Ovarian Follicular Development During the Use of Oral Contraception: A Review

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Abstract

Over the past 40 Years alterations to the composition of oral contraceptives (OCs) have been made in attempts to reduce adverse effects and to improve patient compliance while maintaining contraceptive efficacy. However, there is growing evidence to indicate that reducing the estrogen dose to minimize adverse effects may have compromised the degree of hyothalamo-pituitary-ovarian suppression, particularly during the hormone-free interval (HFI) or following missed doses. Follicle development during OC use appears to occur in association with a loss of endocrine suppression during the HFI. This information provides a rationale for reducing or eliminating the HFI in OC regimens. There is also evidence for an increased risk of follicle development and ovulation in women who use delayed OC initiation schemes such as the “Sunday Start” method. It is not currently known why some follicles ovulate during OC use while others regress or form anovulatory follicle cysts. Continued research about follicle development during OC use would provide insight into understanding the precise mechanisms of action underlying combined OCs, as well as those of continuous OC formulations and emergency contraceptive regimens.

Résumé

Au cours des 40 dernières annèes, des changements ont été a portés à la composition des contraceptifs oraux (CO), dans le but d’en réduire les effets indésirables et d’améliorer l’observance du traitement chez les patientes, tout en maintenant l’efficacité. Cependant, de plus en plus de preuves indiquent que la réduction de la dose d’œstrogènes, en vue de minimiser les effets indésirables pourrait avoir compromis le degré de suppression hypothalamo-hypophyso-ovarienne, particulieèrement pendant l’intervalle sans hormone ou après l’oubli d’un ou de plusieurs comprimés. Lorsqu’une femme prend un CO, son développement folliculaire semble être lié à une baisse de la suppression endocrinienne durant l’intervalle sans hormone. Cette information fournit les motifs nécessaires pour réduire ou éliminer l’intervalle sans hormone des traitements aux CO. Chez les femmes qui retardent le début du cycle de leur CO, notamment chez celles ayant recours à la méthode du « cycle débutant un dimanche », il existe des preuves d’un risque accru de développement folliculaire et d’ovulation. À l’heure actuelle, nous ne savons pas pourquoi certains follicules ovulent malgré la prise d’un CO, alors que d’autres régressent ou forment des kystes folliculaires anovulatoires. La poursuite de recherches sur le développement folliculaire se produisant durant la prise d’un CO permettrait de mieux comprendre les mécanismes d’action précis qui soustendent les CO combinés, ainsi que ceux des préparations de CO à administration continue et des traitements de contraception d’urgence.

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    *

    Dr Pierson has received grants from Janssen-Ortho Inc. Organon NV, RW Johnson Pharmaceutical Research Institute and Ares-Serono and funding from the Canadian Institutes of Health Research.

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