Recent advances in hormonal contraception.

PURPOSE OF REVIEW: The rapid increase in the world population makes it mandatory to develop new contraceptive methods. Disseminating reversible inexpensive and practical hormonal methods to developing countries is a target of many international agencies and funds.

RECENT FINDINGS: The safety of combined oral contraceptives is the main issue. The main guideline is to find women at risk before prescribing combined oral contraceptives. Lowering the estrogen dose should be attempted. New progestins are emerging, but their safety can be assessed only retrospectively. There is an increasing trend to extend the cycles in order to have fewer bleeding days. Progestin-only contraception seems safer than estrogen-progestin combinations in relation to thromboembolic events. A new progestin-only pill and the levonorgestrel intrauterine system have a good acceptability and high continuation rate. New administration methods are being developed and the possible role of mifepristone has been investigated.

SUMMARY: There are more contraceptive choices available than ever before. To educate healthcare providers as to the methods available and to inform and educate consumers are cornerstones for successful contraception.