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Medical Therapies
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Simone Ferrero, Fabio Barra, Giulio Evangelisti, Matteo Tantari
Desogestrel (DSG) is a third-generation progestin. It is a prodrug that is converted to 3-keto-DSG, the active form of the drug (22). DSG has the advantage of also being approved as a licensed contraceptive. A patient preference trial compared the contraceptive vaginal ring (etonogestrel, ENG, 120 μg and ethinylestradiol, EE, 15 μg; 83 women) administered cyclically with DSG (75 μg/day; 60 women). At the end of the 12-month treatment, the satisfaction of the patients was higher in the DSG group. DSG was more efficacious than the vaginal ring in improving NMPP, deep dyspareunia and intestinal symptoms (23). In another patient preference study, DSG (75 μg/day) and cyclic COC (EE 20 μg + DSG 150 μg) were administered to 74 women with symptomatic rectovaginal endometriosis and migraine without aura (24). Although both treatments were equally effective in decreasing endometriosis-related pain, the satisfaction rate was higher for patients receiving DSG. In fact, the severity and number of migraine attacks were significantly different between baseline and the end of treatment in the DSG group but not in the COC group. Recently, an RCT compared DSG and placebo in 40 patients with endometriosis and moderate-to-severe dysmenorrhea or non-menstrual pelvic pain (NMPP) (25). DSG was more efficacious than placebo in improving dysmenorrhea and NMPP. Patients treated with DSG were more satisfied than those receiving placebo. The most frequent adverse effects caused by DSG are breakthrough bleeding, acne, nausea, breast pain and weight gain (22).
Progestogen-only pills
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
Desogestrel progestogen pills have a higher contraceptive efficacy than traditional other progestogen-only pills and so should be the first line of treatment. As no research has found any difference in efficacy between the traditional progestogen pills preparations, then the most suitable choice between them is the one which gives your client fewer side effects and less irregular bleeding. With the introduction of Cerazette on the market there has been new research on progestogen-only pills. Two studies comparing Cerazette to levonorgestrel preparations (Rice et al., 1999) (Collaborative Study Group, 1998) have shown Cerazette to have a significant inhibition of ovulation. Cerazette users had a higher incidence of amenorrhoea and infrequent bleeding, although some users had frequent bleeding and prolonged bleeding at the beginning of the study.
Dermal and Transdermal Drug Delivery Systems
Published in Tapash K. Ghosh, Dermal Drug Delivery, 2020
Kenneth A. Walters, Majella E. Lane
In addition to the combination contraceptive patches, the feasibility of a transdermal patch containing the progestogen (Figure 1.5) desogestrel as a single agent in an adhesive matrix has also been evaluated (Sachdeva et al., 2013). The authors investigated the comparative skin permeation (using hairless rat skin) and found that the permeation of desogestrel was significantly greater than that of levonorgestrel. Evaluation of different adhesives demonstrated that acrylic adhesives with and without functional groups (DuroTakTM 87–4098 and DuroTak 87-202A, Henkel) had a much greater solubility for the drug than a polyisobutylene adhesive (DuroTak 87-608A). Developments in transdermal contraceptive patches have been recently reviewed (Nelson, 2015).
Hormonal and natural contraceptives: a review on efficacy and risks of different methods for an informed choice
Published in Gynecological Endocrinology, 2023
Andrea R. Genazzani, Tiziana Fidecicchi, Domenico Arduini, Andrea Giannini, Tommaso Simoncini
Some progestin-only pills (POPs) have a lower ovulation inhibition capacity than that obtained with CHCs containing the same progestin. However, they maintain the progestogenic effect on cervical mucus and sperm viability. On the contrary, desogestrel- and drospirenone-containing pills have a sufficient progestin dose to efficiently inhibit ovulation, also reducing the incidence of breakthrough bleedings that may occur with other POPs [52, 53]. Non-oral progestin-only contraceptives include injectable progestins, subdermal implant, and intrauterine devices (IUD); they were developed to avoid the one-per-day pill administration. Depot medroxyprogesterone acetate should be injected every three months, subdermal implants last three years, while IUDs should be replaced every three to five years, according to the type used. Thanks to their long life, they ensure greater compliance, with good safety profile and no effects on hemostatic parameters [54].
Comprehensive overview of the venous disorder known as pelvic congestion syndrome
Published in Annals of Medicine, 2022
Kamil Bałabuszek, Michał Toborek, Radosław Pietura
Pharmacological treatment for PCS is limited due to the lack of data determining long-term efficacy [26]. Hormonal therapies that inhibit ovarian function, such as medroxyprogesterone acetate (MPA) and gonadotropin-releasing hormone (GnRH) agonists have shown some efficacy, but the therapy was accompanied by numerous side effects. In addition, stable results 9 months after treatment with MPA were obtained only in combination with psychotherapy [12]. Implanon, a subcutaneous implant containing the desogestrel metabolite etonogestrel was associated with improvements in symptom relief and venographic findings 1 year after treatment. However, the implant was used in only 12 cases and no data regarding long-term results are available [83]. The study published by Reginald et al. in 1987 showed some effectiveness of dihydroergotamine in reducing pain scores. However, the treatment showed only transient efficacy, side effects, and was carried out in only 12 patients [84]. In the short term, nonsteroidal anti-inflammatory drugs may reduce symptoms, while the patient is undergoing further care, but they do not contribute to curing the problem [19]. In a study published in 2019 Tadalafil improved bladder function in rats with pelvic venous congestion. However, this requires further study [85].
Management of perimenopause disorders: hormonal treatment
Published in Gynecological Endocrinology, 2021
Libera Troìa, Simona Martone, Giuseppe Morgante, Stefano Luisi
The progestogen-only pill (POP) can be easily suggested to women in their forties and older to minimize VTE risk. The drawback with the low-dose POP is that its mechanism of action relies on very careful administration with only a 3-h window each day. The higher-dose desogestrel POP has two main advantages compared to low-dose POPs: reliable ovulation inhibition in over 99% of cycles and a 12 h intake window. Although ovulation is suppressed, endogenous estradiol levels are maintained within the physiological range. However, the main drawback with any POP is the high incidence of breakthrough bleeding which is particularly problematic in the perimenopause. There is no proven benefit of POPs for cycle-related symptoms and they may induce continuous PMS, typical of progestogenic side effects [14].