Authors
E E R van der Heide, E S Cohen, L I Pieters, D A M van Heel, A C E Stohr, Z C Dang, L J Schoonmade, W J K Hehenkamp, C T A Moermond
Published in
Integrated environmental assessment and management. Oct 12, 2026. Epub Oct 12, 2026.
Abstract
Contraception contributes to healthcare's global environmental footprint through pharmaceutical emissions and disposable waste. Steroid hormones used in hormonal contraception are widely detected in aquatic environments, raising concerns regarding their ecotoxicological risks. This review synthesizes environmental impacts of registered (non-)hormonal contraceptives, aiming to compare their environmental sustainability and estimate comparative ecotoxicological risk profiles of hormonal methods. A systematic literature search of Medline, Embase, Web of Science Core Collection, and Scopus was conducted through January 8, 2026, covering life cycle assessments, carbon footprint studies, water monitoring studies, chronic ecotoxicological effect studies, and environmental risk assessments. Of 3,409 records retrieved, 78 studies met predefined inclusion criteria. Extracted data were organised by study type, contraceptive method, environmental impact categories, and ecotoxicological endpoints. Available life cycle assessments were limited to condoms and showed that natural rubber condoms were associated with lower production-related environmental burden than polyisoprene condoms. The total waste associated with the use of long-acting hormonal contraceptives was lower compared to short-acting methods and non-hormonal intrauterine devices. Environmental risk assessments revealed global occurrence of estrogens and progestins in surface waters, with some posing risks to aquatic ecosystems. Comparative ecotoxicological profiles suggested lower relative ecotoxicity for drospirenone- and desogestrel-containing oral contraceptives per daily dose compared with other hormonal methods, and potentially lower ecotoxicity for levonorgestrel intrauterine devices compared to levonorgestrel containing oral formulations. Overall, the included studies reported on only a limited range of environmental impacts, such as waste production, carbon footprint and ecotoxicity, while overlooking other aspects of environmental sustainability. Because of this no definitive conclusions or comparisons could be made based on the full environmental sustainability. However, by extending the focus beyond direct environmental impacts towards overall sustainability, different contraceptive groups were ranked according to their overall sustainability. This led to the conclusion that long-acting reversible contraceptives are relatively more sustainable then short-acting reversible methods.
PMID:
42865017
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.
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