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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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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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