Tolerability and safety of combined hormonal contraceptives in reproductive-age women: Gynecologist’s criteria of choice

Combined hormonal contraceptives (CHCs) is the most common method of reversible contraception worldwide. Despite their high efficacy, the problem of tolerability and safety remains a key factor that determines compliance: up to 42% of users discontinue the OC within one year of initiation, primarily due to different adverse effects. The most important aspect of CHCs is their systemic action, which can be associated with both expected beneficial effects and undesirable pharmacological risks, raising the need for strict personalized prescribing and, above all, a thorough initial assessment of the patient’s comorbidities in accordance with the medical eligibility criteria for contraceptive use. The choice of CHCs should not only be guided by its main contraceptive effect, but also by its potential non-contraceptive, in particular, therapeutic effects. Therefore, it is worth paying special attention to the past medical history data, laboratory and instrumental examination findings, clinical manifestations in the patient who visited a practitioner to receive advice about choosing a drug (for example, symptoms of hyperandrogenism, a burdened oncological anamnesis (including ovarian cancer, breast cancer, colorectal cancer), arterial hypertension, smoking, etc.). This review aims to systematize evidence base regarding the tolerability and safety of CHCs in reproductive-age women. It describes advantages and limitations of CHC use, criteria for personalised approach to their choice, and provides an analysis of innovator product E4/DRSP characteristics with the consideration of its promising pleiotropic non-contraceptive effects. Data from the international databases PubMed, Google Scholar, and MEDLINE (with priority given to systematic reviews, metaanalyses, and original multicenter studies) for the period 2022–2026 were reviewed. The unique combination of E4/DRSP has been shown to be a reasonable first-choice contraceptive option for women who start COC use in dysmenorrhea, PMS, acne, and for patients with moderate cardiovascular risk factors in the absence of absolute contraindications to CHCs.

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