Contraception - Update and Trends
Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2007; 4 (6): 337-357
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Keywords: Endokrinologie, Familienplanung, Kontrazeption, contraception, endocrinology, familiy planning
In the future, fertility control will focus on the improvement of existing methods (efficacy, side effects, easy use, duration of action, manufacturing process, costs), on new approaches (mode of action) and on new targets for contraception. Counselling of women in view of contraceptive choices based on individual risks (e. g. cardiovascular disease, thrombophilia, family risk of breast cancer, sexually transmitted diseases) will gain more and more importance. Only a few companies can afford research in contraception such as Bayer-Schering-Pharma, Wyeth-Ayerst, Ortho-McNeil and Organon. Female contraception: Ovulation inhibition: In the future, a focus will be placed on the preselection of patients to minimize their individual risk, new oral contraceptive (OC) regimen, OC with new progestins, OC with estradiol or estradiolesters, new ovulation inhibitors with new progestins and new regimens including long cycles and continuous steroidal contraceptives, new contraceptive patches, vaginal rings, spray-on contraceptives, recently identified genes involved in the ovulation process as new targets for ovulation inhibitors. Fertilisation inhibition: New intrauterine systems will comprise: a smaller Mirena intrauterine system releasing levonorgestrel (LNG) and new frameless progestin-releasing intrauterine systems (IUS). Various new contraceptive barriers have been introduced. Research is ongoing on substances acting both as spermicides and as microbicides, reducing the risk of sexually transmitted diseases. New implantables and injectables will feature an improved pharmacokinetic profile, decreased side effects and a safer delivery system. Additionally, there are various new approaches in female sterilisation. Immunocontraception for the female will not be available in the near future. Implantation inhibition: Selective progesterone receptor modulators (SPRMs) are tested for postcoital contraception. New targets are analysed for immunocontraceptives. Male contraception: Condoms and vasectomy are the "gold standards" in male contraception. The development of hormonal contraceptives for men has recently been stopped by Bayer-Schering-Pharma and Organon. STD: Furthermore, clients of contraceptive methods must be informed about the risk of sexually transmitted diseases and the way how to prevent them (e. g. safer sex methods).