Fig. 4.

Network forest plot of results of hormonal contraceptives with an androgenic progestin versus those with an anti-androgenic progestin.

Two androgenic progestins included in the network (levonorgestrel and desogestrel) were compared with the anti-androgenic progestins included in the network (dienogest, drospirenone, nomegestrol acetate). Synthetic progestins, especially the older ones, not only have affinity to the progesterone receptor, but can also have androgenic or oestrogenic actions. From the synthetic progestins here, levonorgestrel has the strongest affinity to the androgen receptor, followed by desogestrel.³² Newer progestins have higher progesterone potency and additional effects, such as anti-androgenic activity.³² The size of the SMD dots are proportional to the precision of the estimate (one per s.e.). Ethinylestradiol/dienogest (3;2;2;1 mg/0;2;3;0 mg) is a multiphasic combined oral contraceptive that has four different dosages of hormones throughout a 4-week cycle. The dosages before the ‘slash’ refer to the different dosages of ethinylestradiol, and the ones after the ‘slash’ refer to those of dienogest. SMD, standardised mean difference.