Older combined oral contraceptives (COCs) are the combined pills of first choice, says a recent report in Drug and Therapeutics Bulletin (2000;38;1).
Professor Joe Collier, editor of the bulletin, said in a press release issued on January 20: "In general, the best choice seems to be one of the older, ‘second-generation', pills: these are less likely to cause blood clots in the legs or lungs, no more likely to cause other blood vessel problems or heart disease, and are less expensive than newer, 'third-generation', pills."
This advice has come after conflicting reports on the risks associated with the use of second and third generation COCs. Evidence which emerged in 1995 suggested that desogestrel- and gestodene-containing products were associated with a higher risk of venous thromboembolism than pills containing other progestogens. The Committee on Safety of Medicines advised that products containing desogestrel and gestodene should only be used by women who were intolerant of other COCs and were prepared to accept an increased risk of venous thromboembolism. Following an appeal by the drug manufacturers, the UK Medicines Commission modified the advice and said that "third generation oral contraceptives can be used first-line, provided the woman has discussed the risks with her doctor" (PJ, April 10, 1999, p494).
In its report, the bulletin reviews the evidence that led to this change in advice and concludes that there is a slight increase in risk of venous thromboembolism with third generation pills compared with second generation pills, no evidence to support their superiority in terms of other cardiovascular complications, and they are more costly and therefore that second generation products are first choice.