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The bitter pill
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  1. Lucy Cox
  1. General Practitioner and Clinical Lead in Contraception, Saxonbrook Medical, Crawley, West Sussex, UK
  1. Correspondence to Dr Lucy Cox, Saxonbrook Medical, Maidenbower Square, Maidenbower, Crawley, West Sussex RH10 7QH, UK; lucyjcox{at}doctors.org.uk

https://doi.org/10.1136/jfprhc-2014-101015

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    A French pill scare

    The opinion of Marion Larat is that “nobody, but nobody should take the third- and fourth-generation pills”.1 This view is not surprising as she suffered a devastating stroke at the age of 18 years.2 A subsequent enquiry linked her cerebral vascular accident to Méliane®,3 a 20 μg pill containing gestodene that she had been prescribed for contraception. In December 2012, Marion Larat successfully sued the manufacturer, Bayer, and the French drug regulatory board Agence national de sécurité du médicament et des produits de santé (ANSM) for damages. Her case was widely publicised in the media and 30 similar lawsuits soon followed.

    In January 2013, the Minister for Health, Marisol Touraine, announced that France's social security system would no longer reimburse prescriptions for third- and fourth-generation pills.4 At the time around half of the five million French women on the combined pill were taking such pills,5 which cost more to the state than older formulations. Plans were made to strip midwives and nurses of their pill-prescribing powers.5 The ANSM advised that third- and fourth-generation pills should never be used as first-line contraception and should only be prescribed if an older formulation had not been tolerated.5 The ANSM then referred the matter to the European Medicines Agency (EMA) for further investigation.

    The pill controversy

    Since the introduction of the combined oral contraceptive pill (COC) in the 1960s, an association between ethinylestradiol (EE) and venous thromboembolism (VTE) has been apparent. The amount of EE in pills has lessened over time to reduce thrombotic potential as well as estrogenic side effects. Older pills contain testosterone-derived progestogens and can have androgenic side effects. Newer formulations have been developed that contain less androgenic progestogens and so aim for better tolerability.

    Progestogens have been arbitrarily categorised into ‘generations’ based on their chemical structure …

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      BMJ Sexual & Reproductive Health 2015; 41 79-80 Published Online First: 20 Mar 2015. doi: 10.1136/jfprhc-2015-101213