Not All Progestins are Created Equally: Considering Unique Progestins Individually in Psychobehavioral Research

How hormonal contraceptives shape brain and behavior: A review of preclinical studies

Steroid hormones influence different aspects of brain function, including development, neurogenesis, neuronal excitability, and plasticity, thus affecting emotional states, cognition, sociality, and reward. In women, their levels fluctuate across the lifespan and through the reproductive stages but are also altered by exogenous administration of hormonal contraceptives (HC). HC are widely used by women throughout their fertile life both for contraceptive and therapeutic benefits. However, awareness of their effects on brain function and behavior is still poorly appreciated, despite the emerging evidence of their action at the level of the central nervous system. Here, we summarize results obtained in preclinical studies, mostly conducted in intact female rodents, aimed at investigating the neurobiological effects of HC. HC can alter neuroactive hormones, neurotransmitters, neuropeptides, as well as emotional states, cognition, social and sexual behaviors. Animal studies provide insights into the neurobiological effects of HC with the aim to improve women's health and well-being.

Oral Progestins in Hormonal Contraception: Importance and Future Perspectives of a New Progestin Only-Pill Containing 4 mg Drospirenone

Hormonal contraceptives are an effective and safe method for preventing pregnancy. Progestins used in contraception are either components of combined hormonal contraceptives (tablets, patches or vaginal rings) or are used as a single active ingredient in progestin mono-preparations (the progestin-only pill (POP), implants, intrauterine systems or depot preparations). Progestins are highly effective in long-term contraception when used properly, and have a very good safety profile with very few contraindications. A new oestrogen-free ovulation inhibitor (POP) has recently been authorised in the USA and the EU. This progestin mono-preparation contains 4 mg of drospirenone (DRSP), which has anti-gonadotropic, anti-mineralocorticoidic and anti-androgenic properties. The hormone administration regimen of 24 days followed by a 4-day hormone-free period was chosen to improve bleeding control and to maintain oestradiol concentrations at early follicular-phase levels, preventing oestrogen deficiency. Clinical trials have demonstrated a high contraceptive effectiveness, a very low risk of cardiovascular side effects and a favourable menstrual bleeding pattern. Due to the long half-life of DRSP (30 - 34 hours), the effectiveness of the preparation is maintained even if a woman forgets to take a pill on a single occasion. Studies involving deliberate 24-hour delays in taking a pill have demonstrated that ovulation inhibition is maintained if a single pill is missed. Following a summary of the current status of oestrogen-free contraception, this review article will describe the clinical development programme of the 4 mg DRSP mono-preparation and the resulting data on the effectiveness and safety of this new oestrogen-free oral hormonal contraceptive.

Hormonal contraceptive phases matter: Resting-state functional connectivity of emotion-processing regions under stress

Hormonal contraceptives (HCs) affect various processes related to emotion processing, including emotional memory, fear extinction, and the cortisol response to stress. Despite the modulating role of HCs on the stress response in women and variance in synthetic hormone levels across the HC cycle, little is known about the phase-related effects of HCs on the brain's response to stress. We investigated the effect of HC cycle phase on functional connectivity of memory- and emotion-related regions at rest after exposure to a stressor. Twenty HC users completed two sessions of resting-state functional magnetic resonance imaging after exposure to the cold pressor test, one during the hormone-present HC phase (when synthetic hormones are taken) and one during the hormone-absent HC phase (when synthetic hormones are not taken). Women showed higher functional connectivity between left amygdala and ventromedial prefrontal cortex during the hormone-present phase. During the hormone-absent phase, women showed higher coupling between left parahippocampus and right superior lateral occipital cortex. Our results suggest that the synthetic hormones contained in HCs may protect against the negative effects of stress on functional connectivity of emotional processing regions.