Cerazette (desogestrel) is an oral hormonal contraceptive approved by the U.S Food and Drug Administration (FDA). Cerazette can be used to manage the symptoms of endometriosis in women, age 18 and older. It reduces symptoms such as chronic pelvic pain, dysmenorrhea (painful periods), and dyspareunia (painful intercourse) in some patients.
How Cerazette works
Endometriosis is a painful disorder that affects one in 10 women worldwide. It is characterized by the tissue resembling the one that normally lines the inside of the uterus (endometrium) to grow outside the uterus. These extrauterine growths respond to hormonal cycles just like the normal endometrium.
The menstrual cycle is triggered by a surge in sex hormones such as estrogen, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). During this process, the displaced endometrial tissue thickens, breaks down, and bleeds like the normal endometrium, but cannot exit the body. This causes inflammation, chronic pelvic pain, dysmenorrhea, dyspareunia, and reduced fertility.
Cerazette contains a synthetic progestogen hormone, desogestrel, which is rapidly metabolized or converted into 3-keto-desogestrel (etonogestrel) in the liver and the gut. Etonogestrel (ETN) is the active metabolite in Cerazette. It decreases the secretion of gonadotropin-releasing hormone (GnRH) from an area of the brain called the hypothalamus. This blocks the production of GnRH-dependent sex hormones, such as estrogen, LH, and FSH, blocking the menstrual cycle and inducing a temporary, menopausal-like state, which reduces endometriosis-associated pain.
Cerazette in clinical trials
A randomized, double-blind study in 71 healthy female volunteers over 13 menstrual cycles showed that 75 micrograms of desogestrel daily inhibited ovulation in 97 percent of cycles compared to 71.9 percent in patients treated with levonorgestrel, another commonly used hormonal contraceptive.
In another prospective study conducted in 143 women with rectovaginal endometriosis infiltrating the rectum, patients treated with oral desogestrel-only were more satisfied than those treated with a vaginal ring contraceptive at the end of 12 months. The effectiveness of both treatments, however, was comparable.
A randomized placebo-controlled clinical trial (NCT01559480) evaluated pain levels for six months after Cerazette treatment in 40 endometriosis patients who underwent conservative laparoscopic surgery. The study showed that Cerazette significantly reduces overall pain, dysmenorrhea, and pelvic pain compared to placebo.
The most common side effect of Cerazette treatment is scant or heavy vaginal bleeding at irregular intervals. After a couple of months of treatment, bleedings tend to become less frequent. The incidences of headaches, acne, breast pain, nausea, vaginitis, and dysmenorrhea are similar in both Cerazette and levonorgestrel users.
Cerazette can be used by women who do not tolerate estrogens that are combined with a progestogen in combined oral contraceptives.
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