Ethinylestradiol is on the EU list of substances whose concentrations in surface waters should be monitored in the Member States for environmental reasons. Estimated levels in Swedish waters are in some cases sufficiently high to affect reproduction and gender development in fish.
Ethinylestradiol is included in the Stockholm County Council's table of pharmaceuticals with a negative environmental impact according to the environmental programme 2017–2021 based on lowest effect concentration, LOEC = 0.32 nanog/L, and concentrations found in treated wastewater.
The environmental risk of ethinyl estradiol is higher than for estradiol. Compared with estradiol, ethinyl estradiol is less degraded in the body, in wastewater treatmentplants and in the environment, and ethinyl estradiol is also more potent in fish.
Ethinylestradiol is recommended in The Wise list. Environmental classification of pharmaceuticals is taken into consideration, sometimes with other environmental aspects, when selecting pharmaceuticals for the Wise list. When comparable pharmaceuticals are equivalent to medical effects, safety and pharmaceutical efficacy, environmental impact and price are considered.
When using combination preparations with estrogen and gestagen, the gestagen component must also be considered. In particular, levonogestrel stands out as a drug with increased environmental risk. Environmental risk assessment is therefore relevant for both the gestagen and the estrogenic component.
In total, levonorgestrel + ethinylestradiol and etonogestrel + ethinylestradiol are considered to be the highest environmental risk, drospirenone + ethinylestradiol lower risk (based on gestagen component) and nomegestrol and estradiol lowest risk (based primarily on the gestagen component but also the estrogen component).
Concrete proposals on how to work to reduce emissions of environmentally harmful pharmaceuticals on the list have been developed in close cooperation with the Stockholm Drug and Therapeutics Committee's expert advice. The action proposals were developed from an environmental perspective. The patient's best always goes first and several pharmaceuticals on the list are also included in the Wise List. However, for such pharmaceuticals, there may be measures that could reduce the environmental impact.
Concrete proposal for ethinylestradiol
The risk classification high, according to Fass.se, is based on total sold amount (kg) of the substance in Sweden during the year 2011 and the toxicity of the substance.
Author: Health and Medical Care Administration, Region Stockholm