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Quadriphasic versus monophasic oral contraceptives for contraception
Huib A A M Van Vliet1, Marjolein Raps, Laureen M Lopez
1Department of Gynaecology, Division of Reproductive Medicine, Leiden University Medical Center, Leiden, Netherlands. haam.vliet@worldonline.nl
The Cochrane Database of Systematic Reviews
|November 11, 2011
Summary
Quadriphasic oral contraceptives offer similar effectiveness to monophasic pills but may cause more breast pain. More research is needed to confirm differences in side effects and bleeding patterns for these contraceptive options.
Area of Science:
- Reproductive Health
- Contraception
- Pharmacology
Background:
- Quadriphasic oral contraceptives aim to mimic natural cycles and reduce side effects.
- Potential disadvantages include increased pill-taking errors, complex missed-pill instructions, higher cost, and potential side effect issues.
Purpose of the Study:
- To compare contraceptive effectiveness, bleeding patterns, minor side effects, and acceptability of quadriphasic versus monophasic oral contraceptives.
Main Methods:
- Searched multiple databases (CENTRAL, MEDLINE, EMBASE, POPLINE, ClinicalTrials.gov, ICTRP) and contacted researchers/manufacturers.
- Included randomized controlled trials (RCTs) reporting on effectiveness, bleeding, side effects, ease of use, or discontinuation.
- Analyzed data using random-effects models for continuous and dichotomous variables.
Main Results:
- One RCT compared quadriphasic (dienogest/estradiol valerate) with monophasic (levonorgestrel/ethinylestradiol) pills.
- Contraceptive effectiveness, intracyclic bleeding, and discontinuation due to side effects were similar.
- Quadriphasic users had fewer bleeding/spotting days but reported more breast pain; withdrawal bleeding was higher in the monophasic group.
Conclusions:
- Insufficient evidence exists to definitively differentiate quadriphasic from monophasic oral contraceptives regarding effectiveness, bleeding, side effects, or acceptability.
- Further studies are required, particularly those using identical progestogen/estrogen types and comparing against 30 μg ethinylestradiol monophasic pills.
- Monophasic pills with 30 μg estrogen are recommended as the first choice for initiating oral contraceptive use.
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