Clinical experience with multiphasic oral contraceptives

The short-term, mainly estrogen-induced side effects of oral contraceptives (OCs) have been minimized by a reduction in the estrogen component in formulations currently employed. Women may expect to continue OCs for several decades of their reproductive lives, commencing earlier and stopping later than did their mothers. Youth does not appear to offer protection from initiation of cardiovascular pathology. Data from the Bogalusa Heart Study show that risk factors for cardiovascular disease, such as elevated serum low-density-lipoprotein cholesterol, are associated with anatomic changes in the aorta and coronary arteries very early in life. Therefore, the focus now is on long-term OC effects, especially alterations in carbohydrate and lipid metabolism. Progestin components of some OCs may alter both carbohydrate and lipid metabolism significantly, in a dose- and potency-related manner. OC formulations, therefore, are moving toward a reduction in the dose as well as potency of the progestin used, with a special emphasis on lipid profile study. Multiphasic OCs, the most recent generation of formulations, achieve considerable reductions by starting each cycle at a low dose of progestin and altering the dose in stages. Two of the multiphasics incorporate norethindrone as the progestin. Here we examine the clinical experience with one of the norethindrone-containing agents, Ortho Novum 7/7/7, and compare its performance and metabolic side effects with those of the corresponding monophasic preparation.