TABLE 1: Oral Contraceptives Containing Low Doses of Estrogen

Ethinyl estradiol 20 mg/Levonorgestrel 0.1 mg (AlesseTM)
Ethinyl estradiol 20, 10 mg/Desogestrel 0.15 mg (MircetteTM)
Ethinyl estradiol 20, 30, 35 mg/norethindrone 1.0 mg (Estrostepw)
Ethinyl estradiol 20 mg/norethindrone acetate 1.0 mg (Lo-Estrinw 1/20)
Ethinyl estradiol 20 mg/drospirenone 3.0 mg (YazTM)

Many oral contraceptives have been studied in the treatment of acne (Table2 ). These include those containing ethinyl estradiol in combination with cyproterone acetate (Diane, Dianette), ethynodiol diacetate (Demulen), levonorgestrel (TriPhasil, Alesse), norgestimate (Ortho Tri-Cyclenw), desogesterel (Desogen), and drosperinone (Yasmin, Yaz). Numerous studies point to the efficacy of ethinyl estradiol/cyproterone acetate oral contraceptives (Diane and Dianette) in the treatment of acne. Reductions in inflammatory lesion count on the order of 50% to 75% have been reported. Two large studies involving a total of approximately 500 women with moderate acne were conducted with ethinyl estradiol 35 mg/norgestimate (Ortho Tri-Cyclen). Improvement in inflammatory lesions, total lesions, and global assessment was noted with this oral contraceptive after six months of treatment (46,47). There was a 50% to 60% improvement in inflammatory lesions. Decreases in serum free testosterone and an increase in sex hormone-binding globulin were noted in the active group. Two large, six-month, placebo-controlled trials (350 and 371 women, respectively) were conducted

TABLE 2 Oral Contraceptives Studied in Acne

Demulen (ethinyl estradiol 35 mg/ethynodiol diacetate)
Diane, Dianette (ethinyl estradiol 50, 35 mg/cyproterone acetate)
Estrostep (ethinyl estradiol 20, 25, 30 mg/norethindrone)
Alesse (ethinyl estradiol 20 mg/levonorgestrel)
Ortho Tri-Cyclen (ethinyl estradiol 35 mg/norgestimate)
Desogen (ethinyl estradiol 30 mg/desogestrel)
Yasmin (ethinyl estradiol 30 mg/drospirenone)
Yaz (ethinyl estradiol 20 mg/drospirenone)
Triphasil (ethinyl estradiol 30 mg, 40 mg/levonorgestrel)

using ethinyl estradiol 20 mg/levonorgestrel (Alesse) in the treatment of acne. In each study, the oral contraceptive demonstrated significantly greater reduction in acne lesion counts and improvement in global assessment scores compared with placebo. The reduction in inflammatory lesion count was on the order of 47%. A study of 128 women with mild-to-moderate acne compared the efficacy of ethinyl estradiol 30 mg/drospirenone (Yasmin) and ethinyl estradiol 35 mg/cyproterone acetate (Diane-35) in the treatment of acne for nine cycles (50). Both treatments produced comparable reductions in acne lesion counts, with an approximate 60% reduction in inflammatory lesion count. Both treatments also reduced sebum production and yielded comparable increases in sex hormone-binding globulin. Two large placebo-controlled studies involving a total of approximately 593 women with moderate acne, found improvement in inflammatory lesions, total lesions, global assessment, and quality of life in women who were treated for six months with a triphasic oral contraceptive that contains doses of 20 to 35 mg of ethinyl estradiol in combination with 1.0 mg norethindrone acetate (Estrostep). In these studies, inflammatory lesion counts were reduced by approximately 47% .

Oral contraceptives that have been approved for the treatment of acne in the United States include ethinyl estradiol 35 mg/norgestimate (Ortho Tri-Cyclen) ethinyl estradiol 20 to 35 mg/norethindrone acetate (Estrostep), and ethinyl estradiol 20 mg/drospirenone (Yaz).

As oral contraceptives are used mainly by healthy women – it becomes more and more important that these means should be not only very effective but extremely safe as well. Their effectiveness ( if use correctly) does not raise doubt: using combined oral contraceptive that includes two synthetic hormones – estrogen and progestagen, pregnancy ensues in less than 1% of women yearly. Similar results are achieved when using new “multiphase” combined oral contraceptives, which contain hormones in different quantities that imitate a natural scheme of hormones, produced in organism. Women who use multi - hormone progestagen oral contraceptives become pregnant more often – 1-3 cases for 100 women a year. The function of combined oral contraceptives – is to prevent ovulation, creating the imitation of pregnancy and also to make cervical mucus less permeable for sperm cells while endometrium of the uterus – less susceptible to fertilized ovum implantation. Multi-hormone progestagen oral contraceptives also have a main effect on cervical mucus and endometrium of the uterus, though some ovulatory cycle imbalance takes place.

Of course, effectiveness depends on regular use of oral contraceptives. Recent investigation has shown that if use incorrectly - from 6% to 20% of women that take oral contraceptives may become pregnant. The most part of the combined oral contraceptives should be taken during 21 days after what- 7 days period without pills follows (or placebo motion takes place during this time). If oral contraceptive is not taken more than 12 hours, alternative method of contraception (such as contraceptive device or another mechanical method) should be used along with oral contraceptives during the next 7 days. If dose of oral contraceptives is missed close by the beginning or the end of the cycle – increase of ovulation risk and, as a result, pregnancy – becomes more possible.

Interactions with other medicaments may influence on effectiveness. Particularly, among the medicines decreasing the effectiveness of contraceptives those drugs were found which affect gastroenteric activity and stimulate ferments decreasing absorption. These are such medicaments as antibiotics, antimycotics, anticonvulsants or barbiturates. Also there are certain arguments that smoking (besides its association with increased risk of adverse actions on cardiovascular system of women who use oral contraceptives), may decrease the effectiveness of these contraceptives.

Speaking about safety - the results are more contradictory. In the end of 90s it became clear that women who use oral contraceptives were more risky to have thrombosis and other vascular injuries, especially if they smoked. Investigation by the Royal College of General Practitioners that took place a little later, has detected that those who took combined oral contraceptives had 4 times more risk to die from cardiovascular diseases. In the report about investigation it has also been shown that smokers taking oral contraceptives not only had the biggest possibility to have cardiovascular diseases (mainly, heart attack or stroke) but the higher risk of a lethal outcome. The results of investigations have shown that strong trombophlebitis, pulmonary embolism, myocardial infarction, cerebral arterial thrombosis, hemorrhagic stroke and other cardiovascular diseases were more often found in women taking the combined oral contraceptives.