What is the appropriate dosage and use of gestodene for contraception?

From the Guidelines

Gestodene should be used at a dose of 75 micrograms daily, paired with ethinyl estradiol (typically 20-30 micrograms), for contraception in women without a history of venous thromboembolism or other contraindications, as it provides effective contraception with a slightly higher risk of blood clots compared to older progestins like levonorgestrel 1. The standard regimen involves taking one pill daily for 21 days followed by a 7-day pill-free interval during which withdrawal bleeding occurs, then starting a new pack. Some formulations offer 24 active pills with 4 placebo pills. For maximum effectiveness (over 99% with perfect use), pills should be taken at approximately the same time each day. If a pill is missed by less than 12 hours, take it immediately and continue the regular schedule; if missed by more than 12 hours, additional contraception should be used for 7 days. Common side effects include breakthrough bleeding, nausea, breast tenderness, and headaches. Gestodene works primarily by suppressing ovulation, thickening cervical mucus, and altering the endometrial lining to prevent implantation. Key considerations for the use of gestodene include:

• Contraindications such as a history of venous thromboembolism, current breast cancer, and pregnancy 1
• Precautions such as breastfeeding (6 weeks-6 months postpartum), age ≥35 years and light smoker, and history of hypertension or monitoring is not feasible 1
• Potential increased risk of cardiovascular events, including venous thromboembolism and myocardial infarction, particularly in women with underlying risk factors such as cigarette smoking and hypertension 1
• Potential increased risk of breast cancer in current users of combined oral contraceptives, although this risk disappears 10 years after discontinuation 1

From the Research

Dosage and Use of Gestodene for Contraception

The appropriate dosage and use of gestodene for contraception can be understood through various studies:

• The dosage of gestodene in combination with ethinyl estradiol (EE) has been tested in several studies, with common combinations being 75 micrograms of gestodene plus 30 micrograms of EE 2, 3 or 20 micrograms of EE 4, 5.
• These studies have shown that gestodene is an effective and reliable contraceptive agent when used in combination with EE, with no pregnancies or severe side effects reported in many cases 2, 3.
• The pharmacokinetics of gestodene have also been investigated, showing that it is completely absorbed and bioavailable after oral administration, with dose-linear pharmacokinetics 6.

Efficacy and Cycle Control

The efficacy and cycle control of gestodene in combination with EE have been compared to other contraceptive preparations:

• A study comparing gestodene/EE to desogestrel/EE found that both preparations were effective and well-tolerated, with similar continuation rates and no major differences in side effects 3.
• Another study comparing two low-dose oral contraceptives containing 20 micrograms EE and 75 micrograms gestodene or 30 micrograms EE and 75 micrograms gestodene found that both preparations had clinically acceptable cycle control and good tolerance 4.
• A comparative clinical investigation of two low-dose oral contraceptives containing 20 micrograms EE and 75 micrograms gestodene or 20 micrograms EE and 150 micrograms desogestrel found that both preparations were reliable and well-tolerated, with a trend towards a lower incidence of intermenstrual bleeding in the gestodene group 5.

Safety and Tolerance

The safety and tolerance of gestodene in combination with EE have been evaluated in several studies:

• No clinically relevant changes in carbohydrate metabolism, lipid metabolism, or blood clotting were observed in a study comparing gestodene/EE to levonorgestrel/EE 2.
• Another study found that the incidence of spotting and breakthrough bleeding was slightly greater for women taking desogestrel/EE compared to gestodene/EE, but that both preparations were well-tolerated 3.
• A study comparing two low-dose oral contraceptives containing 20 micrograms EE and 75 micrograms gestodene or 30 micrograms EE and 75 micrograms gestodene found that both preparations had a low discontinuation rate due to adverse events, and that adverse events were rare and similar in both groups 4.