While their popularity has lasted through the years, adherence and satisfaction with oral contraceptives continues to pose challenges for some women. 1 Available products have expanded from Enovid® (mestranol-norethynodrel), the first oral contraceptive approved in 1960, into a worldwide market with dozens of brands. They remain the most popular method of contraception in many parts of the world. Oral contraceptives are now in their sixth decade of use. While no one oral contraceptive formulation is likely to be the optimum choice for all women, NOMAC-E2 is a formulation with effectiveness comparable with that of other oral contraceptives, and a reassuring safety profile. Preliminary studies suggest that NOMAC-E2 does not seem to have negative effects on hemostatic and metabolic parameters. The most common adverse events were irregular bleeding, acne, and weight gain. Few severe adverse events were reported in the randomized controlled trials. The adverse event profile appears to be acceptable. The bleeding pattern on NOMAC-E2 is characterized by fewer bleeding/spotting days, shorter withdrawal bleeds, and a higher incidence of amenorrhea than the comparator oral contraceptive containing drospirenone and ethinyl estradiol. Two recently published randomized controlled trials demonstrate that NOMAC-E2 is an effective contraceptive, with a Pearl Index less than one pregnancy per 100 woman-years. Estradiol, though it has a lower bioavailability, has been successfully combined with NOMAC in a monophasic oral contraceptive. NOMAC is a progestin derived from testosterone, which has high bioavailability, rapid absorption, and a long half-life. The approved dosing regimen is 24 days of active hormone, followed by a 4-day hormone-free interval.
The oral contraceptive NOMAC-E2 contains nomegestrol acetate (NOMAC) 2.5 mg + 17b-estradiol (E2) 1.5 mg. Concerns about the risk of venous thromboembolism continue to drive the search for the safest oral contraceptive formulations. While safe and effective for many women, the failure rate of oral contraception is about 8%. Oral contraceptives remain a popular method of contraception over 50 years after their introduction.
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