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The Next Generation of Oral Contraceptives in Clinical Practice: Chairman's Summary

Oral contraceptives with low-dose formulations have mitigated cardiovascular (CV) disease risk. High-density lipoprotein (HDL) had cardioprotective properties whereas low-density lipoprotein (LDL) is positively correlated with high risk. Half of the women have a lipid problem by the age of 30. The benefits of early lipid modification will accrue later in life because of reduced CV morbidity and mortality. The evolution of OCs improved the benefit-to-risk ratio. The risk of venous thromboembolic events has dropped by lowering the dose of estrogen to 30 or 35 mcg. Beta 1 and 2 agonists to H2 receptor blockers are a promising solution to the problem of OC-related CV risk. Norgestimate a selective new progestin has strong progestational potency and antiovulatory activity. 250 mcg norgestimate (NGM) was combined with 35 mcg ethinyl estradiol (EE) in a new formulation NGM/EE and compared to a norgestrel (NG) containing compound Lo/Ovral (NG/EE). The effect of NGM/EE on ovulation suppression was equivalent to NG/EE. The LDL/HDL ratio changed as a result of the increase of HDL in NGM/EE patients and the rise of LDL in NG/EE patients. NGM/EE positively affected lipid parameters increasing HDL levels with a concomitant improvement of the LDL/HDL ratio. Obstetricians and gynecologists have the duty of assessing cardiovascular risk for the sake of the long-term health of women. Effects of lipid-lowering OCs on cardiovascular morbidity and morality are still a long way off from exact quantification. Thus the progestational selectivity of norgestimate will be a valuable alternative by obviating problems associated with oral contraception.