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The evolution of COCPs into different generations reflects ongoing efforts to balance contraceptive efficacy with improved safety and tolerability. Each generation has aimed to reduce specific side effects and health risks associated with earlier formulations. The development has focused on lowering estrogen doses to minimize cardiovascular risks and designing progestins with reduced or antiandrogenic properties to improve the overall side effect profile.
| Generation | Progestins Used | Characteristics | Reason for Evolution |
|---|---|---|---|
| First Generation | Noretynodrel, norethisterone, norethisterone acetate, etynodiol acetate | High Estrogen Dose: Early formulations contained high doses of estrogen (often ≥ 50 μg of ethinylestradiol). Side Effects: Common side effects included nausea, headaches, breakthrough bleeding, and increased risk of venous thromboembolism (VTE) and cardiovascular events such as stroke and myocardial infarction. | High Risk of VTE and Cardiovascular Events: The high estrogen content was associated with a significant risk of blood clots and cardiovascular issues, necessitating the development of safer formulations. |
| Second Generation | Levonorgestrel, norgestrel, norethisterone, norethisterone acetate, etynodiol acetate, norgestimate | Lower Estrogen Dose: These pills typically contained lower doses of estrogen (< 50 μg of ethinylestradiol), reducing the risk of estrogen-related side effects. Improved Tolerance: Second-generation progestins were designed to reduce androgenic side effects such as acne and hirsutism. Side Effects: While... |
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