Combined oral contraceptives formulated to include
estradiol (E2) have recently become available for the indication of pregnancy prevention. A combined
estradiol valerate and
dienogest pill (E2V/DNG), designed to be administered using an
estrogen step-down and a
progestin step-up regimen over 26 days of active treatment followed by 2 days of placebo (26/2-day regimen), has also undergone research to assess the potential for additional noncontraceptive benefits. Randomized, placebo-controlled studies have demonstrated that E2V/DNG is an effective treatment for
heavy menstrual bleeding - a reduction in median menstrual blood loss approaching 90% occurs after 6 months of treatment. To date, E2V/DNG is the only
oral contraceptive approved for this indication. Comparator studies have also demonstrated a reduction in
hormone withdrawal-associated symptoms in users of E2V/DNG compared with a conventional 21/7-day regimen of ethinylestradiol/
levonorgestrel. Other potential noncontraceptive benefits associated with E2V/DNG, like improvement in
dysmenorrhea, sexual function, and quality of life, are comparable with those associated with other
combined oral contraceptives and are discussed further in this review.