Table 2.

Summary of characteristics of synthetic progestogens and indications for use^a

Generation	Progestogen	COCP preparation		Available as POP	Physiological activity	Best formulation for use

		Monophasic	Multiphasic
1st	Medroxyprogesterone	✓	✗	✓	Moderate androgenic	Irregular or missed periods
	Medroxyprogesterone	✓	✗	✓	Minor glucocorticoid	Irregular or missed periods

	Norethisterone	✓	✓	✓	Moderate progestogenic	Menorrhagia, adenomyosis
	Norethisterone	✓	✓	✓	Mild androgenic	Menorrhagia, adenomyosis

2nd	Levonorgestrel	✓	✓	✓	Strongly progestogenic	Menorrhagia, adenomyosis
2nd	Levonorgestrel	✓	✓	✓	Strongly androgenic	Menorrhagia, adenomyosis

3rd	Desogestrel	✓	✗	✓	Strongly progestogenic	Dysmenorrhoea, endometriosis

	Norgestimate	✓	✗	✗	Medium progestogenic	Moderate acne
	Norgestimate	✓	✗	✗	Weakly androgenic	Moderate acne

	Gestodene	✓	✗	✗	Strongly progestogenic	Dysmenorrhoea
	Gestodene	✓	✗	✗	Mildly androgenic	Dysmenorrhoea

4th	Drospirenone	✓	✗	✗	Anti-androgenic	Acne, PCOS, PMS
	Drospirenone	✓	✗	✗	Anti-mineralocorticoid	Acne, PCOS, PMS

	Dienogest	✗	✓	✓	Anti-androgenic	Endometriosis
	Dienogest	✗	✓	POP not licensed for contraceptive purposes in UK

	Nomegestrol	✓	✗	✗	Targeted anti-oestrogenic at endometrium	Menorrhagia, PCOS, PMS
	Nomegestrol	✓	✗	✗	Partial anti-androgenic	Menorrhagia, PCOS, PMS

↵a The indications for use apply regardless of whether the progestogen is prescribed in combination with oestrogen or if available, as the POP. COCP = combined oral contraceptive pill. PCOS = polycystic ovarian syndrome. PMS = pre-menstrual syndrome. POP = progestogen-only pill.