1, 2, 3, 4… Different generations of pills are marketed in France depending on the nature of the progestogen(s) they contain. Their indications, side effects or risks are not the same.
There contraceptive pill is a means of female contraception intended to prevent pregnancy. It contains hormones, so we say that it is a hormonal contraception. There are two main categories:
► pills that contain both estrogen and progestin are called combined oral contraceptives. These are the classic pills, the most commonly prescribed. They are classified by “generation” according to their seniority. Also the 3rd generation pills are newer than the 2nd generation ones. What distinguishes them is the nature of the progestin they contain.
► microdose pills or also called “microprogestins” Who contain much less (or none at all) estrogen. They are recommended for women who are at risk of thrombosis: smokers, those with hypertension or diabetes or during breastfeeding.
What are the 1st generation pills?
The 1st generation pills appeared in the 1960s, they contain a high dose of estrogen. Among their side effects are, for example, breast swelling, nausea, migraines, vascular disorders. Today, Triella® is the only first generation pill marketed in France.
What are 2nd generation pills?
The 2nd generation pills were released in the 70s and 80s.”These pills contain progestins (norgestrel, levonorgestrel). The change in composition helped reduce some of the side effects associated with 1st generation pills“, explains Dr Philippe Mironneau, gynecologist and obstetrician in Dijon. 2nd generation pills (today Minidril®, Adepal®, Trinordiol®) nevertheless still present a risk of venous thrombosis among their side effects.
What are 3rd generation pills?
The 3rd generation pills appeared in the 1990s, they combine three new synthetic derivatives of progesterone, desogestrel, gestodene and norgestimate. They are supposed limit unwanted effects pills from previous generations such as acne, breast pain or nausea for example. But these pills are associated with a higher risk of thromboembolic accident (formation of a clot (thrombus) in a vein, most often in the legs) than second generation pills. The risk of venous thrombosis is screened based on the patient’s personal and family history.. It increases when there is a family history of venous thrombosis or pulmonary embolism (especially in first-degree relatives, i.e. parent, brother, sister or child).
What are 4th generation pills?
The 4th generation pills, the most recent, contain a new progestin, drospirenone. Their side effects are close to those of 3rd generation pills.
Table of pills according to generations
| Pill Names |
|---|
| 1st: Triella |
| 2nd: Adepal, Amarance Ge, Daily Ge, Evanecia Ge, Evepar, Leeloo Ge, Lovapharm, Ludéal Ge, Microval, Minidril, Optidril, Optilova, Pacilia Ge, Seasonique, Stediril, Trinordiol, Zikiale Ge |
| 3rd: Antigone, Carlin, Cerazette, Cilest, Clareal Ge, Cycleane, Desobel Ge, Desopop, Diamilla, Efezial, Effiprev, Felixita, Harmonet, Holgyeme, Meliane, Melodia, Mercilion, Minerva, Minesse, Minulet, Moneva, Optinesse, Perleane, Phaeva, Sylviane, Triafemi, Tricilest, Triminulet, Varnoline, |
| 4th: Belanette, Belara, Convuline, Drospibel, Jasmine, Jasminelle, Qlaira, Rimendia, Yaz, Zoely |
Official recommendations
The Haute Autorisation de Santé (HAS) has updated its recommendations regarding the contraceptive pill. The HAS explains that “estroprogestins can be used in adolescents without contraindications (mainly venous or arterial thromboembolism, hepatic, oncological, etc.) and taking into account the risk factors for thrombosis (in particular personal or family history of venous thrombosis or arterial, known biological thrombophilia, prolonged immobilization, obesity, hypertension, diabetes, dyslipidemia, smoking, migraine, etc.)“.
Regarding 3rd generation pills containing desogestrel or gestodene, and 4th generation containing drospirenone, the HAS reminds that they “expose to an increased risk of thromboembolic accidents compared to pills containing levonorgestrel; they should not be used as first intention“. And to conclude: “Other estrogen-progestogens (including rings and patches) should only be reserved for cases of intolerance to 1st or 2nd generation pills and for women for whom another type of contraception is not possible.“.
Thanks to Dr Philippe Mironneau, gynecologist and obstetrician in Dijon.