What role for Qlaira in contraception?

Around 25% of women in the UK aged 16-49 years use oral contraception.1 Annually, around 5 million combined oral contraceptive (COC) items are prescribed in primary care in England alone, at a cost of over pound40 million. The effectiveness of such contraception depends on correct and consistent use of the pills and is influenced by unwanted effects that can lead to discontinuation (e.g. bleeding irregularities), and by adherence to specified procedures for when a pill is missed. Qlaira (Bayer plc) is the first licensed COC in the UK to include the oestrogen estradiol valerate (E2V, which is metabolised to oestradiol, a natural human hormone) and the progestogen dienogest (DNG). It has been marketed as "the first and only COC to deliver...the same oestrogen as produced by a woman's body". In theory, it might be less likely than other COCs to cause unwanted effects. However, it has a complex dosage regimen, and has its own missed-pill guidance which differs substantially from that for other pills.3 Here we review the effectiveness and place of Qlaira.