两种单向复方口服避孕药对经前期综合征影响的研究

目的观察两种单向口服避孕药(OCs)优思明和妈富隆对育龄妇女经前期综合症(PMS)的影响。方法将自愿服用COC避孕的妇女随机分为两组,其中优思明(DRSP/EE)组47例,妈富隆(DSG/EE)组19例。两组均从月经周期第1天开始服药,1片/d,连续服用21天,之后停药7天。两组均连续服用6个周期(28天/周期)。两组对象在研究开始前及6个月经周期后各完成1份相同的经期不适问卷(MDQ)。计算服用避孕药前和服药6个周期后各组MDQ平均得分和平均得分的变化。结果①服药6个周期后,优思明组经前期水潴留和注意力损害评分、月经期水潴留评分比妈富隆组有显著性改善(P<0.05)。②优思明组服药6个周期后,经前期水潴留和消极情绪评分,月经期水潴留评分比服药前有显著性下降(P<0.05)。妈富隆组服药6个周期后,经前期消极情绪比服药前有显著性下降(P<0.05)。结论两种COC对PMS均有一定的改善作用;口服避孕药优思明比妈富隆对PMS的改善作用更加显著,这与DRSP抗盐皮质激素作用有关。     

A randomized study on the influence of oral contraceptives containing ethinylestradiol combined with drospirenone or desogestrel on lipid and lipoprotein metabolism over a period of 13 cycles

In this open-label, randomized study we compared the influence of a new oral contraceptive containing 30 microg ethinylestradiol and 3 mg drospirenone (EE + DRSP = Yasmin), with a reference preparation containing 30 microg ethinylestradiol and 150 microg desogestrel (EE + DSG = Marvelon) on the lipid profile. The primary target variables were total high-density lipoprotein (HDL) cholesterol, HDL2 cholesterol and low-density lipoprotein (LDL) cholesterol. These and additional lipid and lipoprotein fractions were measured at baseline and in the 3rd, 6th and 13th treatment cycles in a total of 50 volunteers, and also assessed after density gradient ultracentrifugation. A slight increase in mean total HDL cholesterol vs. baseline was found for the DRSP group (+12.8%) and the DSG group (+11.8%) after 13 treatment cycles. HDL2 cholesterol did not change remarkably in both groups. The mean LDL cholesterol values increased by 10.6% vs. baseline in the DSG group and remained nearly stable in the DRSP group (+1.8%). All measured values remained within the reference ranges. No statistically significant differences were found between the two treatment groups for those primary endpoints. A slight rise in mean total cholesterol was found for all cycles after the initiation of treatment. The mean increase after 1 year of treatment was approximately 8% in both treatment groups. Mean triglyceride levels increased for both treatment groups without leaving the reference range. The increase for total triglycerides was +73.6 % in the DRSP group and +61.3% in DSG group. For total phospholipids, an increase of +13.6% (DRSP) and +18.5% (DSG) over 13 cycles was measured. The apolipoproteins Apo A-I, Apo A-II and Apo B increased slightly more during DRSP treatment than during DSG treatment. The reduction of Apo E was similar in both groups. Lipoprotein (a) remained stable in the DRSP group, whereas it increased by +10.8% in the DSG group. In conclusion, the combined low-dose oral contraceptive Yasmin, with 30 microg ethinylestradiol and 3 mg of the novel progestogen drospirenone, as well as the reference preparation, had little impact on the lipid profile. While both preparations displayed a favorable lipid profile with increased total HDL cholesterol, the antiandrogenic or missing androgenic activity of Yasmin may be regarded as responsible for the stable LDL cholesterol levels. As a result, the ratio of total HDL:LDL was increased, a pattern that is usually considered clinically beneficial with respect to cardiovascular disease risk.     

A randomized study over 13 cycles to assess the influence of oral contraceptives containing ethinylestradiol combined with drospirenone or desogestrel on carbohydrate metabolism

In this open-label, randomized study we compared the influence of a new oral contraceptive containing 30 μg ethinylestradiol and 3 mg drospirenone (Yasmin™) with a reference preparation containing 30 μg ethinylestradiol and 150 μg desogestrel (Marvelon™) on variables of carbohydrate metabolism by means of oral glucose tolerance tests at baseline and in the 6th and 13th treatment cycle. The mean levels of fasting glucose and insulin were similar at baseline and after 13 treatment cycles, whereas C-peptide and free fatty acid levels decreased slightly in both groups. All blood glucose and insulin values measured in the oral glucose tolerance tests were within normal ranges, despite a slight increase in the mean areas under the curves of 0–3 h [AUCs (0–3 h)] of both variables from baseline to treatment cycle 13. Differences between both treatments were not statistically significant. The mean AUCs (0–3 h) for C-peptide were not markedly changed in any treatment group. Free fatty acid levels decreased by 42% in the drospirenone group and increased by 48.9% in the desogestrel group, in terms of means of individual changes. Both preparations were well tolerated and equally efficacious regarding contraception and cycle control. The mean body weight was slightly decreased in most cycles during treatment with the drospirenone combination, as compared to baseline, while it was slightly increased versus baseline in all cycles during treatment with the desogestrel combination. The combination with drospirenone had less impact on blood pressure than the combination with desogestrel. In conclusion, Yasmin, a combined low-dose oral contraceptive with 30 μg ethinylestradiol and 3 mg of the novel progestogen drospirenone, as well as the reference Marvelon, containing 30 μg ethinylestradiol and 150 μg desogestrel had little impact on carbohydrate metabolism when used for 1 year. The observed changes were small and not suggestive of a clinically relevant deterioration of carbohydrate metabolism.     

Third-generation progestogen type influences hemostatic changes caused by oral contraceptives in Brazilian women

We compared the effects of two third-generation progestogens, desogestrel (DSG) and gestodene (GSD), on coagulation and fibrinolysis in Brazilian users of oral contraceptives (OCs). Forty-six women were evaluated before treatment and after six cycles of treatment. The coagulation, anticoagulant, and fibrinolytic systems were investigated. During the use of the DSG-containing OC, the activity of factors VII, VIII, IX, X, and XII increased significantly whereas the GSD-containing OC caused no changes in coagulation parameters. Concerning the anticoagulant pathways, the DSG-containing OC increased protein C levels and decreased total protein S levels, and the GSD-containing OC only decreased total protein S. Both OCs increased plasminogen activity, although the DSG-containing OC increased fibrin degradation products levels and decreased the tissue plasminogen activator antigen. In conclusion, we have found that in Brazilian women the effects of DSG and GSD on hemostatic parameters are different and, therefore, third-generation progestogens may not contribute equally to the thrombotic risk.     

A prospective study on the effects on hemostasis of two oral contraceptives containing drospirenone in combination with either 30 or 20 microg ethinyl estradiol and a reference containing desogestrel and 30 microg ethinyl estradiol

PURPOSE: In this open-label, randomized study, we assessed the effects on hemostasis of two combined oral contraceptives containing drospirenone (DRSP) as progestogen component. METHODS: Three milligrams of DRSP, a progestogen with antimineralocorticoid activity, was combined with either 30 or 20 microg ethinyl estradiol (EE) (DRSP/30EE; DRSP/20EE) and compared with a preparation containing 150 microg desogestrel (DSG) and 30 microg ethinyl estradiol (DSG/30EE). A total of 75 healthy female volunteers aged 18-35 years were enrolled. The hemostasis variables were measured in the medication-free precycle (baseline); in the first, third and sixth treatment cycle; and in the follow-up phase. The target variables for comparison were the relative changes from baseline to Cycle 6. RESULTS: Data of 25 volunteers in each group were valid for the per-protocol evaluation. Most changes in hemostasis variables were similar in the three treatment groups. All procoagulatory variables and the anticoagulatory variable protein C antigen increased slightly, while protein S antigen and activity decreased. For fibrinogen and protein S activity, the changes were statistically significant: less pronounced with DRSP/20EE compared to DSG/30EE at Cycle 6. There were no statistically significant differences in the changes of antifibrinolytic variables, the global clotting tests and D-dimer. All pairwise comparisons of DRSP/30EE vs. DSG/30EE yielded nonsignificant results; however, there was a trend of a lower impact of DRSP/20EE on nearly all hemostatic parameters compared to the 30EE products. All three study treatments were safe and well tolerated by the volunteers and provided adequate contraceptive reliability. CONCLUSION: The changes in the hemostatic variables for DRSP/20EE were less pronounced compared to DSG/30EE and DRSP/30EE. The results were in accordance with previous reports on effects of similar OCs.     

Efficacy of second versus third generation oral contraceptives in the treatment of hirsutism

OBJECTIVE: To compare second versus third generation combination oral contraceptives (OCs) in the treatment of hirsutism. METHODS: Women with hirsutism, as defined by a minimum Ferriman-Gallwey score of 10, were randomized in a double-blind fashion to receive an OC containing either ethinyl estradiol/desogestrel or ethinyl estradiol/levonorgestrel for 9 months of treatment. Ferriman-Gallwey scores, androgen levels and sex hormone-binding globulin were measured at baseline and every 3 months for the duration of the study. Hormones were measured in duplicate by radioimmunoassay. RESULTS: Of the 47 women enrolled, 24 were randomized to ethinyl estradiol/desogestrel and 23 were randomized to ethinyl estradiol/levonorgestrel. Mean sex hormone-binding globulin increased significantly in subjects using the desogestrel-containing contraceptive compared with the levonorgestrel-containing contraceptive. Ten subjects completed the 9 months of treatment in the levonorgestrel group and 11 completed the study in the desogestrel group. Mean free testosterone and 3alpha-androstanediol glucuronide decreased significantly in the group receiving ethinyl estradiol/desogestrel but not in the ethinyl estradiol/levonorgestrel group. Mean Ferriman-Gallwey scores decreased significantly in both treatment groups. Improvement in mean Ferriman-Gallwey score was 35.7 +/- 38.1% (p < 0.001) for the ethinyl estradiol/desogestrel arm and 33.4 +/- 27.3% (p < 0.001) for the ethinyl estradiol/levonorgestrel arm. There were no statistically significant differences found in the improvement of Ferriman-Gallwey scores between the two treatment arms, although the power to detect a difference was limited by the small sample size. CONCLUSIONS: Treatment of hirsute women with third generation OCs containing desogestrel results in a significant increase in sex hormone-binding globulin and decrease in free testosterone and 3alpha-androstanediol glucuronide. Both second and third generation OCs were clinically effective in treating hirsutism.     

The effects of seven monophasic oral contraceptive regimens on hemostatic variables: conclusions from a large randomized multicenter study

We investigated the effects of ethinylestradiol dose (50, 30 and 20 μg) and progestogen type [desogestrel (DSG), gestodene (GSD), levonorgestrel (LNG) and norgestimate (NGM)] in oral contraceptives on 24 hemostatic variables. In a multicenter, randomized, comparative study, 707 healthy, nonsmoking, nulliparous women were treated for six cycles with one of the seven monophasic oral contraceptives tested. Significantly greater increases in prothrombin fragment 1+2 and factor VII (activity and antigen), were found in the DSG, NGM and GSD groups compared to the LNG group. Similarly, significantly lower levels of protein S (free and total) and increased APC-sr (endogenous thrombin potential based) were found in the same groups compared with the LNG group. In addition, the estradiol dose (50 vs. 30 μg) significantly influenced these parameters. All changes were within the normal range and have not been associated with an increased risk of venous thromboembolic event (VTE). However, raised levels of these variables are associated with prothrombotic states such as pregnancy. The significance of the haemostatic changes found in this study in relation to VTE risk remains to be determined, but results of this study probably cannot explain the differences in risk of VTE between OCs containing different progestogens.     

An open-label randomized comparative study of oral contraceptives between medications containing 3 mg drospirenone/30 microg ethinylestradiol and 150 microg levonogestrel/30 microg ethinylestradiol in Thai women

This study was conducted to compare the cycle control, efficacy and adverse events of a new low-dose oral contraceptive pill regimen containing 3 mg drospirenone (DRSP)/30 microg ethinylestradiol (EE), with a widely prescribed 150 microg levonogestrel (LNG)/30 microg EE. The results of this comparative trial demonstrated that the two preparations had no statistically significant difference in terms of cycle control, efficacy and adverse events. The occurrence of spotting and breakthrough bleeding was low and was not different between the two regimens. There was neither amenorrhea nor pregnancies reported in either group. The most common adverse events in both groups were nausea, headache and breast tenderness. Also statistically significant changes were found in body weight and blood pressure in both groups at the end of the study. In conclusion, the 3 mg DRSP/30 microg EE regimen provides good cycle control with reliable contraceptive efficacy and a low incidence of adverse events equal to the 150 microg LNG/30 microg EE preparation. Compared with the 150 microg LNG/30 microg EE preparation, the 3 mg DRSP/30 microg EE preparation demonstrated a more favorable effect on body weight and blood pressure, with the mean body weight and mean blood pressure remaining lower than baseline mean. The new formulation may be especially beneficial for women susceptible to body weight gain and rise in blood pressure.     

Effects of two different oral contraceptives on total body water: a randomized study

Purpose

This open-label, randomized study evaluated the effect of two different oral contraceptives on body weight and composition during one cycle of treatment.

Method

Eighty women (mean age, 24.6 years) were randomized into three groups and given one of the following contraceptive methods: ethinylestradiol 15 μg/gestodene 60 μg (EE/GST, n=25), ethinylestradiol 30 μg/drospirenone 3 mg (EE/DRS, n=29) or male condom (control group, n=26). Bioelectric impedance analysis (BIA) was carried out on the first, 10th and 21st days during the use of oral contraceptives or in the menstrual cycle (control group), and total body water (TBW), fat mass (FM) and fat-free mass (FFM) were measured.

Results

No significant variations in TBW, FM or FFM were observed in the three groups during the cycle. Intergroup analysis showed no differences in TBW or FM; however, users of EE/GST showed a statistically significant increase in FFM compared to the control group.

Conclusion

The different doses of ethinylestradiol associated with gestodene or drospirenone showed no statistically significant effects on TBW or FM during one cycle of observation.     

Serum resistin levels in women taking combined oral contraceptives containing desogestrel or gestodene

Resistin is a hormone secreted by adipose tissue that could be involved in the development of insulin resistance. Previous studies confirmed that endogenous sex steroids may influence serum resistin concentration in women. The aim of our study was to investigate the influence of combined oral contraceptives containing desogestrel or gestodene on circulating levels of resistin. Fifty-three women were enrolled in the study. Thirteen patients received 20 μg ethinylestradiol/150 μg desogestrel, 15 women were treated with 20 μg ethinylestradiol/75 μg gestodene, 11 with 30 μg ethinylestradiol/150 μg desogestrel and 14 with 30 μg ethinylestradiol/75 μg gestodene. Blood samples for estimation of serum resistin and insulin levels were drawn before administration of oral contraceptive and after 6 cycles of therapy. We found that serum resistin level remained unchanged in women receiving ethinylestradiol/desogestrel and was reduced in women treated with formulations containing gestodene. We conclude that ethinylestradiol combined with desogestrel or gestodene is unlikely to induce insulin resistance through resistin pathway.     

The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance Study on oral contraceptives based on 142,475 women-years of observation

OBJECTIVES: The study was conducted to compare risks of adverse cardiovascular and other events associated with the use of drospirenone (DRSP)-containing oral contraceptives (OCs) and other OCs. METHODS AND MATERIALS: The European Active Surveillance study (EURAS) was a multinational, prospective, noninterventional cohort study of new users of DRSP, levonorgestrel (LNG) and other progestin-containing OCs. Semiannual follow-up was based on mailed questionnaires, with additional follow-up procedures when needed. RESULTS: Overall, 58,674 women were followed for 142,475 women-years of observation. Loss to follow-up was 2.4%. Serious adverse and fatal events were rare, and rate ratios were close to unity (1.0). Cox regression analysis of cardiovascular outcomes yielded hazard ratios for DRSP-containing vs. LNG-containing and other OCs of 1.0 and 0.8 (upper 95% confidence limits, 1.8 and 1.3) for venous, and 0.3 and 0.3 (upper 95% confidence limits, 1.2 and 1.5) for arterial thromboembolism, respectively. CONCLUSIONS: Risks of adverse cardiovascular and other serious events in users of a DRSP-containing OC are similar to those associated with the use of other OCs.     

Effects of two combined oral contraceptives containing ethinyl estradiol 20 microg combined with either drospirenone or desogestrel on lipids, hemostatic parameters and carbohydrate metabolism

OBJECTIVE: To compare the effect of ethinyl estradiol 20 microg/drospirenone 3 mg (EE 20 microg/DRSP 3 mg) administered according to a 24/4 regimen with ethinyl estradiol 20 microg/desogestrel 150 microg (EE 20 microg/DSG 150 microg) administered according to the conventional 21/7 regimen on lipid, carbohydrate and hemostatic parameters. STUDY DESIGN: In this open-label study, healthy women were randomized to EE 20 microg/DRSP 3 mg or EE 20 microg/DSG 150 microg for seven cycles. Mean differences in high-density lipoprotein (HDL)- and low-density lipoprotein (LDL)-cholesterol levels at cycle 7 compared to baseline were assessed. Secondary variables included changes in other lipid, hemostatic and carbohydrate parameters. RESULTS: Both treatments increased HDL-cholesterol, but decreased LDL-cholesterol by a comparable extent. Although slightly elevated in both groups, blood glucose and C-peptide levels measured during oral glucose tolerance tests were within normal reference ranges at cycle 7. Overall, the differences in lipid, hemostatic or carbohydrate parameters were not significant between the two treatments. CONCLUSION: EE 20 microg/DRSP 3 mg has a good safety profile comparable with EE 20 microg/DSG 150 microg.     

Noncontraceptive benefits of two combined oral contraceptives with antiandrogenic properties among adolescents

BACKGROUND: The aim of this study was to assess the noncontraceptive benefits of two combined oral contraceptives, containing progestins with well-known antiandrogenic properties, in adolescent girls. STUDY DESIGN: In this prospective observational study, the effects of two formulations containing 30 mcg of ethinyl estradiol combined with 2 mg chlormadinone acetate or 3 mg drospirenone were compared. Six-month data were obtained from 156 sexually active adolescents requiring contraception. We investigated the advantages of these regimens on intermenstrual bleeding, dysmenorrhea, acne and hair and skin disorders. Furthermore, their effects on sexual interest, intercourse frequency and sexual satisfaction were evaluated. CONCLUSION: Both preparations provided effective contraception, good cycle control and beneficial effects on preexisting hair and skin disorders without effects on body weight. However, the best results were obtained with the formulation containing chlormadinone acetate, with the difference being statistically significant. Furthermore, the contraceptive adherence to teenager expectations and the counseling effectiveness enhancing compliance contribute to a high rate of continuation.     

Success with oral contraceptives: a pilot study

The objective of this pilot study was to examine the effectiveness of a postpartum educational intervention aimed at increasing compliance with oral contraception (OCs) and decreasing repeat pregnancies in young, African American women in the year following an unplanned pregnancy. In this longitudinal study, 43 young, pregnant women attending Prentice Ambulatory Care, Northwestern Hospital, were enrolled and 33 were randomized to receive an antepartum, multicomponent intervention consisting of counseling, a videotape about OCs and written material or resident-physician counseling (usual care). Questionnaire data were collected at enrollment, immediately following the intervention, at 6 weeks, 6 months and 12 months. At 1 year, 25 women remained in the study. More women in the intervention group were not pregnant and still using contraception, and were able to successfully switch contraceptive methods compared to women in the control group. There was no decrease in repeat pregnancy in the intervention group at 1 year compared to the control group. Our intervention resulted in a sustained increase in knowledge of OCs throughout the study period. However, more is needed to promote postpartum contraceptive compliance and decrease repeat pregnancies in young, low-income African Americans with unintended pregnancies.     

乡级计划生育服务人员对口服避孕药认知调查分析

目的:了解河南省乡级计划生育服务人员对口服避孕药的认知情况及影响因素。方法:通过自行设计问卷对180名乡级计划生育服务人员基本情况、口服避孕药知识掌握、接受培训等情况进行调查,并对影响因素进行分析。结果:调查对象认为口服避孕药中毓婷(22.07%)、避孕1号(17.93%)、三相片(14.48%)避孕效果好;63.22%的调查对象认为避孕药副作用中等;影响口服避孕药使用的主要原因有:不接受这种方法(57.74%),对这种方法认识不够(49.41%),认为影响生育(17.26%)。口服避孕药知识得分:0分为23人(13.69%),<60分为112人(66.7%),≥60分为33人(19.6%)。单因素分析结果显示,职称、接受避孕药培训次数、下乡工作次数及需求对知识得分的影响有统计学意义;多因素logistic回归分析显示,职称、接受培训次数是口服避孕药知识得分的影响因素。结论:基层计划生育服务人员口服避孕药知识匮乏,认识不够,应加强相关业务培训,提高综合素质。     

Pulmonary embolus in an adolescent on oral contraceptives

Deep venous thrombosis with pulmonary embolus is a rare complication of oral contraceptives, which generally occurs in adult women and becomes more common with increasing age. These complications are believed to be less common with low dose oral contraceptives than with the higher dose forms. This is a case report of a deep venous thrombosis presenting with a life-threatening pulmonary embolus in an adolescent on low dose triphasic oral contraceptives.     

常用口服避孕药及宫内节育器效果评估

目的:评估口服避孕药及宫内节育器(IUD)的综合效果,探讨最合适的避孕措施。方法:将研究对象随机分为两组各200例,评估分析两组的避孕效果、不良反应及非希望妊娠停用情况。结果:口服避孕药组珍珠指数0.62,不良反应发生率7.0%,非希望妊娠停用率4.5%;IUD组珍珠指数2.63,不良反应发生率13.5%,非希望妊娠停用率9.0%。结论:口服避孕药及宫内节育器各有利弊,整体评估口服避孕药优于IUD;同类不同品种效果也存在较大差异,口服避孕药以优思明、IUD以吉妮环的临床效果最佳。     

小儿上消化道异物的流行特征及防护对策

为了解小儿上消化道异物流行特征 ,制定防护对策 ,对我院 1990年 1月至 2 0 0 0年 12月登记的小儿上消化道异物资料进行调查 ,现报告如下。1.材料与方法 :(1)一般资料 :我院 1990年 1月至 2 0 0 0年 12月登记的小儿上消化道异物患者 146例 ,其中男性 92例 ,女性 5 4例。年龄 7ｄ～ 12岁 ,其中新生儿 15例 ,～ 1岁 2 7例 ,～ 3岁 31例 ,～ 6岁 48例 ,～ 12岁 2 5例。(2 )诊断标准 :患儿有误服或疑似病史 ,部分病例有吞咽困难、腹痛、腹胀等临床表现 ,结合Ｘ线透视或摄片检查、腹部Ｂ超 ,其中内镜确诊 114例。(3)调查方法 :首先查阅我院门、急…     

口服避孕药和基因多态性与不同类型脑卒中关系的初步探讨

目的：探讨使用复方口服避孕药（COC）与不同类型脑卒中发生的关系,以及遗传易感因素在服药妇女发生脑卒中的过程中作用。方法：选取111例女性脑卒中患者,用基因多态性分析法观察凝血因子V Leiden突变（G1691→A）,凝血酶原基因多态性（G20210→A）和血管紧张素转化酶（ACE）基因多态性（I/D)泊分布。运用病例－病例研究的方法分析危险因素在出血性和缺血性脑卒中之间的差异,结果：与未使用COC妇女相比,服药妇女发生出血性脑卒中的危险要显著高于缺血性脑卒中（OR＝3．03）,体质指数大于等于24kg/m2与缺血性脑卒中的联系强于出血性脑卒中（OR＝2．99）,基因多态性分析未能找到G1691→A和G20210→A突变,D型ACE等位基因频率在缺血性脑卒中组中略高,但无显著性。结论：结果提示口服避孕药可能与出血性脑卒中有关,而未见与G1691→A和G20210→A突变以及ACE基因I／D多态性有相关性。     

Biphasic versus triphasic oral contraceptives for contraception

Side effects caused by oral contraceptives discourage compliance with and continuation of oral contraceptives. A suggested disadvantage of biphasic oral contraceptive pills compared to triphasic oral contraceptive pills is an increase in breakthrough bleeding. We examined this potential disadvantage by conducting a systematic review comparing biphasic oral contraceptives with triphasic oral contraceptives in terms of efficacy, cycle control, and discontinuation because of side effects.We included randomized, controlled trials comparing any biphasic oral contraceptive with any triphasic oral contraceptive when used to prevent pregnancy. Only two trials of limited quality met our inclusion criteria. Larranaga compared two biphasic and one triphasic pills, each containing levonorgestrel and ethinyl estradiol. No important differences emerged, and the frequency of discontinuation because of medical problems was similar with all three pills. Percival-Smith compared a biphasic pill containing norethindrone (Ortho 10/11) with a triphasic pill containing levonorgestrel (Triphasil) and another triphasic pill containing norethindrone (Ortho 7/7/7). The biphasic pill had inferior cycle control compared with the levonorgestrel triphasic pill.The available evidence is limited and of poor quality; the internal validity of these trials is questionable. Given that caveat, the biphasic pill containing norethindrone was associated with inferior cycle control compared with the triphasic pill containing levonorgestrel. This suggests that the choice of progestin may be more important that the phasic regimen in determining bleeding patterns.