Estrogen Content and Clinical Implications of Combined Oral Contraceptives

Estrogen Content Comparison

The American Academy of Dermatology notes that Nextellis contains 20 μg of ethinyl estradiol, which is at the lower end of the typical range for combined oral contraceptives 1, 2
Marvelon contains 30 μg of ethinyl estradiol, placing it in the mid-range of ethinyl estradiol dosing 1, 3
The typical range for ethinyl estradiol content in modern combined oral contraceptives is 10-50 μg 1

Lower estrogen doses are associated with reduced risk of venous thromboembolism (VTE) compared to higher-dose formulations, with an odds ratio of 1.19 [95% CI, 1.16-1.23] for every 10 μg increase in ethinyl estradiol 4
The absolute risk of VTE is approximately 3-9 per 10,000 person-years in combined oral contraceptive users, compared to 1-5 in non-users 1, 2
The American Heart Association, as published in Stroke, recommends considering the risk of VTE when prescribing combined oral contraceptives, especially in women with a history of VTE 4
The American Academy of Dermatology notes that both Nextellis and Marvelon contain different progestins which also impact their overall risk profiles 1, 2
Marvelon contains desogestrel, a third-generation progestin considered less androgenic than earlier generations, according to Blood Reviews 1, 5
Drospirenone-containing pills, such as Nextellis, may have a slightly higher VTE risk (approximately 10 per 10,000 person-years) compared to other combined oral contraceptives 1

The American Heart Association, as published in Hypertension, suggests that lower estrogen formulations like Nextellis may be preferred for patients concerned about estrogen-related side effects, especially those with hypertension 6, 7
The American Academy of Dermatology notes that all combined oral contraceptives, regardless of estrogen dose, are contraindicated in women with certain risk factors, such as history of venous thromboembolism, hypertension, or migraine with aura 1, 4, 6
The absolute risk of VTE with any combined oral contraceptive is still lower than the risk associated with pregnancy (5-20 per 10,000 person-years in pregnancy) 1