Priority 12 from the Contraception PSP

UNCERTAINTY: What are the benefits and risks of using micronised progestogen or newer progestogens (such as Nomegestrol acetate, drospirenone) either in pill form or in long acting preparations, such as implants or in combined hormonal contraception?  (JLA PSP Priority 12)
Overall ranking 12
JLA question ID 0049/12
Explanatory note Newer progestogens such as drosperinone are derived from spironolactone rather than 19-nor testosterone. Compared to placebo the drosperinone ethinyl estradiol pill seemed to help women with severed symptoms in the short term, the placebo also had a positive effect. his may have an influence on fluid balance, and reduce side effects. Differences between progestogens were minimal in the systematic review comparing different formulations- it was noted the RCTs in the quality of the evidence was low, outcomes were unblinded, 23/33 RCTs were sponsored by the pharmaceutical companies. The potential risks of newer progestogens is uncertain.  Further double-blind comparisons of the side-effect and benefit profiles of new progestogens versus the earlier progestogens in combined and progestogen only contraception is needed to evaluate the benefits and common side effects of these preparations.
Evidence

Oral contraceptives containing drospirenone for premenstrual syndrome. Laureen M Lopez , Adrian A Kaptein and Frans M Helmerhorst . February 2012

Types of progestogens in combined oral contraception: effectiveness and side-effects.Theresa A Lawrie , Frans M Helmerhorst , Nandita K. Maitra , Regina Kulier , Kitty Bloemenkamp and A Metin Gülmezoglu. May 2011

Combined oral contraceptives: venous thrombosis. Marcos de Bastos , Bernardine H. Stegeman , Frits R. Rosendaal , Astrid Van Hylckama Vlieg , Frans M Helmerhorst , Theo Stijnen and Olaf M Dekkers. March 2014
Health Research Classification System category Reproductive Health and Childbirth
Extra information provided by this PSP
Original uncertainty examples

“more Info on the benefits / negative aspects of contraceptives with newer generation progesterone (e.g.? micronised) e.g. zoely”(HCP) 
Submitted by Healthcare Professionals x 1~Patients x 0~Both x 0
PSP information
PSP unique ID 0049
PSP name Contraception
Total number of uncertainties identified by this PSP. 57  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 21 April 2017