Currently, combined oral contraceptive pills (COCPs) not only prevent unwanted pregnancy, but also have a wide range of beneficial non-contraceptive properties leading to their widespread use in various gynecological disea ses.
The therapeutic aspects of COCPs use allowed to radically change the approaches to preservation of woman's reproductive health and quality of life.
It should be noted that COCPs differ in the composition and dose of both estrogenic and gestagenic components. COCPs of first generation contained 50 mg of ethinylestradiol (EE), COCPs of second generation - lower doses of estradiol (20, 30, or 35 mg) along with progestin norethindrone and its derivatives, including levonorgestrel. COCPs of the third generation (with desogestrel and gestodene progestins) were formulated as less androgenic than second-generation progestins. Norgestimate is a progestin of the third generation, but its bioactivity is mediated mainly through levonorgestrel, which differentiates it from other third-generation progestins. Contraceptives of the fourth generation contain, among other, progestin drospirenone, which is derived from spironolactone and has antiandrogenic activity.
It was noted that certain contraceptives affect the vaginal microbiome. In women, who took COCPs, colonization with bacteria associated with bacterial vaginosis, was observed more rarely than in women who used condoms. In women, taking COCPs, intensive colonization with beneficial H2O2-pro-ducing Lactobacillus species was also observed.
Data from a systematic review and meta-analysis confirm that the use of COCPs is associated with a reduced risk of occurrence and recurrence of bacterial vaginosis. COCPs help to increase glycogen content in epithelial cells, which is metabolized by Lactobacilli and epithelial cells into lactic acid.