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Desogestrel, Ethinyl Estradiol

N.V.Organon
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2019-09-19
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Clinical Pharmacology

Pharmacodynamics
Contraceptive effect of the drug Mercilon®Like other combined oral contraceptives (COCs), it is based on the interaction of various factors, the most important of which are suppression of ovulation and changes in cervical secretion.
Progestin drug (desogestrel) reduces the secretion of gonadotropic hormones, more luteinizing hormone (LH), and thus prevents the maturation of the follicle (blocks ovulation). Ethinyl estradiol, a synthetic analogue of the natural hormone estradiol, reduces the likelihood of acyclic bleeding when using COC.

Along with these central and peripheral mechanisms that prevent the maturation of an oocyte capable of fertilization, the contraceptive effect is due to an increase in the viscosity of mucus in the cervix, which makes it relatively impassable for sperm.
In addition to contraceptive properties, the drug Mercilon®has a number of effects that can be considered when choosing a method of contraception. Menstrual-like reactions become more regular, less painful and less bleeding. The latter circumstance leads to a decrease in the frequency of concomitant iron deficiency anemia. When using the COC has been shown to reduce the risk of developing cancer of the ovary and endometrium.

Pharmacokinetics
Desogestrel
Suction
Desogestrel, taken orally, is quickly and completely absorbed and then turns into etonogestrel. Its maximum concentration in serum is reached after 1.5 hours. Bioavailability is 62-81%.
Distribution
Etonogestrel binds to serum albumin and sex hormone-binding globulin (SHBG). Only 2-4% of the total concentration of etonogestrel in serum is present as a free steroid, 40-70% specifically binds to SHBG. An increase in the concentration of SHBG caused by ethinyl estradiol affects the distribution between blood proteins, leading to an increase in the SHBG-bound fraction and a decrease in the albumin-bound fraction. The apparent volume of distribution of desogestrel is 1.5 L / kg.
Metabolism
Etonogestrel is fully metabolized by the known metabolism of steroid hormones; The rate of metabolic elimination from serum is 2 ml / min / kg. No etonogestrel interaction was detected with concurrent ethinyl estradiol.
Removal
The concentration of etonogestrel in serum decreases in 2 stages. The final stage is characterized by a half-life (T1 / 2) of about 30 hours. Desogestrel and its metabolites are excreted by the kidneys and through the intestines in a ratio of about 6: 4.
Equilibrium conditions
The pharmacokinetics of etonogestrel are influenced by SHBG, the concentration of which increases by the action of ethinyl estradiol 3 times. With daily intake, the concentration of etonogestrel in serum increases by 2-3 times, reaching a constant value in the second half of the cycle.

Ethinyl Estradiol
Suction
Ethinyl estradiol after oral administration is rapidly and completely absorbed. Its maximum plasma concentration is reached within 1-2 hours after ingestion. Absolute bioavailability (the result of presystemic metabolism) is about 60%.

Distribution
Ethinyl estradiol nonspecific binds to serum albumin almost completely (98.5%), increases the concentration of SHBG. The apparent volume of distribution of ethinyl estradiol is 5 l / kg.

Metabolism
Ethinyl estradiol is subjected to presystemic metabolism, both in the mucous membrane of the small intestine and in the liver.Ethinyl estradiol is initially metabolized during aromatic hydroxylation to form various hydroxylated and methylated metabolites, which are present both in the free state and in the form of conjugates with glucuronides and sulfates. The rate of metabolic elimination of ethinyl estradiol from blood plasma is about 5 ml / min / kg.

Removal
The concentration of ethinyl estradiol in serum decreases in 2 stages. The final stage is characterized by T1 / 2 about 24 hours. In unchanged form, the drug is not excreted, metabolites of ethinyl estradiol are excreted by the kidneys and through the intestine in the ratio 4: 6. T1 / 2 metabolites is about a day.

Equilibrium conditions
Equilibrium concentration is reached after 3-4 days of intake, when the concentration in serum by 30-40% exceeds the concentration after taking one dose.

Indications

Contraception.

Composition

1 tablet contains
Active substances: desogestrel 0.150 mg, ethinyl estradiol 0.020 mg.
Excipients: potato starch 8.0 mg, povidone 2.4 mg, stearic acid 0.8 mg, colloidal silicon dioxide 0.8 mg, alpha-tocopherol 0.08 mg, lactose monohydrate to 80 mg.

Desogestrel, Ethinyl Estradiol is marketed under different brands and generic names, and comes in different dosage forms:

Brand nameManufacturerCountryDosage form
Mersilon N.V.Organon Netherlands pills
Marvelon N.V.Organon Netherlands pills
Model Ovule pills
Novynette® Gedeon Richter Hungary pills
Regulon Gedeon Richter Hungary pills

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Desogestrel, Ethinyl Estradiol

Dosage and Administration

pills should be taken orally in the order indicated on the packaging, every day at approximately the same time, with a little water, if necessary. Take 1 tablet daily for 21 days. Acceptance of pills from the next package should be started 7 days after the end of the previous one. During these 7 days, menstrual bleeding occurs. It usually starts 2-3 days after taking the last pill and may not stop before the next pack is started.

How to start taking the drug Mercilon®
- If hormonal contraceptives have not been used in the last month
Taking the pills should begin on day 1 of the menstrual cycle (ie, on the first day of the menstrual bleeding). You can start taking the drug on the 2-5 day of the cycle, but in this case it is recommended to use an additional (non-hormonal) method of contraception during the first 7 days of taking the pills in the first cycle.
- Transition from combined hormonal contraceptives (combined oral contraceptive, vaginal ring or transdermal patch)
It is advisable to start taking the drug Mercilon® the next day after taking the last active tablet of a previously used drug (the last tablet containing the active substances), but no later than the next day after the end of the usual interruption in taking the pills or the next day after taking the last pill that does not contain hormones. In case of using the vaginal ring or transdermal patch, it is advisable to start taking the drug Mercilon® on the day of their removal, but not later than the day when a new ring was to be inserted or the next patch applied.
If a woman used the previous method of contraception consistently and correctly and if it is reliably known that the woman is not pregnant, in this case, the woman can switch to taking the drug Mercilon® on any day of the cycle.
It should be noted that the usual interval in the application of the previous method of contraception should not exceed its recommended duration.

- Transition from drugs containing only progestogen (“mini-pili”, injections, implant) or from progestogen-releasing intrauterine system (IUD)
A woman taking a "mini-drank", can switch to taking the drug Mercilon® any day; using an implant or IUD - on the day of their removal; using the drug in the form of injections - on the day when there should be the next injection, in all cases during the first 7 days of taking the drug Mercilon® It is recommended to use additional methods of contraception.
- After the first trimester abortion
A woman can start taking the drug immediately. No need to use any additional methods of contraception.
- After childbirth or abortion made in the second trimester
For nursing mothers, see the section "Use during pregnancy and during breastfeeding."
It is recommended to start taking the drug no earlier than 21-28 days after childbirth or an abortion made in the second trimester of pregnancy. At the beginning of taking the drug at a later date, it is recommended during the first 7 days of taking the drug Mercilon® use barrier methods of contraception. In any case, if a woman after childbirth or abortion before the start of the drug Mercilon® Already had sexual contact, you should exclude pregnancy before taking the drug or wait until the first menstruation.

What to do if you miss the next drug intake
If the reception of the next pill is delayed by less than 12 hours, the reliability of contraception is not reduced. A woman should take a pill as soon as she remembers, and take the next pill at the usual time.
If the reception of a regular pill is delayed by more than 12 hours, the reliability of contraception can be reduced. In this case, the following two rules should be followed:
1. taking pills should never be interrupted for more than 7 days.
2. for adequate suppression of the hypothalamic-pituitary-ovarian system, it is necessary to take pills 7 days in a row.
The cyclical use of the drug involves 3 weeks of use. Accordingly, the following recommendations can be made:

Week 1
A woman should take the missed pill as soon as she remembered it, even if it means taking two pills at the same time. Then you should continue to receive the usual pattern. Additionally, you should use the barrier contraceptive method for the next 7 days. If a woman has had sexual intercourse within the previous 7 days, consider the possibility of pregnancy. The more pills missed, and the closer the break in taking the drug to the time of sexual intercourse, the higher the risk of pregnancy.

Week 2
A woman should take the missed pill as soon as she remembered it, even if it means taking two pills at the same time. Then you should continue to receive the usual pattern. Provided that the woman took the pills on time within 7 days preceding the first missed dose, there is no need to use additional (non-hormonal) methods of contraception. Otherwise, or if the woman missed more than 1 tablet, it is recommended to use additional methods of contraception for the next 7 days.

Week 3
Reliability of contraception can be reduced due to the subsequent interruption in the intake of the drug. This can be avoided by adapting the regimen. If you use either of the following two schemes, there is no need to use additional contraceptive measures, provided that the woman took the pills on time within 7 days preceding the first missed dose. Otherwise, it is recommended to use one of the two following schemes and also to use additional contraceptive measures for the next 7 days.
1. A woman should take a missed pill as soon as she remembered it, even if it means taking two pills at the same time. Then you should continue to receive the usual pattern. New packaging should start as soon as the current packaging ends, i.e., do not break between the packages. The likelihood of "withdrawal bleeding" before the end of the second package is small, but some may experience a spotting or heavy bleeding even while taking the drug.
2. A woman may be recommended to stop taking the drug from the current package. A woman should take a break in taking the drug Mercilon® lasting no more than 7 days, including the days when she forgot to take the pills, and then start a new package.
When you skip the drug intake and the subsequent absence of "withdrawal bleeding" in the near interruption in taking the pills, you should consider the possibility of pregnancy.

Recommendations in case of gastrointestinal disorders
In the presence of severe gastrointestinal disorders, absorption may be incomplete and additional contraceptive measures should be taken. If vomiting occurs within 3-4 hours after taking the drug, you should use the recommendations regarding skipping the next dose of the drug. If a woman does not want to change her usual regimen, she needs to take additional pill (s) from another package (the number of additional pills is determined by a specialist obstetrician-gynecologist at the in-person consultation).

How to change the period of the onset of menstrual bleeding
In order to delay menstrual bleeding, you should continue taking pills from another package of the drug Mercilon® without the usual break in reception. You can delay menstrual bleeding for any period until the end of the pills from the second package. During this period, women may experience a spotting or heavy bleeding. The drug in the usual way should be resumed after a 7-day interval in the reception.
In order to shift the day of the onset of menstrual bleeding to another day, you can shorten the usual break in the pill for as many days as necessary. The shorter the break, the higher the risk of a lack of menstrual-like bleeding during a break and the occurrence of heavy or spotting bleeding while taking pills from the second package.

Adverse reactions

  • Thrombosis or thromboembolism (including myocardial infarction, stroke, deep vein thrombosis, pulmonary thromboembolism), hepatic thromboembolism, mesenteric, renal arteries and veins, retinal arteries.
  • Increased blood pressure.
  • Hormone-dependent tumors (liver tumors, breast cancer).
  • Chloasma (especially if there is a history of chloasma during pregnancy).
  • Acyclic bloody discharge more often in the first months of administration.
  • Allergic reactions.

Contraindications

Drug Mercilon®As with other combined oral contraceptives, it should not be taken if any of the diseases (conditions) listed below are present. If any of them occur while taking the drug, you should immediately stop taking it.

  • Hypersensitivity to the active substances or to any excipient of the drug Mercilon®.
  • The presence at the moment or in the history of venous thrombosis (including deep vein thrombosis of the lower leg, pulmonary embolism).
  • Presence at the moment or in the history of arterial thrombosis (including myocardial infarction, stroke) or precursors of thrombosis (including transient ischemic attack, angina).
  • Identified susceptibility to venous or arterial thrombosis, including resistance to activated protein C, hyperhomocysteinemia, antithrombin III deficiency, protein C deficiency, protein S deficiency, antiphospholipid antibodies (antibodies to cardiolipin, lupus anticoagulant).
  • Migraine with focal neurological symptoms in history.
  • Diabetes mellitus with vascular lesions.
  • The presence of severe or multiple risk factors for venous or arterial thrombosis (including arterial hypertension with blood pressure of 160/100 mm Hg and above).
  • Pancreatitis (including history), accompanied by severe hypertriglyceridemia
  • Severe liver disease (until normalization of liver function indicators), including in the anamnesis.
  • Liver tumors (benign and malignant), incl. in the anamnesis.
  • Hormone-dependent malignant neoplasms of the genitals or mammary glands (including suspects).
  • Bleeding from the vagina of unknown etiology.
  • Smoking over the age of 35 (more than 15 cigarettes per day).
  • Pregnancy (including estimated).
  • Lactation period.
  • Lactose intolerance, lactase deficiency, glucose-galactose malabsorption.

Carefully

If any of the conditions / risk factors listed below are presently present, then the potential risk and the expected benefit of using Mercilon should be carefully weighed.® in each individual case:

  • age over 35 years;
  • smoking;
  • family history of thromboembolic diseases (venous or arterial thrombosis / thromboembolism in siblings or parents at a relatively early age);
  • obesity (body mass index> 30 kg / m);
  • dyslipoproteinemia;
  • arterial hypertension;
  • migraine;
  • valvular heart disease;
  • atrial fibrillation;
  • prolonged immobilization, extensive surgery, surgery on the lower limbs, severe trauma (with prolonged immobilization and the above surgical interventions, it is recommended to stop using the drug, with planned surgical interventions no later than 4 weeks before surgery, and not to resume reception for 2 weeks after complete remobilization);
  • varicose veins, superficial thrombophlebitis (at the moment there is no unequivocal opinion about the possible role of these conditions in the etiology of venous thromboembolism);
  • postpartum period;
  • changes in biochemical indicators which may be markers of innate or acquired predisposition to venous or arterial thrombosis, including resistance to activated protein C, hyperhomocysteinemia, antithrombin III deficiency, protein C deficiency, protein deficit S, antiphospholipid antibodies (antibodies to cardiolipin, lupus anticoagulant);
  • diabetes;
  • systemic lupus erythematosus;
  • hemolytic uremic syndrome;
  • chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis);
  • sickle cell anemia;
  • hypertriglyceridemia (including in family history);
  • acute and chronic liver diseases, incl. congenital hyperbilirubinemia (Gilbert, Dubin-Johnson syndrome, Rotor).

Drug interactions

The interaction between oral contraceptives and other drugs can lead to acyclic bleeding and / or reduce the effectiveness of contraceptives. The literature describes the following interactions.
Hepatic metabolism: interactions can occur with drugs that induce microsomal enzymes, which can lead to an increase in the clearance of sex hormones (for example, phenytoin, barbiturates, primidone, carbamazepine, rifampicin, rifabutin; and possibly also oxcarbazepine, topiramate, felbamate, ritonavir, grizome, grizyne, grizynenephylfyrophylfyrothyne, rifavutin, rhytonavir, rhymes, hormones Hypericum perforatum). The maximum induction of enzymes is not observed in the first 2-3 weeks of taking the drug Mercilon®, but may occur at the end of 4 weeks after the usual interruption in taking the drug.
A violation of the contraceptive effect when taking the drug Mercilon® with antibiotics such as ampicillin and tetracyclines. The mechanism of this influence is not clear.
Women who are taking any of the above drugs should temporarily use an additional method of barrier contraception or choose another method of contraception. With the simultaneous use of inducers of microsomal enzymes, a barrier method of contraception should be used throughout the course of treatment and for 28 days after stopping treatment. In the case of long-term treatment with the use of microsomal enzyme inducers, another method of contraception should be used. Women using antibiotics (with the exception of rifampicin and griseofulvin, which have the properties of microsomal enzyme inducers) must use a barrier method of contraception throughout the course of treatment and for 7 days after the end of therapy. If the period during which the barrier method of contraception is applied continues after the end of the pills in the KOK package, then the next package of the drug should be started without the usual interval in administration.
Oral contraceptives can affect the metabolism of other medicines.
Accordingly, their plasma and tissue concentrations can be altered: increase (for example, cyclosporine) or decrease (lamotrigine).
When treating with other drugs to determine possible interactions, it is necessary to familiarize yourself with the instructions for the medical use of these medicines.

Pregnancy and Lactation

Use of the drug Mercilon® during pregnancy is contraindicated. In case of pregnancy when using the drug Mercilon® should stop taking the drug. It should be noted that extensive epidemiological studies have not revealed an increase in the risk of having children with birth defects in women who took COCs before pregnancy, or have a teratogenic effect if they inadvertently receive COCs in early pregnancy.
Mersilon® may affect lactation, as COCs reduce the amount and change the composition of breast milk. Therefore, the use of the drug Mercilon® It is not recommended until the nursing mother completely stops breastfeeding.
A small amount of contraceptive steroids and / or their metabolic products may be excreted in milk.

Special instructions

If any of the conditions or risk factors listed below are present, you should carefully weigh the benefits and the possible harm of taking Mercilon.®. This question should be discussed with the patient before the start of the drug. In the case of exacerbation of the disease, deterioration of the condition or the appearance of the first symptoms of the above-mentioned conditions or risk factors, the patient should immediately consult a doctor. The physician should decide whether to discontinue the drug.

Vascular diseases

During epidemiological studies, it was found that there may be a link between using COCs and increasing the risk of arterial and venous thrombotic and thromboembolic diseases, such as myocardial infarction, stroke, deep vein thrombosis and pulmonary embolism. These diseases are extremely rare.

The use of any COC is associated with an increased risk of venous thromboembolism (VTE), manifested as deep vein thrombosis and / or pulmonary embolism. The risk is higher in the first year of admission than in women taking KOC for more than 1 year.

Some epidemiological studies show that women who took low-dose COCs containing the third generation of progestogens, including desogestrel, have an increased risk of VTE compared to women who have taken low-dose COCs containing the progestogen levonorgestrel.

Thrombosis occurs very rarely in other blood vessels (for example, in the veins and arteries of the liver, mesentery, kidneys, brain or retina). There is no single point of view whether this thrombosis is a consequence of using COC.

Increase in the frequency and intensity of migraines while taking the drug Mercilon® (which may be a sign of cerebrovascular disorders) may be grounds for immediate discontinuation of the drug. Tumors

The most important risk factor for cervical cancer is the persistence of human papillomavirus (HPV infection). Epidemiological studies have shown an increase in the risk of cervical cancer in women who have been using COC for a long time, but so far there is uncertainty about the extent to which various factors influence the mixing data, such as an increase in cervical screening and sexual behavior, including the use of barrier methods. contraception, or their relationship.

There is evidence that there is a slight increase in the relative risk (1.24) of breast cancer in women using COCs. The increased risk gradually decreases over 10 years after the abolition of COC. Since breast cancer in women under 40 years of age is quite rare, the increase in the likelihood of developing breast cancer in women using COCs currently or recently abandoned their use is small relative to the initial probability of developing cancer. These studies do not provide data on the etiology of cancer.The increase in the risk of breast cancer can be explained by the fact that women taking COCs, the diagnosis of breast cancer is established earlier, and the biological effects of COCs, or a combination of both of these factors. There is a tendency that women who have ever taken COCs have breast cancer that is less clinically advanced than women who have never taken COCs.

It is extremely rare when using the drug Mercilon® there have been cases of benign, and even more rarely, malignant liver tumors.
In some cases, these tumors led to life-threatening intra-abdominal bleeding. The doctor should consider the possibility of the presence of a liver tumor in the differential diagnosis of diseases in a woman taking the drug Mercilon®if symptoms include acute pain in the upper abdomen, enlarged liver, or signs of intra-abdominal bleeding.
Other diseases

If hypertriglyceridemia is diagnosed in a woman or her family members, then an increased risk of pancreatitis is possible when taking the drug Mercilon®.

If a woman uses the drug Mercilon®, persistent clinically significant arterial hypertension develops, the doctor should cancel the drug Mercilon® and prescribe the treatment of hypertension. In cases where normal blood pressure can be achieved with antihypertensive therapy, the doctor may find it possible for the patient to resume taking the drug.

There are reports that jaundice and / or itching caused by cholestasis; gallstones, porphyria, systemic lupus erythematosus, hemolytic-uremic syndrome, Sydengham's chorea (minor chorea), pregnant herpes, hearing loss due to otosclerosis, (hereditary) angioedema develops or worsens during pregnancy and when taking the drug Mercilon®however, there is evidence of this regarding the administration of the drug Mercilon®are inconclusive.

Acute or chronic abnormal liver function may serve as a basis for discontinuation of the drug Mercilon.® until the liver function normalizes. Relapse of cholestatic jaundice, observed earlier during pregnancy or when using sex steroids, requires discontinuation of the drug Mercilon®.

Although the drug Mercilon® can affect the tolerance of peripheral tissues to insulin and glucose, there is no evidence that patients with diabetes need to change the therapeutic regimen of low-dose COCs (containing less than 0.05 mg of ethinyl estradiol). In any case, women with diabetes should be carefully monitored by a doctor while taking the drug Mercilon.®.

There is evidence that there is a link between taking COC and Crohn's disease and ulcerative colitis.

Sometimes while taking the drug Mercilon® skin pigmentation (chloasma) can occur, especially if it was previously during pregnancy. Women with a predisposition to chloasma should avoid direct sunlight and ultraviolet radiation from other sources when taking the drug Mercilon®.
Medical examinations / consultations
Before starting or resuming use of the drug Mercilon® a woman must have a detailed medical history (including family history) and conduct a thorough examination. Blood pressure should be measured, and if clinically significant signs are detected, a physical examination should be carried out, guided by contraindications and warnings. The woman should be instructed to carefully read these instructions for use and follow the recommendations.The frequency and list of surveys should be based on common practice and selected individually for each woman (but at least 1 time in 6 months).
The woman should be informed that oral contraceptives do not protect against HIV (AIDS) and other sexually transmitted infections.
Reduced efficiency
The effectiveness of the drug Mercilon® may decrease if you miss a drug intake, gastrointestinal disorders or with the concomitant use of certain medications (see the section "Interaction with other medications").
Irregular spotting
When taking the drug Mercilon®, especially in the first months of use, irregular spotting or heavy spotting may occur. Therefore, the assessment of irregular bleeding should be carried out only after the end of the adaptation period, lasting three months.
If irregular bleeding persists or appears after previous regular cycles, consider possible non-hormonal causes of cycle disturbances and conduct appropriate research to rule out malignant tumors or pregnancy. These measures may include diagnostic curettage.
Some women may not have menstrual bleeding during the interval between taking the drug. If the drug Mercilon® was taken as recommended above, the probability that a woman is pregnant is small. Otherwise, or if there are no bleeding twice in a row, you should exclude the possibility of pregnancy and consult a doctor.
Laboratory research
Oral contraceptives can affect the results of some laboratory tests, including biochemical indicators of liver, thyroid, adrenal and kidney function, plasma transport proteins, such as corticosteroid-binding globulin and lipid / lipoprotein fractions, carbohydrate metabolism parameters, coagulation parameters and fibrinolysis. Typically, these changes are within normal laboratory values.
Lactose
Each tablet drug Mercilon® contains less than 80 mg of lactose. Women with rare hereditary disorders, such as lactose intolerance, lactase deficiency, glucose-galactose malabsorption, who are on a lactose-free diet should take into account the lactose content of Mercilon®.

Influence on ability to steer the car and other mechanisms
Effects of Mercilon® the ability to drive and work with mechanisms is not marked.

Overdosage

Any serious complications of an overdose of the drug Mercilon® not observed. Symptoms that may occur during an overdose: nausea, vomiting, in young girls - bloody discharge from the vagina. There are no antidotes and further treatment should be symptomatic.

  • Brand name: Mersilon
  • Active ingredient: Desogestrel, Ethinyl Estradiol
  • Dosage form: pills
  • Manufacturer: N.V.Organon
  • Country of Origin: Netherlands

Studies and clinical trials of Desogestrel, Ethinyl Estradiol (Click to expand)

  1. Effects of an oral contraceptive combination containing 0.150 mg desogestrel plus 0.020 mg ethinyl estradiol on healthy premenopausal women
  2. Contraceptive efficacy and acceptability of a monophasic oral contraceptive containing 30 μg ethinyl estradiol and 150 μg desogestrel in Latin-American women
  3. Comparative study on the acceptability of two modern monophasic oral contraceptive preparations: 30 μg ethinyl estradiol combined with 150 μg desogestrel or 75 μg gestodene
  4. Ovarian activity in women taking an oral contraceptive containing 20 μg ethinyl estradiol and 150 μg desogestrel: Effects of low estrogen doses during the hormone-free interval
  5. Plasma hormone levels in women receiving new oral contraceptives containing ethinyl estradiol plus levonorgestrel or desogestrel
  6. A multicenter efficacy and safety study of an oral contraceptive containing 150 μg desogestrel and 30 μg ethinyl estradiol
  7. Influence of gestodene and desogestrel as components of low-dose oral contraceptives on the pharmacokinetics of ethinyl estradiol (EE2), on serum CBG and on urinary cortisol and 6β-hydroxycortisol
  8. Hemostatic and metabolic effects of lowering the ethinyl-estradiol dose from 30 mcg to 20 mcg in oral contraceptives containing desogestrel
  9. Clinical comparison of monophasic oral contraceptive preparations of gestodene/ ethinyl estradiol and desogestrel/ethinyl estradiol
  10. Effects of two combined oral contraceptives containing ethinyl estradiol 20 μg combined with either drospirenone or desogestrel on lipids, hemostatic parameters and carbohydrate metabolism
  11. A prospective study on the effects on hemostasis of two oral contraceptives containing drospirenone in combination with either 30 or 20 μg ethinyl estradiol and a reference containing desogestrel and 30 μg ethinyl estradiol
  12. Study of low-density lipoprotein receptor regulation by oral (steroid) contraceptives: desogestrel, levonorgestrel and ethinyl estradiol in JEG-3 cell line and placental tissue
  13. Ethinyl estradiol-to-desogestrel ratio impacts endothelial function in young women
  14. The effects of two monophasic oral contraceptives containing 30 mcg of ethinyl estradiol and either 2 mg of chlormadinone acetate or 0.15 mg of desogestrel on lipid, hormone and metabolic parameters
  15. Bleeding pattern with drospirenone 3 mg+ethinyl estradiol 20 mcg 24/4 combined oral contraceptive compared with desogestrel 150 mcg+ethinyl estradiol 20 mcg 21/7 combined oral contraceptive
  16. Erratum to “Bleeding pattern with drospirenone 3 mg+ethinyl estradiol 20 mcg 24/4 combined oral contraceptive compared with desogestrel 150 mcg+ethinyl estradiol 20 mcg 21/7 combined oral contraceptive” [Contraception 2009;80:445–51]
  17. Effect of oral contraceptive containing ethinyl estradiol combined with drospirenone vs. desogestrel on clinical and biochemical parameters in patients with polycystic ovary syndrome
  18. Effect of a combination oral contraceptive (desogestrel+ethinyl estradiol) on the expression of low-density lipoprotein receptor and its transcription factor (SREBP2) in placental trophoblast cells
  19. Reciprocal coordination of a combination oral contraceptive containing desogestrel+ethinyl estradiol on the expression of LOX-1 and LDLR in placental trophoblast cells
  20. Efficacy, cycle control, and safety of two triphasic oral contraceptives: CyclessaTM (desogestrel/ethinyl estradiol) and Ortho-Novum® 7/7/7 (norethindrone/ethinyl estradiol) a randomized clinical trial
  21. Open, multicenter comparison of efficacy, cycle control, and tolerability of a 23-day oral contraceptive regimen with 20 μg ethinyl estradiol and 75 μg gestodene and a 21-day regimen with 20 μg ethinyl estradiol and 150 μg desogestrel
  22. Developments in contraception: a comprehensive review of Desogen® (desogestrel and ethinyl estradiol)
  23. O491 Effect of oral contraceptive containing Ethinyl Estradiol combined with Drospirenone vs Desogestrel on clinical and biochemical parameters in patients of polycystic ovarian syndrome
  24. Comparative studies of 30 μg ethinyl estradiol combined with gestodene and desogestrel on blood coagulation, fibrinolysis, and platelets

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