Riskanalys: Faror och risker med p-piller bestående av Ethinylestradiol (EE2) och Estradiol (E2) i Helge å

Sammanfattning: During the 90’s intersex individuals was found among fish downstream sewage treatment plants, this was found to be due to estrogens in the water. Today we know that one of the largest contributors of the effects on fish is 17a-ethinylestradiol (EE2). EE2 is a synthetic estrogen used in contraceptive pills and is one of the most used pharmaceuticals in the world. In addition to intersex EE2 also generates elevated levels of vitellogenin, altered gene expression and behavior change. These effects are also produced by estradiol (E2), a natural estrogen. The effects are induced at sub-ng/l with slightly higher concentrations for E2 compared to EE2, therefore E2 is consider more environmental friendly compared to EE2. In this study the two substances E2 and EE2 were compared and determined if they represent any risk to a river in Scania (Helge river) through an environmental risk assessment. The environmental risk assessment was performed by the guideline on the environmental risk assessment of medicinal products for human use mead by European Medicines Agency. To determine if E2 is more environmental friendly compared to EE2, the dose of EE2 was changed towards E2. This study shows that E2 and EE2 today do not represent a risk for Helge River. It mainly depends on the high dilution of Helge River and the many industries connected to the sewage treatment plant. The result shows that E2 is not more environmental friendly compared to EE2 in contraceptives, due to the higher amount E2 (1-3 mg) in the pills compared to EE2 (20-30 µg). The most cost-effective solution to the negative effects on aquatic organisms due to EE2 and E2 is to not prescribe contraceptive consisting of estrogen. The alternative is to rebuild the treatment plants to remove the estrogens from the wastewater but it is more expensive.