Abstract | BACKGROUND: Quadriphasic oral contraceptives have been developed to reduce the adverse effects of oral contraceptives and are presented as more physiological since they mimic the natural cycle. However, suggested disadvantages of quadriphasic oral contraceptives include a possible increased risk of pill-taking errors caused by the array of different color pills, complicated directions for catching up when a pill is missed, the higher price and potential inferiority in terms of side effects. OBJECTIVES: SEARCH METHODS: We searched CENTRAL, MEDLINE, EMBASE, POPLINE, ClinicalTrials.gov and ICTRP for trials comparing quadriphasic pills with monophasic pills. We contacted researchers and manufacturers of quadriphasic oral contraceptives to identify additional studies. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing quadriphasic with monophasic oral contraceptives . Trials had to report on contraceptive effectiveness, bleeding patterns, minor side effects, ease of use or trial discontinuation. We excluded studies where the intervention was primarily used as a treatment for disorders or was administered for fewer than three consecutive cycles. DATA COLLECTION AND ANALYSIS: T wo authors abstracted and entered data into RevMan. We critically appraised the methodological quality of the included trials. For continuous variables, we computed the mean difference with 95% confidence interval (CI) using the random-effects model. For dichotomous variables, we calculated the risk ratio with 95% CI using the random-effects model. MAIN RESULTS: AUTHORS' CONCLUSIONS: The available evidence is insufficient to determine whether quadriphasic differ from monophasic oral contraceptives in contraceptive effectiveness, bleeding pattern, minor side effects and acceptability. Studies that compare quadriphasic and monophasic oral contraceptives with an identical progestogen and estrogen type are needed to determine whether the quadriphasic approach differs from the monophasic approach. Studies that compare quadriphasic pills with monophasic pills containing 30 μg ethinylestradiol are indicated to determine whether quadriphasic oral contraceptives have an advantage over the current, first choice oral contraceptive . Until then, we recommend monophasic pills containing 30 μg estrogen as the first choice for women starting oral contraceptive use.
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Authors | Huib A A M Van Vliet, Marjolein Raps, Laureen M Lopez, Frans M Helmerhorst |
Journal | The Cochrane database of systematic reviews
(Cochrane Database Syst Rev)
Issue 11
Pg. CD009038
(Nov 09 2011)
ISSN: 1469-493X [Electronic] England |
PMID | 22071862
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)
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Chemical References |
- Contraceptives, Oral, Combined
- Ethinyl Estradiol
- dienogest
- Estradiol
- Levonorgestrel
- Nandrolone
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Topics |
- Contraceptives, Oral, Combined
(adverse effects)
- Estradiol
(adverse effects, analogs & derivatives)
- Ethinyl Estradiol
(adverse effects)
- Female
- Humans
- Levonorgestrel
(adverse effects)
- Medication Adherence
- Menstruation
(drug effects, physiology)
- Nandrolone
(adverse effects, analogs & derivatives)
- Randomized Controlled Trials as Topic
- Uterine Hemorrhage
(chemically induced)
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