Estrogen-progestin combinations

Definition
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Hormone preparations of female sex hormones. Classification see table 2.

Indication
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Hormonal contraception, severe acne, seborrhea, alopecia androgenetica (see Alopecia androgenetica in women, Alopecia androgenetica in men), hirsutism in women, see Table 1.

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Limited indication
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Breastfeeding, 6 weeks before planned operations, smokers > 30 years, liver diseases, gallbladder diseases, kidney failure, heart failure, lipid metabolism disorders.

Undesirable effects
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visual disturbances, weight gain, menstrual disorders, hirsutism, thrombosis, gastrointestinal disorders, liver tumors, cholestasis, jaundice, allergic reactions, chloasma, acne, rec. vulvovaginal candidiasis, blood pressure rise, dizziness, headache, epilepsy, depression, hearing disorders, see Table 3.

Interactions
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See Table 4.

Contraindication
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Pregnancy, acute and progressive liver diseases, intrahepatic cholestasis, liver tumors, hormone-dependent malignant tumors, Z.n. thrombosis, tendency to thrombosis, sickle cell anemia, difficult to adjust hypertriglyceridemia, otosclerosis, severe diabetes mellitus, unexplained uterine bleeding, difficult to adjust hypertension, migraine.

Tables
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Medical indications for estrogen-progestin combinations

Symptomatology	Type of preparation
Dysfunctional bleeding	progesterone
Hypermenorrhoea	progesterone
Dysmenorrhoea	low-dose
Ovarian functional cysts	monophasic
Premenstrual Syndrome	low-dose
Mastopathy I	progesterone
Endometriosis	progesterone
Hirsutism	antiandrogen

Overview of the most common estrogen-progestin combinations

Oestrogen	Single dose [μg]	Gestagen	Single dose [mg]	Finished preparations
Single-phase preparations
Ethinylestradiol	30	Norethisterone acetate	0,5	Conceplan M
	30	Levonorgestrel	0,15	Microgynon
	30	Levonorgestrel	0,05	NovaStep
	30	Levonorgestrel	0,125	Minisiston
	50	Lynestrenol	0,125	Gravistat
	50	Lynestrenol	0,25	Neogynon
	37,5	Lynestrenol	0,75	Ovoresta
	30	Desogestrel	0,15	Marvelon
	30	Gestodene	0,075	Femovan
	30	Norethisterone	0,5	Conceplan M
	20	Norethisterone	0,5	Eve 20
	30	Chloromadinone acetate	2	Belara
Mestranol	50	Chloromadinone acetate	2	Gestamestrol N
Two-Phase Preparations
Ethinylestradiol	50	Norethisterone acetate	0 / 1	Sequostat
	50	Levonorgestrel	0,05 / 0,125	Sequilar
	50	Lynestrenol	0,05 / 2,5	Lyn-ratiopharm sequence
	50	Chloromadinone acetate	1 / 2	Neo-Eunomine
	50	Desogestrel	0 / 0,125	Oviol
Three-Phase Preparations
Ethinylestradiol	30/40/30	Levonorgestrel	0,05 / 0,075 / 0,125	Triquilar
	30/50/40	Norethisterone	0,05 / 0,05 / 0,125	TriStep
	35	Norethisterone	0,5 / 0,75 / 1	TriNovum

Side effects depending on the hormone potency

Symptom	Oestrogen		Gestagen
Symptom	too much	shy of	too much	shy of
Acne			+
Candidavulvovaginitis		+	+
Chloasma	+
Depression		+	+
Breakthrough bleeding in the first cycle phase		+
Breakthrough bleeding in the second cycle phase		+		+
Dysmenorrhoea				+
Vomiting	+
Hair Loss			+
Hirsutism			+
Hypermenorrhoea	+			+
Hypertrichosis			+
hypo- and amenorrhoea		+	+
Headaches in the pill-free interval			+
Headaches while taking the tablets	+
slow weight gain, appetite increase			+
Libido reduction		+	+
Lubricatio deficiens		+	+
Mastodynia	+		+
Tiredness			+
Nervousness		+
rapid weight gain, water retention, oedema	+
Seborrhoea			+
Feeling of tension in the breasts	+
Nausea	+
Varices	+
Calf Cramps			+
cervical hypersecretion	+

Essential interactions of estrogen-progestin combinations

Antidiabetics, oral	Carbohydrate Tolerance ↓
Barbiturates	contraceptive effect ↓
Benzodiazepines	Benzodiazepine action ↑
Broadband antibiotics	contraceptive effect ↓
Carbamazepine	contraceptive effect ↓
Griseofulvin	Griseofulvin effect ↑
Phenytoin	contraceptive effect ↓
Rifampicin	contraceptive effect ↓