![]() We excluded women who were using hormone within 3 months prior to enrolment, were taking medication with a known interaction with COC, had contraindications to hormonal contraception, had a history of allergy to COC, had a pregnancy, or were undergoing breastfeeding. Study populationĮligible participants were healthy women aged 18–40 years who had a normal menstrual history (cycle length of 24–38 days). ![]() This non-inferiority, single-blinded (investigator-blinded), parallel-arm, randomized controlled trial was conducted at the Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand from April to August 2017. Therefore, the present study aimed to determine ovarian activity inhibition associated with QS COCs containing NOMAC/E2 compared with GS/EE. Although the contraceptive effectiveness of NOMAC/E2 on the ovulation inhibition outcome is reassuring with CS, no data are available with QS practice 19. One of the successful COC containing E2 is a monophasic pill comprising 2.5 mg nomegestrol acetate and 1.5 mg E2 (NOMAC/E2). These modalities included the application of newer potent progestin, the reduction of EE dosage, and the replacement of EE with a natural estrogen, 17-β estradiol (E2) 20. Over several decades since the first introduction of COC, various modalities have been employed to produce COC with better tolerability and less cardiovascular adverse effects without compromising the contraceptive efficacy 14, 15, 16, 17, 18, 19. Based on our best review, there is little evidence about ovulation inhibition effect of QS of COC use and the emerging information is limited to data from COC containing ethinyl estradiol (EE) with various progestin 8, 9, 10, 11, 12, 13. Some studies reported a slightly lower ovulation inhibition rate when QS, with inconclusive data regarding the pregnancy rate compared with CS 7. Although there is considered to be a small increased risk of pregnancy associated with QS when compared with CS, data specific to QS of COC is scarce. ![]() This approach is an off-labelled use but it is endorsed by several recommendations 5, 6. The starting of contraceptive use outside the recommended time is called “quick start (QS)”. However, this starting method may not be practical for women who want to achieve a reliable contraception as soon as possible instead of waiting for their next period. To achieve the highest contraceptive benefit, the user should start taking the first pill not later than the fifth day of the menstrual cycle, the so-called “conventional start (CS)” 5, 6. The effectiveness of COC varies significantly depending on its hormonal components and the correctness of use by individuals 3, 4. In concert, estrogen also acts to prevent the ovulation by negatively influencing FSH secretion and sequel follicular development suppression 2. Progestin compound exerts mainly to prevent ovulation by decreasing LH secretion via a negative feedback on the anterior pituitary gland. The principle mechanism of contraceptive action is an ovulation inhibition. Progestin and estrogen are the two hormonal components of COC. The quick starting NOMAC/E2 is non-inferior to GS/EE for preventing ovulation and suppressing follicular growth.Ĭombined oral contraception (COC) is one of the most popular forms contraception because of its high efficacy and accessibility 1. Quick starting COC during day7–9 of menstrual cycle can inhibit ovulation for more than 90%. No significant difference was observed between the study and control groups for ovulation inhibition rate (93.4% vs. Baseline characteristics were similar between groups. Forty-six and 23 participants were randomized to NOMAC/E2 and GS/EE groups, respectively. The ovarian activity was assessed by using Hoogland and Skouby grading. To determine the effectiveness of quick starting combined oral contraception (COC) contain 2.5 mg nomegestrol acetate and 1.5 mg estradiol (NOMAC/E2) comparing with 0.075 mg gestodene and 0.02 mg ethinyl estradiol (GS/EE) on ovarian ovulation inhibition rate, we conducted a non-inferiority randomized controlled trial involving 69 healthy female volunteers aged 18–40 years who had normal menstrual history and were randomized at a 2:1 ratio to take one pack of COC containing either NOMAC/E2 (study group) or GS/EE (control group) starting on menstrual cycle Day7–9.
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