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Hormonal contraception provides the safest and most effective method of contraception.The combined oral contraceptive pills (COCP) contain progestogens and oestrogens. Ethinylestradiol is usually used as oestrogen.But types of progestogens are different in the pills. The COCP prevents ovulation. It also has an effect on the tubes by reducing tubal function, on the endometrium by reducing the receptiveness of the endometrium, and on the cervix by increasing cervical mucus and thus reducing the penetrability to sperm.The COCPs can be classified by the variation in the dose of oestrogen throughout the cycle.Those with a fixed amount are called »monophasic«,whereas those with varying amounts of the two hormones according to the stage of the cycle are called »biphasic« and »triphasic«. The long-cycle-taking of COCP is a new possibility to eliminate cycle-depending gynecological and non-gynecological diseases.

Progestogen-only pills (POP) should be taken continuously without any break to safe the contraceptive effect.They act mainly by thickening the cervical mucus.They also inhibit endometrial proliferation. Some POP also suppress ovulation. They have minimal metabolic effects and therefore the indications are breastfeeding as well as oestrogenrelated side-effects and contra-indications such as nausea, headaches, bloating and hypertension, history of thromboembolism, obesity respectively.

The implantable Implanon®, the intrauterine system Mirena®, the 3 month-injection DepoClinovir® and Noristerat ® as long-acting contraceptives also belong to the progestogen-only-systems.They require minimal compliance and have a high contraceptive effectiveness.However, irregular bleeding is frequently seen, which tends to resolve on long-term treatment.The vaginal ring NuvaRing® and the patch Evra® are non-oral contraceptives which also have a high effectiveness. Using parenteral contraceptives bypasses the entero-hepatic circulation and is also not affected by diarrhoea or vomiting.They usually have no user failure.

Other methods such as the intrauterine copper-device, barrier methods such as diaphragms and condoms, male and female sterilization as well as natural family planning are available as non-hormonal contraception. Every woman and her partner can be individually counselled according to their personal choice and their medical condition.

Hans-Joachim Ahrendt

Reviewer: Julia Bartley, Berlin und Thilo Schill,Hannover

CME Praktische Fortbildung Gynäkologie, Geburtsmedizin und Gynäkologische Endokrinologie 3/2005: 54 - 62