Norgestimate.

Abstract

Norgestimate (NGM) is one of a class of newer, more selective progestins. The authors describe its structure and biologic activity, contraceptive effectiveness, cycle control, metabolic effects, carbohydrate metabolism, coagulation factors, and clinical side effects. NGM-containing oral contraceptives (OC), either as a monophasic or triphasic formulation, perform as well as pills using older progestins. Androgenic side effects, however, are somewhat lower with NGM, but not enough to be of in clinical importance. Clinicians who believe in the potential for clinical consequences associated with changes in lipid and carbohydrate metabolism should make NGM their first choice OC progestin. Although no study has ever demonstrated a long-term superiority of one OC over another with respect to atherogenesis, there is some evidence that changes in HDL and LDL cholesterol, especially over a 20-year period secondary to pill use, may play a role in accelerating or retarding atherosclerosis. There are also multiple influences upon cardiovascular risk, including direct effects of estrogens upon the endothelium. The prudent healthcare professional should therefore choose, with the patient, the preparation which has the most favorable impact upon lipid metabolism.