Endocrine Abstracts

Estroprogestins (EP) are the short-acting hormonal contraceptives most commonly used in Europe, and include combined oral contraceptives (COCs), the patch, and the vaginal ring. Although the safety and efficacy of EP have being extensively investigated, scarce and controversial evidence is available on their impact on female sexuality. The potential negative effects of EP on female mood and desire are hypothesized to derive from sex steroids altering the interplay between neurotransmitters in specific brain areas. Detrimental effects on arousal, lubrication and orgasm have been attributed to changes peripheral concentration in both androgens and estrogens. In fact, EP suppress ovarian synthesis of androstenedione and testosterone and also reduce free androgen levels by increasing the hepatic production of sex hormone binding globulin (SHBG). The progestin component may influence such increase in SHBG, since progestins with androgenic activity induce a less pronounced increase than those with antiandrogenic activity. However, all available EP reduce androgen levels, independently of estrogen dosage and progestin type. As for estrogens, in the last years COCs containing low and very-low doses of ethinyl estradiol have been developed, in order to reduce the risk of side effects, but potentially leading to hypoestrogenism. Despite this strong pathogenetic background, in the vast majority of studies the use of oral EP did not significantly affect sexual desire, whereas data on non-oral forms of EP are scarce. On the other hand, EP seem to change female perception of male attractiveness with a weaker preference for cues of genetic fitness. Low-level evidence also suggests that EP induce a reduction in orgasm frequency. While the effect of oral EP on vaginal lubrication and vulvovaginal atrophy are controversial, no negative effects with the vaginal ring have been reported on these aspects. Finally, oral EP have been associated with an increased risk of painful bladder syndrome.