Alternatives

Abstract

The authors deserve thanks for their accomplished summary of such a complex topic (1); however, we wish to make some additional comments from a specialist perspective. Although the title of the article promises a comprehensive overview of all hormonal contraceptive methods, it actually discusses merely combined preparations, and the main emphasis is on the contraceptive pill. The reason given—that all other methods were of lesser importance in Germany—may well be correct, but is a disappointment for readers expecting a comprehensive overview and thus satisfactory comparability. What was not mentioned at all was the trend found among many women, not to want to ingest any more hormones and to look for genuine alternatives—which are actually available, and even as high-quality products. At least the gestagen methods, which are effective in the long term, are clearly superior to the pill in terms of the Pearl index, in particular because of the reduced potential for missing a dose. Breakthrough bleeding—a common side effect in the initial phase—can be corrected by selecting suitable patients and providing careful explanations; the success is ultimately measured on the basis of the amenorrhea that is achieved in the long term, usually without problems. When discussing the risks, the main issue is the fact that such preparations are estrogen-free (which is naturally the case for all gestagen methods) or that estrogen is reduced: In women who wish to maintain a regular monthly cycle, the dates at which they are exposed to hormones need to be borne in mind, which as the “area under the curve” (AUC) for ethinylestradiol show notable differences when the complete cycle is considered (2). It is not least on this background that parenteral and primarily vaginal access via the contraceptive ring deserves far more attention. Newer methods, which furthermore are superior to the established ones, are essential to any discussion; individualized treatment and risk minimization are the crucial steps towards greater satisfaction and health on the women’s part.