevant 1993 {published data only}
    1. Basdevant A, Conard J, Pelissier C, Guyene TT, Lapousterle C, Mayer M, et al. Hemostatic and metabolic effects of lowering the ethinyl‐estradiol dose from 30 mcg to 20 mcg in oral contraceptives containing desogestrel. Contraception 1993;48(3):193‐204. - PubMed
Bounds 1979 {published data only}
    1. Bounds W, Vessey M, Wiggins P. A randomized double‐blind trial of two low dose combined oral contraceptives. British Journal of Obstetrics and Gynaecology 1979;86(4):325‐9. - PubMed
Brill 1996 {published data only}
    1. Brill K, Then A, Beisiegel U, Jene A, Wunsch C, Leidenberger F. Investigation of the influence of two low‐dose monophasic oral contraceptives containing 20 µg ethinylestradiol/75 µg gestodene and 30 µg ethinylestradiol/75 µg gestodene, on lipid metabolism in an open randomized trial. Contraception 1996;54(5):291‐7. - PubMed
Bruni 2000 {published data only}
    1. Bruni V, Croxatto H, Cruz J, Dhont M, Durlot F, Fernandes MT, 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. Gynecological Endocrinology 2000;14(2):90‐8. - PubMed
Chavez 1999 {published data only}
    1. Chavez A, DelConte A. A comparison of cycle control with monophasic levonorgestrel/ethinylestradiol 100 µg/20 µg versus triphasic norethindrone/ethinylestradiol 500‐750‐1000 µg/35 µg: a multicenter, randomized, open‐label study. The European Journal of Contraception and Reproductive Health Care 1999;4(2):75‐83. - PubMed
Endrikat 1997 {published data only}
    1. Endrikat J, Müller U, Düsterberg B. A twelve‐month comparative clinical investigation of two low‐dose oral contraceptives containing 20 µg ethinylestradiol/75 µg gestodene and 30 µg ethinylestradiol/75 µg gestodene, with respect to efficacy, cycle control, and tolerance. Contraception 1997;55(3):131‐7. - PubMed
Endrikat 2001 {published data only}
    1. Endrikat J, Klipping C, Gerlinger C, Ruebig A, Schmidt W, Holler T, et al. A double‐blind comparative study of the effects of a 23‐day oral contraceptive regimen with 20 µg ethinyl estradiol and 75 µg gestodene and a 21‐day regimen with 30 µg ethinyl estradiol and 75 µg gestodene on hemostatic variables, lipids, and carbohydrate metabolism. Contraception 2001;64(4):235‐41. - PubMed
Hampton 2001 {published data only}
    1. Burkman RT, Fisher AC, LaGuardia KD. Effects of low‐dose oral contraceptives on body weight. Journal of Reproductive Medicine 2007;52(11):1030‐4. - PubMed
    1. Hampton RM, Fisher AC, Pagano S, LaGuardia KD. Scheduled and unscheduled bleeding patterns with two combined hormonal contraceptives: application of new recommendations for standardization. Fertility and Sterility 2009;92(2):434‐40. - PubMed
    1. Hampton RM, Short M, Bieber E, Bouchard C, Ayotte N, Shangold G, et al. Comparison of a novel norgestimate/ethinyl estradiol oral contraceptive (Ortho Tri‐Cyclen Lo) with the oral contraceptive Loestrin Fe 1/20. Contraception 2001;63(6):289‐95. - PubMed
Inauen 1991 {published data only}
    1. Inauen W, Stocker G, Haeberli A, Straub PW. Effects of low and high dose oral contraceptives on blood coagulation and thrombogenesis induced by vascular subendothelium exposed to flowing human blood. Contraception 1991;43(5):435‐46. - PubMed
Kaunitz 2009 {published data only}
    1. Kaunitz AM, Burkman RT, Fisher AC, LaGuardia KD. Cycle control with a 21‐day compared with a 24‐day oral contraceptive pill: a randomized controlled trial. Obstetrics & Gynecology. 2009/11/26 2009; Vol. 114, issue 6:1205‐12. - PubMed
Kirkman 1994 {published data only}
    1. Kirkman RJ. Clinical comparison of two low dose oral contraceptives in women over 30 years of age [abstract]. Advances in Contraception 1992; Vol. 8, issue 3:170‐1. - PubMed
    1. Kirkman RJ. Clinical comparison of two low‐dose oral contraceptives in women older than 30 years. Advances in Contraception 1991;7(Suppl 2):63‐76.
    1. Kirkman RJ, Pedersen JH, Fioretti P, Roberts HE. Clinical comparison of two low‐dose oral contraceptives, Minulet® and Mercilon®, in women over 30 years of age. Contraception 1994;49(1):33‐46. - PubMed
    1. Kirkman RJ, Pedersen JH, Fioretti P, Roberts HG. Comparison of acceptability and efficacy of low dose oral contraceptives containing gestodene or desogestrel [abstract]. Advances in Contraception 1995;11(1):36‐7.
Kluft 2006 {published data only}
    1. Kluft C, Endrikat J, Mulder SM, Gerlinger C, Heithecker R. A prospective study on the effects on hemostasis of two oral contraceptives containing drospirenone in combination with either 30 or 20 µg ethinyl estradiol and a reference containing desogestrel and 30 µg ethinyl estradiol. Contraception 2006;73(4):336‐43. - PubMed
Reisman 1999 {published data only}
    1. Reisman H, Martin D, Gast MJ. A multicenter randomized comparison of cycle control and laboratory findings with oral contraceptive agents containing 100 µg levonorgestrel with 20 µg ethinyl estradiol or triphasic norethindrone with ethinyl estradiol. American Journal of Obstetrics and Gynecology 1999;181(5 Pt 1):45‐52. - PubMed
Rosenberg 1999 {published data only}
    1. Rosenberg MJ, Meyers A, Roy V. Efficacy, cycle control, and side effects of low‐ and lower‐dose oral contraceptives: a randomized trial of 20 µg and 35 µg estrogen preparations. Contraception 1999;60(6):321‐9. - PubMed
Skouby 2005 {published data only}
    1. Jespersen J, Endrikat J, Dusterberg B, Schmidt W, Gerlinger C, Wessel J, et al. A 1‐year study to compare the hemostatic effects of oral contraceptive containing 20 µg of ethinylestradiol and 100 µg of levonorgestrel with 30 µg of ethinylestradiol and 100 µg of levonorgestrel. Contraception 2005;72(2):98‐104. - PubMed
    1. Skouby SO, Endrikat J, Dusterberg B, Schmidt W, Gerlinger C, Wessel J, et al. A 1‐yr randomized study to evaluate the effects of a dose reduction in oral contraceptives on lipids and carbohydrate metabolism: 20 µg ethinyl estradiol combined with 100 µg levonorgesterel. Contraception 2005;71(2):111‐7. - PubMed
Taneepanichskul 2002 {published data only}
    1. Taneepanichskul S, Kriengsinyot R, Jaisamrarn U. A comparison of cycle control, efficacy, and side effects among healthy Thai women between two low‐dose oral contraceptives containing 20 µg ethinylestradiol/75 µg gestodene (Meliane) and 30 µg ethinylestradiol/75 µg gestodene (Gynera). Contraception 2002;66(6):407‐9. - PubMed
Teichmann 1995 {published data only}
    1. Teichmann AT, Brill K, Albring M, Schnitker J, Wojtynek P, Kustra E. The influence of the dose of ethinylestradiol in oral contraceptives on follicle growth. Gynecological Endocrinology 1995;9(4):299‐305. - PubMed
WHO 1982 {published data only}
    1. Task Force on Oral Contraceptives, WHO Special Programme of Research, Development and Research Training in Human Reproduction. A randomized, double‐blind study of six combined oral contraceptives. Contraception 1982;25(3):231‐41. - PubMed
Winkler 1996 {published data only}
    1. Winkler UH, Schindler AE, Endrikat J, Dusterberg B. A comparative study of the effects of the hemostatic system of two monophasic gestodene oral contraceptives containing 20 µg and 30 µg ethinylestradiol. Contraception 1996;53(2):75‐84. - PubMed

References to studies excluded from this review

Bassol 2000 {published data only}
    1. Bassol S, Alvarado A, Celis C, Cravioto MC, Peralta O, Montano R, et al. Latin American experience with two low‐dose oral contraceptives containing 30 µg ethinylestradiol/75 µg gestodene and 20 µg ethinylestradiol/150 µg desogestrel. Contraception 2000;62(3):131‐5. - PubMed
Lawson 1979 {published data only}
    1. Lawson JS, Yuliano SE, Pasquale SA, Osterman JJ. Optimum dosage of an oral contraceptive. American Journal of Obstetrics and Gynecology 1979;134(3):315‐20. - PubMed
Marr 2012 {published data only}
    1. Bachmann G, Sulak PJ, Sampson‐Landers C, Benda N, Marr J. Efficacy and safety of a low‐dose 24‐day combined oral contraceptive containing 20 micrograms ethinylestradiol and 3 mg drospirenone. Contraception. 2004/08/25 2004; Vol. 70, issue 3:191‐8. - PubMed
    1. Marr J, Gerlinger C, Kunz M. A historical cycle control comparison of two drospirenone‐containing combined oral contraceptives: ethinylestradiol 30 µg/drospirenone 3 mg administered in a 21/7 regimen versus ethinylestradiol 20 µg/drospirenone 3 mg administered in a 24/4 regimen. European Journal of Obstetrics & Gynecology and Reproductive Biology 2012;162(1):91‐5. - PubMed
    1. Parsey KS, Pong A. An open‐label, multicenter study to evaluate Yasmin, a low‐dose combination oral contraceptive containing drospirenone, a new progestogen. Contraception. 2000/05/10 2000; Vol. 61, issue 2:105‐11. - PubMed
Rosenberg 1996 {published data only}
    1. Benagiano G. Comparison of two monophasic oral contraceptives: gestodene/ethinyl estradiol versus desogestrel/ethinyl estradiol. International Journal of Fertility 1989;34(Suppl):31‐9. - PubMed
    1. Rosenberg MJ, Waugh MS, Higgins JE. The effect of desogestrel, gestodene, and other factors on spotting and bleeding. Contraception 1996;53(2):85‐90. - PubMed
Westhoff 2005 {published data only}
    1. Westhoff C, Osborne LM, Schafer JE, Morroni C. Bleeding patterns after immediate initiation of an oral compared with a vaginal hormonal contraceptive. Obstetrics and Gynecology 2005;106(1):89‐96. - PubMed
Wiegratz 2003 {published data only}
    1. Wiegratz I, Kutschera E, Lee JH, Moore C, Mellinger U, Winkler UH, et al. Effect of four different oral contraceptives on various sex hormones and serum‐binding globulins. Contraception 2003;67(1):25‐32. - PubMed

Additional references

Anonymous 2000
    1. Anonymous 2000. Oral contraceptives and cardiovascular risk. Drug and Therapeutics Bulletin 2000;38(1):1‐5. - PubMed
Belsey 1986
    1. Belsey EM, Machin D, d'Arcangues C. The analysis of vaginal bleeding patterns induced by fertility regulating methods. Contraception 1986;34(3):253‐60. - PubMed
CGHFBC 1996
    1. 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 1996;347(9017):1713‐27. - PubMed
CONSORT 2009
    1. CONSORT group. CONSORT: Transparent reporting of trials. http://www.consort‐statement.org/ (accessed 15 Jul 2009).
Elstein 1994
    1. Elstein M. Low dose contraceptive formulations: is further reduction in steroid dosage justified?. Advances in Contraception 1994;10(1):1‐4. - PubMed
Gerstman 1991
    1. Gerstman BB, Gross TP, Kennedy DL, Bennett RC, Tomita DK, Stadel BV. Trends in the content and use of oral contraceptives in the United States, 1964‐88. American Journal of Public Health 1991;81(1):90‐6. - PMC - PubMed
Guillebaud 1989
    1. Guillebaud J. Practical prescribing of the combined oral contraceptive pill. In: Filshie M, Guillebaud J Filshie, John Guillebaud editor(s). Contraception: science and practice. London: Butterworth & Co., 1989:69‐93.
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org. John Wiley & Sons, Ltd, (accessed 08 Jul 2013).
Holt 1992
    1. Holt VL, Daling JR, McKnight B, Moore D, Stergachis A, Weiss NS. Functional ovarian cysts in relation to the use of monophasic and triphasic oral contraceptives. Obstetrics and Gynecology 1992;79(4):529‐33. - PubMed
IPPF 2013
    1. International Planned Parenthood Federation. Directory of Hormonal Contraceptives. http://contraceptive.ippf.org/search (accessed 10 Jul 2013).
Lexchin 2003
    1. Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. British Medical Journal 2003;326(7400):1167‐70. - PMC - PubMed
Maitra 2004
    1. Maitra N, Kulier R, Bloemenkamp KWM, Helmerhorst FM, Gülmezoglu AM. Progestogens in combined oral contraceptives for contraception. Cochrane Database of Systematic Reviews 2004, Issue 3. [DOI: 10.1002/14651858.CD004861] - DOI - PubMed
Miller 2001
    1. Miller L, Notter KM. Menstrual reduction with extended use of combination oral contraceptive pills: randomized controlled trial. Obstetrics and Gynecology 2001;98(5 Pt 1):771‐8. - PubMed
Mishell 2007a
    1. Mishell DR, Guillebaud J, Westhoff C, Nelson AL, Kaunitz AM, Trussell J, et al. Combined hormonal contraceptive trials: variable data collection and bleeding assessment methodologies influence study outcomes and physician perception. Contraception 2007;75(1):4‐10. - PubMed
Mishell 2007b
    1. Mishell DR, Guillebaud J, Westhoff C, Nelson AL, Kaunitz AM, Trussell J, et al. Recommendations for standardization of data collection and analysis of bleeding in combined hormone contraceptive trials. Contraception 2007;75(1):11‐5. - PubMed
Nelson 2007
    1. Nelson AL. Combined oral contraceptives. In: Hatcher RA, Trussell J, Nelson AL, Cates W Jr, Stewart F, Kowal D editor(s). Contraceptive Technology. 19th Edition. New York: Ardent Media, Inc., 2007:193‐270.
Ness 2000
    1. Ness RB, Grisso JA, Klapper J, Schlesselman JJ, Silberzweig S, Vergona R, et al. Risk of ovarian cancer in relation to estrogen and progestin dose and use characteristics of oral contraceptives. American Journal of Epidemiology 2000;152(3):233‐41. - PubMed
Norris 1996
    1. Norris LA, Bonnar J. The effect of oestrogen dose and progestogen type on haemostatic changes in women taking low dose oral contraceptives. British Journal of Obstetrics and Gynaecology 1996;103(3):261‐7. - PubMed
Rosenberg 1992
    1. Rosenberg MJ, Long SC. Oral contraceptives and cycle control: a critical review of the literature. Advances in Contraception 1992;8(Suppl 1):35‐45. - PubMed
Rosenberg 1998
    1. Rosenberg MJ, Waugh MS. Oral contraceptive discontinuation: a prospective evaluation of frequency and reasons. American Journal of Obstetrics and Gynecology 1998;179(3 Pt 1):577‐82. - PubMed
Rothman 1998
    1. Rothman KJ, Greenland S. Approaches to statistical analysis. In: Rothman KJ, Greenland S editor(s). Modern epidemiology. 2nd Edition. New York: Lippincott Williams and Wilkins, 1998:183‐99.
Schulz 2002
    1. Schulz KF, Grimes DA. Allocation concealment in randomised trials: defending against deciphering. Lancet 2002;359(9306):614‐700. - PubMed
Spona 1996
    1. Spona J, Elstein M, Feichtinger W, Sullivan H, Ludicke F, Muller U, et al. Shorter pill‐free interval in combined oral contraceptives decreases follicular development. Contraception 1996;54(2):71‐7. - PubMed
Strauss 2005
    1. Strauss SE, Richardson WS, Glasziou P, Haynes RB. Evidence‐based Medicine: How to Practice and Teach EBM. Third Edition. New York: Churchill Livingstone, 2005.
Thiboutot 2001
    1. Thiboutot D, Archer DF, Lemay A, Washenik K, Roberts J, Harrison DD. A randomized, controlled trial of a low‐dose contraceptive containing 20 µg of ethinyl estradiol and 100 µg of levonorgestrel for acne treatment. Fertility and Sterility 2001;76(3):461‐8. - PubMed
Trussell 1998
    1. Trussell J. Dynamics of reproductive behavior and population change. In: Hatcher RA, Trussell J, Stewart F, Cates W Jr, Stewart GK, Guest F, et al. editor(s). Contraceptive technology. 17th Edition. New York: Ardent Media Inc., 1998:745‐77.
Wallach 2000
    1. Wallach M, Grimes DA. Modern oral contraception. 1st Edition. Totowa, NJ: Emron, 2000.

References to other published versions of this review

Gallo 2005
    1. Gallo MF, Nanda K, Grimes DA, Schulz KF. 20 mcg versus > 20 mcg Estrogen combined oral contraceptives for contraception. Contraception 2005;71(3):162‐9. - PubMed

Publication types

MeSH terms

LinkOut - more resources