Ethinyl estradiol and 17β-estradiol in combined oral contraceptives: pharmacokinetics, pharmacodynamics and risk assessment
Abstract
The need to seek improved combined oral contraceptive (COC) efficacy, with fewer health risks and better acceptability, has been ongoing since the introduction of COCs more than 50 years ago. New progestin formulations combined with lower doses of ethinyl estradiol (EE), the predominant estrogenic component of COCs, have reduced the incidence of venous thromboembolism and other negative outcomes of COC treatment. Previous attempts to use endogenous 17β-estradiol (E₂) instead of EE were limited primarily by poor cycle control. The recent introduction of E₂-based formulations has renewed interest to determine if there are potential benefits of using E₂ in COCs. These formulations have been shown to have similar efficacy and cycle control as EE-based COCs. This review provides a brief summary of the pharmacology of EE and E₂, including metabolism, pharmacokinetics and pharmacodynamics, as well as adverse effects of these estrogens.
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New combinations containing E2, its ester estradiol valerate (EV), and estetrol (E4) have proven effective in combined contraceptives.
“New combinations containing E2, its ester estradiol valerate (EV), and estetrol (E4) have proven effective in combined contraceptives.”
From Ethinylestradiol in combined hormonal contraceptive has a broader effect on serum proteome compared with estradiol valerate: a randomized controlled trial (2023) · cites this paper as Stanczyk et al., 2013
Natural estrogen-containing combined oral contraceptives induce good cycle control and provoke less marked changes in metabolic and endocrine parameters compared with ethinylestradiol.
“They induce good cycle control and provoke less marked changes in metabolic and endocrine parameters compared with EE”
From Ethinylestradiol in combined hormonal contraceptive has a broader effect on serum proteome compared with estradiol valerate: a randomized controlled trial (2023) · cites this paper as Stanczyk et al., 2013
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- Authors
- Stanczyk, F. Z., Archer, D. F., & Bhavnani, B. R.
- Affiliations
- University of Southern California (US)
- Eastern Virginia Medical School (US)
- St. Michael's Hospital (CA)
- Venue
- Contraception
- Publisher
- Elsevier BV
- Published
- 2013-06
- Volume
- 87
- Issue
- 6
- Pages
- 706-727
- ISSN
- 0010-7824 (ISSN-L)
- OpenAlex
- W2072831812
- Cited by
- 201
- References
- 268
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 29 · 2023: 18 · 2022: 25 · 2021: 25 · 2020: 16 · 2019: 12 · 2018: 9 · 2017: 8 · 2016: 4 · 2015: 11 · 2014: 10 · 2013: 2
- FWCI
- 1.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Contraception (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- ethinyl estradiol, estradiol, combined oral contraceptives, estrogen metabolism, endogenous estradiol, venous thromboembolism, cycle control, contraceptive efficacy, risk assessment
- MeSH terms
- Contraceptives, Oral, Combined, Dose-Response Relationship, Drug, Drug Interactions, Estradiol, Estrogens, Ethinyl Estradiol, Female, Humans, Menstrual Cycle, Progestins, Progesterone, Risk Assessment
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