The aim of this study was to compare contraceptive reliability, cycle control, and tolerance of an oral contraceptive containing 20 micrograms ethinylestradiol (EE2) and 75 micrograms gestodene (GSD), with a reference preparation containing a similar dose of gestodene but in combination with 30 micrograms ethinylestradiol. A higher incidence of intermenstrual bleeding was apparent under the 20 micrograms EE2 oral contraceptive. For the 20 micrograms EE2 preparation, 47.4% of all women reported spotting at least once over a period of 12 treatment cycles, whereas this figure was 35.5% for the 30 micrograms EE2 pill (p < 0.05). However, the incidence was within a range that corresponds to that of other OCs. The cumulative breakthrough bleeding rates (at least once during the one year of treatment) of 14.5% (20 micrograms EE2) and 11.8% (30 micrograms EE2) of women were not significantly different. In relation to all cycles, the intermenstrual bleeding rates were remarkably lower, indicating that the majority of the volunteers experienced such events only in few cycles under treatment: the spotting rate was 11.5% (20 micrograms EE2) and 7.2% (30 micrograms EE2) of all cycles, and the breakthrough bleeding rate was 2.6% and 1.6% of all cycles, respectively. Three pregnancies were recorded during the study (one in the 20 micrograms EE2 + 75 micrograms GSD group, two in the 30 micrograms EE2 + 75 micrograms GSD group). All three could be explained either by intake irregularities or by circumstances impairing the contraceptive effect. The influence of both treatments on the blood pressure and body weight proved to be extremely slight. Adverse events in both groups were rare and differences in the frequency of adverse events were not apparent. The discontinuation rate due to adverse events, including intermenstrual bleeding, was low (9.8% for 20 micrograms EE2 + 75 micrograms GSD, and 7.2% for 30 micrograms EE2 + 75 micrograms GSD) and was in the lower range known for other oral contraceptives. Both preparations were well accepted by the volunteers. The data obtained demonstrate clinically acceptable cycle control, good tolerance, and a high standard of contraceptive reliability for both drugs. Prescription of the 20 micrograms EE2 preparation could be the first-line therapy in order to provide the lowest amount of EE2 possible. In case of persistent cycle control problems, a switch to the 30 micrograms EE2 drug should be considered.
PIP: A double-blind, comparative study of oral contraceptives (OCs) containing 75 mcg of gestodene and either 20 mcg or 30 mcg of ethinyl estradiol (EE2) indicates that the lower-dose formulation neither compromises contraceptive effectiveness nor produces unacceptable cycle control. Study subjects included 649 randomly selected healthy women requesting contraception from 10 family planning centers in Germany; the 20 mcg EE2 pill was evaluated in 428 women for a total of 4470 cycles, while the 30 mcg preparation was tested in 221 women for 2377 cycles. During the 12-month study period, the incidence of at least 1 episode of intermenstrual bleeding (generally in the first cycle) was significantly greater in the 20 mcg EE2 group (47.4%) than in the 30 mcg group (35.5%); however, the cumulative breakthrough bleeding rates (14.5% and 11.8%, respectively) were not dissimilar. In relation to the sum of all cycles, the spotting rates were 11.5% for the 20 mcg EE2 OC and 7.2% for the 30 mcg OC, and the breakthrough bleeding rates were 2.6% and 1.6%, respectively. The 3 pregnancies that occurred all involved user failure. The discontinuation rates due to side effects, including spotting, were 9.8% in the 20 mcg EE2 group and 7.2% in the 30 mcg group. 66.6% of women in the former group and 71.0% of those in the latter group never complained of an adverse effect during the study. The incidences of spotting and discontinuation were well within the range reported for other OCs. These findings indicate that the 20 mcg EE2 preparation should be prescribed first; if cycle control problems persist, a 30 mcg EE2 OC can be considered.