In mid-December, a 25-year-old woman suffering from a stroke filed a complaint, implicating the taking of a 3rd generation contraceptive pill. Explanations.
The public health pole of the tribunal de grande instance (TGI) of Paris is responsible for examining the complaint filed by Marion Larat, 25 years old. This young woman, 65% disabled, accuses the 3rd generation pill of having caused the stroke at the origin of her disability. This first complaint targets the Bayer laboratory and the director general of the National Medicines Safety Agency for “unintentional attack on the integrity of the human person” and for non-compliance with the precautionary principle. The young woman’s lawyers announced this weekend that the complaints of 30 other women, also considering themselves victims of 3rd and 4th generation contraceptive pills, would be filed in early January.
These legal proceedings reveal serious shortcomings in the way in which 3rd and 4th generation contraceptive pills were prescribed. The Medicines Agency has launched several alerts in the past on the thromboembolic risks associated with these pills.
The Minister of Health, Marisol Touraine, announced in mid-September the end of the reimbursement by Social Security of these pills, which will however not take effect until September 30, 2013. But why is there several generations of pills?
How does a birth control pill work? The pill, popular in France, is a so-called hormonal method of contraception. The pill indeed contains hormones which, thanks to their actions on the body, prevent a woman from getting pregnant. These actions, which are called “contraceptive locks”, are manifold. For example, there is an effect on the inhibition of follicular growth, the mechanism that normally allows ovulation. Or, the pill causes atrophy of the endometrium, which lines the uterus. It is usually intended to accommodate the embryo and if it is not thick enough, implantation does not take place. Depending on the different types of pills, the contraceptive locks are more or less activated.
What are the different generations of pills? There are two types of pills: estrogen plus progestin and progestin. Estrogen-progestogen pills are made up of two hormones: estrogen and progestin, while progestin-only pills contain only progestin. The estrogen contained in estrogen-progestogen pills (also called combined) is always the same, ethinyl-estradiol (EE), the dosage of which varies depending on the pill. The progestin may be different.
This is where the different generations of pills come in: depending on the progestin used, we are talking about 1e, 2e, 3e or 4e generation. These different generations of pills also have different EE dosages, the first generations being more highly EE dosed. The more recent generations are thus qualified as mini-dosed. Progestin-only pills, on the other hand, are also classified according to the generation of progestin used. These pills are also called micropills.
Why continue to prescribe the old ones? The first generation pills are not obsolete. From one generation of pill to the next, we did vary the EE levels and different progestins were used with the aim of reducing the side effects of the pill (cholesterol, blood pressure, weight gain, increased hair growth, acne occurrence, etc.). The new generations are generally better tolerated and reduce the cardiovascular risk but at the same time, it has been observed that the risk of thromboembolism (appearance of clots which prevents the good circulation of the blood) was increased. Thus, the pills are to be adapted according to the characteristics of the patient and her antecedents. For example, for new users, the Haute Autorité de santé recommends not to prescribe the pills of 3e generation than in ‘second line after oral contraceptives of 1e and 2e generation due to a higher risk of venous thromboembolism ”. Or, pills containing only a progestogen are generally prescribed when there are contraindications to estrogen, or in the event of smoking, for example.
