Abstract
This work explores the relationships between a user's choice of a given contraceptive option and the load of steroidal estrogens that can be associated with that choice. Family planning data for the USA served as a basis for the analysis. The results showed that collectively the use of contraception in the USA conservatively averts the release of approximately 4.8 tonnes of estradiol equivalents to the environment. 35% of the estrogenic load released over the course of all experienced pregnancies events and 34% the estrogenic load represented by all resultant legacies are a result of contraception failure and the non-use of contraception. A scenario analysis conducted to explore the impacts of discontinuing the use of ethinylestradiol-based oral contraceptives revealed that this would not only result in a 1.7-fold increase in the estrogenic loading of the users, but the users would also be expected to experience undesired family planning outcomes at a rate that is 3.3 times higher. Additional scenario analyses in which ethinylestradiol-based oral contraceptive users were modeled as having switched entirely to the use of male condoms, diaphragms or copper IUDs suggested that whether a higher or lower estrogenic load can be associated with the switching population depends on the typical failure rates of the options adopted following discontinuation. And, finally, it was estimated that, in the USA, at most 13% of the annual estrogenic load can be averted by fully meeting the contraceptive needs of the population. Therefore, while the issue of estrogen impacts on the environment cannot be addressed solely by meeting the population's contraceptive needs, a significant fraction of the estrogenic mass released to environment can be averted by improving the level with which their contraceptive needs are met.
Highlights
The environmental release of natural and synthetic steroidal estrogens is of concern because it is suspected that these compounds are major causative agents of fish feminization and other associated environmental impacts [1,2,3,4,5,6,7,8,9,10]
Such results indicate that relationship between the choice to use a given contraceptive option and its associated estrogenic load is a much more complex choice than broadly assumed in literature, whereby the choice to use estrogen-based options such as EE2-oral contraceptive (OC) is the only one considered to impose estrogenic loading on the environment [26], [27]. These results demonstrate that certain non-estrogen based contraceptive choices have higher overall estrogenic loads associated with their use than the one associated with the choice to use EE2-OC
This research has focussed on developing an understanding of the relationships between the choice to use a given contraceptive option and the associated loads of steroidal estrogens on the environment
Summary
The environmental release of natural and synthetic steroidal estrogens is of concern because it is suspected that these compounds are major causative agents of fish feminization and other associated environmental impacts [1,2,3,4,5,6,7,8,9,10]. Ethinylestradiol (EE2), the synthetic estrogen used in birth control pills, and estradiol (E2), the most potent natural estrogen, are being considered for regulation by the European Union with proposed Environmental Quality Standards of 35 and 400 pg/L, respectively [11], [12]. In addition to being endogenously produced, E2 is released into the environment through the use of hormone replacement therapy (HRT) preparations and recently due to the use of Natazia, a one-of-a-kind combined oral contraceptive (OC) pill containing E2 instead of EE2 as the estrogen [15,16,17,18,19,20,21]. In addition to being endogenously produced, E1 and E3 are released into the environment due to their use in various HRT preparations [16,17,18,19]
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