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Desogestrel: Effects, Uses & Side Effects

Desogestrel is a synthetic progestogen used as a hormonal contraceptive. It primarily works by inhibiting ovulation and is taken as a progestogen-only pill.

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Things worth knowing about "Desogestrel"

Desogestrel is a synthetic progestogen used as a hormonal contraceptive. It primarily works by inhibiting ovulation and is taken as a progestogen-only pill.

What is Desogestrel?

Desogestrel is a third-generation synthetic progestogen widely used in hormonal contraception. It belongs to the class of progestins and is primarily known as the active ingredient in the so-called progestogen-only pill (POP), commonly referred to as the mini-pill. Unlike older progestogen-only pills, desogestrel reliably inhibits ovulation, providing a high level of contraceptive efficacy.

Mechanism of Action

Desogestrel exerts its contraceptive effects through several mechanisms:

Inhibition of ovulation: Desogestrel suppresses the release of LH (luteinizing hormone) and FSH (follicle-stimulating hormone) from the pituitary gland, thereby preventing the release of an egg.
Thickening of cervical mucus: The cervical mucus becomes thicker, making it more difficult for sperm to reach the uterus.
Alteration of the endometrium: Changes to the uterine lining reduce the likelihood of a fertilized egg implanting successfully.

Indications

Desogestrel is used in the following situations:

Contraception: As a progestogen-only pill for women of all ages, including those who are breastfeeding, as it does not affect milk production.
Alternative for women with contraindications to estrogen: Since desogestrel contains no estrogen, it is suitable for women who cannot take estrogen-containing preparations, such as those with an increased risk of thrombosis, high blood pressure, or migraine with aura.
Management of menstrual pain: In some cases, desogestrel may also be used to relieve dysmenorrhea (painful periods).

Dosage and Administration

The standard dose is 75 micrograms of desogestrel daily, taken continuously without a break. The tablet should be taken at the same time each day. Desogestrel offers a 12-hour window for taking the pill, which is significantly more flexible than older progestogen-only pills that required a 3-hour window. Treatment typically begins on the first day of menstruation.

Side Effects

Like all hormonal preparations, desogestrel can cause side effects. Commonly reported side effects include:

Changes to the menstrual cycle: Irregular bleeding, spotting, or complete absence of menstruation (amenorrhea)
Acne and skin changes
Mood changes, including depressive symptoms
Decreased libido
Headaches
Nausea
Breast tenderness or pain
Weight gain
Ovarian cysts, which usually resolve on their own

Contraindications

Desogestrel should not be used in cases of:

Known or suspected hormone-dependent tumors (e.g., breast cancer)
Unexplained vaginal bleeding
Severe liver disease or liver tumors
Hypersensitivity to the active substance
Active deep vein thrombosis or pulmonary embolism (use with caution)

Drug Interactions

Certain medications can reduce the effectiveness of desogestrel:

Enzyme-inducing drugs such as rifampicin, certain antiepileptics (e.g., phenytoin, carbamazepine), and the herbal remedy St. John's Wort can accelerate the metabolism of desogestrel and reduce its contraceptive effect.
An additional contraceptive method should be used when taking such medications.

References

European Medicines Agency (EMA): Product information for desogestrel-containing medicinal products. Available at: www.ema.europa.eu
Summary of Product Characteristics - Cerazette (Desogestrel 75 micrograms) - Organon Healthcare B.V., 2023.
World Health Organization (WHO): Medical eligibility criteria for contraceptive use, 5th Edition, 2015. Available at: www.who.int

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