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I'm a bit confused. Are progesterone-only pills the same as progestin-only pills ("mini pills"), or are the two merely related? There's currently no article or redirect for mini pill, which is a fairly common term. --LostLeviathan 07:39, 8 August 2005 (UTC)[reply]
- progesterone - to refer to the natural hormone produced by the ovary (specifically the corpus luteum); and - progestogen or progestins - to refer to the synthetic steroids that demonstrate progestogenic properties (and possibly, other partial effects, e.g., anti-androgenic partial effect(as in cyproterone acetate), estrogenic partial effect(as in norethisterone), anti-mineralocorticoid effect (as in drospirenone);
Whilst all POPs do indeed use the progestin synthetic analogues of the natural progesterone, in the UK at least they seem in common medical use only to be known as 'Progesterone Only Pills' (similar I suppose to talking about 'Penicillin allergy' or 'Tetracyclines' refering to the relevant drug groups than specific single chemicals), - is this not the case in the US ? A quick search on PubMed and Google was interesting:
| Search Term | PubMed | |
| Progestin only pill | 337 | 253,000 |
| Progestin only pills | 296 | |
| Progestagen only pill | 117 | 11,200 |
| Progestagen only pills | 95 | |
| Progestogen only pill | 203 | 99,600 |
| Progestogen only pills | 142 | |
| Progesterone only pill | 206 | 613,000 |
| Progesterone only pills | 157 |
'Progesterone only pill/s' only has 53% as many PubMed entries as 'Progestin only pill/s', yet 'Progestin only pill/s' has only 41% as many Google hits as 'Progesterone only pill/s'. David Ruben Talk 15:00, 20 March 2006 (UTC)[reply]
In the United States, the FDA requires that these be labeled as "progestin-only pills" since they do not contain progesterone. Oral progesterone is approved under the brand name Prometrium, but this is approved only for postmenopausal hormonal therapy, not birth control. (Prometrium is not an effective contraceptive due to the large variance in oral bioavailability.)
Labeling requirements seem to be less strict in the UK, and these pills are often called "progesterone-only pills" in the UK and elsewhere, as the google results show. Nonetheless this naming is clearly confusing people. I'd generally prefer the term "progestin-only pill" to avoid confusion with drugs like Prometrium.
Would there be any objection to moving this page to "Progestin-only pill" and keeping "Progesterone only pill" as a redirect? Kiral 16:30, 24 March 2006 (UTC)[reply]
| Search Term | PubMed | ||
| Progestin only | 334 | 96,900 | |
| Progestogen only | 320 | 61,000 | |
| Progesterone only | 99 | 40,800 | |
| Progestagen only | 78 | 1,420 |
| Search Term | PubMed | ||
| Progestin only pill(s) | 57 | 45,000 | |
| Progestogen only pill(s) | 87 | 39,900 | |
| Progesterone only pill(s) | 11 | 17,800 | |
| Progestagen only pill(s) | 12 | 311 |
i support the change from "progesterone only" to "progestogen only" because there do appear to be some significant differences between progesterone/progestogens; makes things more clear, especially regarding exogenous/endogenous hormones. (i admit to a preference for "progestin," but that is probably because i am a lousy typist and it has fewer letters.) if the WHO calls it progestogen and use/intro is countries that call it progestogen, i agree it makes more sense to call it progestogen for title purpose. Cindery 23:45, 27 August 2006 (UTC)[reply]
i just accidentally stumbled upon this while looking for a chemical definition of levonorgestrel: PMID 15697108 and i don't know that it's the authoritative definition re the difference between progestogen and progestin (or if there is one or they are conflatable etc) but it seemed interesting...? Cindery 02:25, 28 August 2006 (UTC)[reply]
PMID 15697108 states "The term progestogen has been widely utilized to indicate the general class of agents that includes both progesterone and its synthetic analogs, whereas the term progestin refers only to synthetic progestational steroids." The wikipedia articles progestin and progestagen contain essentially the same definition, although the definition of progestin on answers.com is somewhat more inclusive. I proposed "progestin-only pill" above, only because that seems to be the more commonly used term. -- Kiral 12:31, 28 August 2006 (UTC)[reply]
Let's all work on reaching a consensus for a new infobox to be placed on each individual birth control method's article. I've created one to start with on the Wikipedia Proposed Infoboxes page, so go check it out and get involved in the process. MamaGeek (Talk/Contrib) 12:25, 14 June 2006 (UTC)[reply]
"1970s – Hormone levels decrease, the first progestin-only pill is introduced Studies confirm that far less hormone than contained in early pill formulations is needed to prevent conception. Ortho Pharmaceutical Corporation introduces pills with decreasing estrogen and progestin levels. The company introduces the first progestin-only pill, which contains 350 mcg of norethindrone with no estrogen component, in 1973." From "History of the Pill." They must have studied it--and therefore "used" it--prior to 1973, which is, I assume, the date of its introduction to the general public, following approval (presumably by the FDA, in the US). I do not know if another brand was developed elsewhere and used first.Cindery 16:10, 28 July 2006 (UTC)[reply]
I think it may be justified to state that the long-term breast cancer risk is not known. No studies have been conducted specifically of POP and breast cancer--nor could they really have been done, as this drug is so new. There is some worrisome data on the relationship between progestin and breast cancer. But it cannot be stated that it is one (definite risk of breast cancer) or the other (no risk). The lack of studies and the great increase of breast cancer in the Nurse's study for the women who took progesterone and estrogen (much higher than estrogen alone) is significant. 1973 is not so long ago, and The Breast Cancer Fund cites pill use as a high risk activity, with greater danger for "early and prolonged use." Young women who took/began to take POP in the 70s/80s/90s have not yet come into their 50s and 60s and 70s in large enough numbers for us to rule out breast cancer and POP use. To my knowledge, no one is tracking them, either. I think a caution regarding progestin is in order, in some wording other than "breast cancer risk with HRT," as if HRT had nothing to do with progestin. Cindery 16:07, 28 July 2006 (UTC)[reply]
I'm not aware of any, and I admit to becoming more and more confused and overwhelmed re cancer and HRT/BC pills, the more I read. I think this is a time of great flux regarding medical opinion re hormones, and that not enough studies have been done/are being done. (While I maintain my personal bias that hormones just aren't worth the risk, for accuracy/neutral POV I think it's fair to say that the risks just can't be stated either way for prgesterone only pill--but there is cause for concern viz breast cancer, and because the drug is new in human-historical terms, generations not aged to prime risk years yet, and studies not being done/women not being tracked? "Risks not conclusively known either way; some cause for concern; more study needed" seems pretty fair to me--what do you think? Cindery 23:57, 28 July 2006 (UTC)[reply]
Because breast cancer is "epidemic" in comparison to all other gynecological cancers, I would oppose conjoinment with other cancers. (The numbers I have seen--Breast Cancer State of Evidence table) are that ovarian cancer is about %6, breast cancer is %37. (Cases--not risks). Cervical/Endometrial around--%9? Breast cancer is a very, very serious --one of leading causes of death for women worldwide--and should be addressed separately, I think. Cindery 00:26, 30 July 2006 (UTC)[reply]
Removed bold section Breast cancer risk.
A section on the cancer risks, and a sub-section on the breast cancer risks of progestin-only oral contraceptives is appropriate, but should give information on what is known about the risks of progestin-only oral contraceptives.
And a bold heading for a section would be appropriate if a risk was especially great or well-established.
The section cited a study that showed an increased risk of breast cancer in postmenopausal women using estrogen-plus-progestin hormone replacement therapy[1] and a 1999 IARC Summary & evaluation of combined oral contraceptives.[2]
A risk of breast cancer in postmenopausal women using high dose estrogen-plus-progestin HRTisnot evidence of a risk of breast cancer in premenopausal women using low dose progestin-only oral contraceptives.
And the Summary & evaluation of progestogen-only hormonal contraceptives [3] in the the same 1999 IARC monograph, concludes regarding breast cancer in humans: "Overall, there is no evidence of an increased risk for breast cancer." JessM 07:40, 16 August 2006 (UTC)[reply]
what is known about the risks of progestin only contraceptives=what is known about progestins. (see iarc data regarding 2B status of progestins.) the hrt studies are significant because a very key finding was that progestin+estrogen increases breast cancer risk significantly more than estrogen alone. progestin-only contraception is believed to increase breast cancer risk, esp. for women under 35, and recent or current users. (see medroxyprogesterone acetate in particular). "overall risk" has to be compared to animal studies/different progestins, as there have been no adequate human tests. inadequate human tests does not equal no risk--it means we are assuming the risk. breast cancer is more significant than other gynaecological cancers because it is epidemic by comparison. one misconception about the danger of progestin is that "dose" is the determinant factor/low dose is safer--that is not known. what is known is that women metabolize it differently (depending on size, genes, the type of progestin) and that cancer may begin with disrupted PRA/PRB receptor signalling (mediated by estrogen receptors). there are different types of breast cancer cells, and different progestins cause proliferation in them to greater/lesser degrees...there are many variables, and definitely a need for more study. but progestins are associated with breast cancer risk. (all progestins in the us come with a warning that they should not be used by any woman who has, has had, or suspects she may have breast cancer, as it is a hormone-dependent cancer). Cindery 15:59, 16 August 2006 (UTC)[reply]
http://www.gp-training.net/protocol/gynaecology/contraception/ocbreca.htm
above is the actual advisory notice sent to doctors warning them that, as i said, there is an increased risk for breast cancer for pill users (pop or cocp) especially users under 35, recent or current use. if you would prefer that we use that as a ref for the breast cancer risk section in the article, i have no objection, as long as the iarc refs and the hrt ref is cited also.
i think it's important for people investigating progestin-only birth control to investigate progestins, and that it is educational/useful to provide links/refs, because:
1) in spite of the official warning above, no comprehensive safety tests have been done on progestins in humans. (they should have been done.) in the absence of comprehensive safety tests, a) that does not conclusively prove there is no risk/low risk--it conclusively proves risk hasn't been established b) animal studies are more significant in the absence of comprehensive human study
2) the progestins used in pops very a great deal
3) dose is a relative factor, not a sole factor
Cindery 18:09, 16 August 2006 (UTC)[reply]
Oral contraceptives and breast cancer
Specific objections to your Breast Cancer Risk section:
Progestin-only pills slightly increase the risk of breast cancer, especially in women under 35 who are current or recent users. [4]
above is NIH link as of 2005 regarding whether log-term effects of the pill are known.
the current summary of known studies is that women under 35 have greater risk/women with current and recent use.
the problem with large scale retro studies/generalizations of all data to date are: 1. no large enough group of women solely using POP (or any progestin only contraceptive) has been followed long term, with control group and control for confounding factors (i.e., lifesytle factors, genes, other known risks for breast cancer.) 2. in the absence of that (which would constitute adequte study/the kind of study which should have been done before progetsin only contraceptives were approved for general use as "proven safe") the real breast cancer risk is not exactly known. (but the breast cancer risk suggested by animal studies is still at issue, and the recent hrt studies have caused a flurry of research/concern for progestins/breast cancer.) 3. some studies have found increased risk, some have not--hence the generalized agreement "risk slightly increased, esp. for women under 35 with recent/current use"--that's imperfect knowledge to date, factoring conflicting studies. Cindery 00:49, 17 August 2006 (UTC)[reply]
Animal studies in progestins raise concerns about their carcinogenicity--some more than others.
Although the risk of breast cancer per each specific progestin is not specified in the current general warning given to doctors, specific progestins in different POP formulations may have greater or lesser carcinogenicity.
Recently, one of the same progestins used in POP--medroxyprogesterone acetate-- has been found to significantly increase breast cancer risk when used in HRT.[5]
1999 IARC Summary and evaluation of combined oral contraceptives
1999 IARC Summary and evaluation of progestogen-only hormonal contraceptives
JessM 22:51, 16 August 2006 (UTC)[reply]
what it actually says of overall risk is "overall, progestins are possibly carcinogenic to humans." Cindery 01:31, 17 August 2006 (UTC)[reply]
the "oxford study" is the large, worldwide compilation/generalization of data as of 1996, from which the "slight increase of risk for women under 35 with recent current use" has become the standard reductive warning. the specific wording which has relevance to POP is below (i.e., type and dose of hormone not relevant).
"Other features of hormonal contraceptive use such as duration of use, age at first use, and the dose and type of hormone within the contraceptives had little additional effect on breast cancer risk, once recency of use had been taken into account."
link to abstract of oxford study: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=8656904
here is an example of a single study, post 1996. it does not tell us if the ocs were cocp or pop or both. (i think that's relevant, which is why i'm reluctant to cite all kinds of single studies.) but per the oxford study observation, we could say dose/type of hormone doesn't matter, and it is relevant. the study notes that women who used ocs under the age of 18 had a doubled risk of breast cancer. many studies find a link between women under 35 (it is speculated that this may be because their breasts undergo more epithelial changes) which is why it was of note in the oxford study. [6] Cindery 01:47, 17 August 2006 (UTC)[reply]
Stop revert warring please - it wont help develop the article and both JessM & Cindery risk being reported for breaching intention of WP:3RR and being temporarily blocked.
Please meet each others concerns half-way and help agree on a suitable encyclopaedic consensus (remember wikipedia is not a soapbox to carry out the debate itself, but merely reports on existance of real-world debates) David Ruben Talk 01:41, 17 August 2006 (UTC)[reply]
...the actual overall conclusion per IARC is that "overall, progestins are possibly carcinogenic to humans," and this takes into account animal studies re breast cancer risk.
the oxford study should be noted, as it is the "standard."
i actually didn't just "revert"--i tried to rewrite/modify the section to make it less objectionable to jessm. i don't think she should keep automatically deleting the section in its various forms...especially without doing research/trying to contribute to the article in a constructive way by including her objections in the article/citing an alternate reliable source. Cindery 01:58, 17 August 2006 (UTC) Cindery 01:58, 17 August 2006 (UTC)[reply]
this is a link to just one of hundreds of recent biochem/oncology studies re exogenous hormones and breast cancer. [7] many of them note that PRs (progesterone receptors) and ERs (estrogen receptors) have a very complicated interplay. this study describes how synthetic progestins in oc function estrogenically--through ER not PR receptors/are opposed by an anti-estrogen, not an anti-progestin. the point being i suppose that COCP/POP may not be strictly separate categories, as progestins can be estrogenic as well as progestogenic. Cindery 03:57, 17 August 2006 (UTC)[reply]
thanks for clarifying that. here is more info about how 19 nors are estrogenic, even beyond aromatase?: "Synthetic 19-nortestosterone derivatives as estrogen receptor alpha subtype-selective ligands induce similar receptor conformational changes and steroid receptor coactivator recruitment than natural estrogens." PMID: 16616843 Cindery 02:12, 18 September 2006 (UTC)[reply]
My wife has been on a combined high-dose formulation here in Australia for many, many years. After struggling with the regular pills that have a break in dosage to allow for periods, still getting incredible pain during her periods (enough to make her nearly cry at the thought of it), she did as her doctor suggested and skipped the placebos and finally put an end to her periods altogether. I am worried about the Estrogen (Ethylestradiol) effect on her after so much negative press about it. Is there a Progesterone-only birth control that she can take to escape periods? (do not lecture on the medical ethics and dangers of doing so - she will never hear otherwise, period. Thank you.)
There is considerable medical debate surrounding whether the thinning effect POPs have on the lining of the endometrium contributes in any significancy to the prevention of implantation of a blastocyst and thereby the prevention of a clinincally recognized pregnancy. This mechanism of action is not discussed at all in this article, and I believe it would benefit from a section describing this. What do other editors think? Brad 00:51, 28 December 2006 (UTC)[reply]
Is there really any considerable medical debate regarding whether POPs adversely affect the endometrial lining so as to interfere with the implantation of a fertilised egg? A Google search on 'how do Progestogen only pills work' made me ask that question. Four of the first five results listed a 'thinning of the endometrial lining' as a secondary mechanism of action that inhibited implantation post-fertilization.
The fifth site (first in order of ranking) was Wikipedia's article under discussion here. Multiple other sites that did not list such a mechanism as an accepted secondary action discussed the disagreement surrounding whether it contributed. Several further sites discussed the medical debate itself:
For a paper summarizing research in this area, see Walter L. Larimore, MD; Joseph B. Stanford, MD, MSPH, "Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent" (http://archfami.ama-assn.org/cgi/content/abstract/9/2/126).
Something influenced those four top sites to list the thinning of the endometrial lining, so it seemed to me there is some debate as to whether this is a mechanism of action of the POP in inhibiting pregnancy, I would think? Either it is simple rumor or misinformation, outright deception, or a debateable mechanism. Either way, I would think this article would benefit from discussing it? Brad 13:25, 28 December 2006 (UTC)[reply]
I would like to treat this parameter the same on all the hormonal contraception articles. Please read my opinion and discuss this issue at Talk:Combined oral contraceptive pill#Weight parameter in infobox. LyrlTalk C 21:30, 20 August 2007 (UTC)[reply]
I've removed the statement that the POP causes less weight gain than the COCP as the COCP doesn't cause weight gain (reference to Cochrane review in the COCP article) so I think the previous wording was misleading Zchahe7 (talk) 14:45, 24 February 2014 (UTC)[reply]
Based on CDC (United States) recommendations from (Classifications for Progestin-Only Contraceptives | CDC) - here are various situations where the risk of Progestogen-only pill may be contraindicated (Category 3+).
General
- Pregnant Patients - Those with malabsorptive bariatric surgery (may not have effective medication based on malabsorption)
Cardiovascular Disease
(3) Current or History of Ischemic Heart Disease
Rheumatic Disease
(3) Positive Antiphospholipid antibodies
Breast Disease (such as cancer)
(4) Current
(3) Past but no evidence of disease for 5 years
Liver Disease
(3) Severe Cirrhosis
(3) Liver Tumors Hepatocellular Adenoma
(3) Liver Tumors Malignant Hepatoma Kmsmola (talk) 12:42, 27 October 2023 (UTC)[reply]
First Generation
- Norethindrone Acetate (0.35mg tablets; commercial name Camila/Errin)
- Ethynodiol diacetate
- Lynestrenol
- Norethynodrel
Second Generation
- di-Norgestrel (28 tabs of 0.075 mg; Commercial name Opill)
- Levonorgestrel
Third Generation
- Desogestrel (75 mcg POP forumulation)
- Gestodene
- Norgestimate
Unclassified
- Drospirenone (package containing 24 tabs with 4mg of drospirenone; commercial name Slynd)
- Cyproterone Acetate Kmsmola (talk) 12:56, 27 October 2023 (UTC)[reply]
This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 October 2023 and 19 November 2023. Further details are available on the course page. Student editor(s): Kmsmola (article contribs).
— Assignment last updated by Kmsmola (talk) 13:23, 27 October 2023 (UTC)[reply]
