>10%:
Cardiovascular: Peripheral edema
Endocrine & metabolic: Enlargement of breasts, breast tenderness
Gastrointestinal: Nausea, anorexia, bloating
1% to 10%:
Central nervous system: Headache
Endocrine & metabolic: Increased libido
Gastrointestinal: Vomiting, diarrhea
<1%: Hypertension, thromboembolism, stroke, myocardial infarction, edema,
depression, dizziness, anxiety, chloasma, melasma, rash, decreased glucose
tolerance, breast tumors, amenorrhea, alterations in frequency and flow of
menses, increased triglycerides and LDL, GI distress, cholestatic jaundice,
intolerance to contact lenses, increased susceptibility to Candida
infection
Minimize these effects by adjusting the estrogen/progestin balance or dosage.
The table categorizes products by both their estrogenic and progestational
potencies; because overall activity is influenced by the interaction of
components, it is difficult to precisely classify products; placement in the
table is only approximate. Differences between products within a group are
probably not clinically significant.
Hormonal Balance in Oral Contraceptives:
Estrogen Excess: Nausea, bloating, cervical mucorrhea, polyposis,
melasma, migraine headache, breast fullness or tenderness, edema, hypertension
Estrogen Deficiency: Early or midcycle breakthrough bleeding,
increased spotting, hypomenorrhea
Progestin Excess: Increased appetite, weight gain, tiredness,
fatigue, hypomenorrhea, acne, oily scalp*, hair loss, hirsutism*, depression,
monilial vaginitis, breast regression
Progestin Deficiency: Late breakthrough bleeding, amenorrhea,
hypermenorrhea
*Result of androgenic activity of progestins
Pharmacological effects of progestins used in oral
contraceptives:
Norgestrel/levonorgestrel:
Progestin: Pronounced effect
Estrogen: No effect
Antiestrogen: Moderate effect
Androgen: Pronounced effect
Ethynodiol diacetate:
Progestin: Moderate effect
Estrogen: Slight effect*
Antiestrogen: Slight effect*
Androgen: Slight effect
Norethindrone acetate:
Progestin: Slight effect
Estrogen: Slight effect
Antiestrogen: Pronounced effect
Androgen: Slight effect
Norethindrone:
Progestin: Slight effect
Estrogen: Slight effect*
Antiestrogen +*
Androgen: Slight effect
Norethynodrel:
Progestin: Slight effect
Estrogen: Pronounced effect
Antiestrogen: No effect
Androgen: No effect
*Has estrogenic effect at low doses; may have antiestrogenic effect at higher
doses.