At a 1991 symposium on the new progestins, Dr. David Upmalis, Associate Research Director at R.W. Johnson Pharmaceutical Research Institute said, "Although definitive clinical studies have yet to be done, it is thought that androgenic activity may contribute to side effects such as acne, hirsutism [excessive hair growth on the face, breasts, etc.] and weight gain." Androgenic side effects may also contribute to breakthrough bleeding and mood swings.

An interesting study of 11,605 women taking the desogestrel pill, of whom 1,021 had pre-existing acne, showed that 80 percent of them had the acne disappear. In the same study, of 499 women with excessive hair growth before they start taking the new pill, almost 50 percent had it disappear.

Is the overall side effect picture better than the old progestin type pills? According to Belgian professor Dr. Theo Brat from the University of Brussels Department of Obstetrics and Gynecology, clinical trials to date show no significant difference in side effects (emphasis mine) between OC's currently in use and those based on the new progestins.

The most recent review of the effects of the new progestins was published in the June 1993 issue of Obstetrics and Gynecology. (Vol 81-6) Dr. Leon Speroff and Dr. Alan DeCherney and others reviewed approximately 100 studies.

They note less breakthrough bleeding and better cycle control with the desogestrel pill. However, they also note that larger trials comparing the old progesterones with new ones have not been done, and that lack of standardization in reporting and analysis "prevents meaningful comparisons of the new formulations from one study to another."

On the question of changes in blood sugar levels, the authors concluded that the new progesterones cause less changes than the old progesterones.

However, one of the main reasons doctors are being sold on these new progestins is their apparent beneficial effect on the HDL cholesterol ("good cholesterol").

Dr. Upmalis stated that the lipid effects of the new lipids are at least neutral "with a potential for lipid effects which could be beneficial."

Dr. John Collins, Professor of Gynecology and Epidemiology at McMaster University in Hamilton, Ontario, reviewed 40 studies involving over 100,000 women, on the new progesterones (Journal SOGC, Oct/91). Seventy percent of the studies did not extend past nine months. Only two studies extended follow-up for two years.

Dr. Collins concluded that the new progesterones have better effects on the levels of fatty substances in the blood than the old progesterones. They increase HDL levels and decrease LDL levels ("bad cholesterol").

However, as Dr. Collins points out, although higher HDL blood levels in women aged 50 to 70 are associated with a lower risk of heart disease, no statistics are available for younger women. Moreover, he says that studies done on men, which show that lowering the cholesterol leads to a reduction in heart disease, cannot be generalized to women particularly in the age group of pill users. Still Dr. Collins concedes that it "does make sense to prescribe birth control pills that are associated with the optimal lipid profile..."

Dr. Speroff and Dr. DeCherney reviewed 40 studies on blood fat levels and the new progesterones. Observed drawbacks included the facts that most studies lasted only six months or less, that changes in blood fats may not appear until after six months, and that in none of the studies were the treatment group compared to a non-treatment group to account for lifestyle effects like weight change, exercise and environmental changes.

In his review, Dr. Collins found that no single study evaluated a comprehensive set of metabolic and clinical effects of the new progestins.

Dr. Collins also noted that studies on blood clotting were limited to small numbers of patients, and there had been no orderly studies on the frequency of minor side effects in these new products, and how these compared to the old progestins.

Dr. Speroff and Dr. DeCherney concluded in a similar vein saying that many of the studies in this review reported laboratory data collected over a relatively short period. They recommended larger follow-up studies.