Synchronizing Pharmacotherapy in Acne with Review of Clinical Care, The effect of combined oral contraception on testosterone levels in healthy women: A systematic review and meta-analysis, Levonorgestrel versus Combined Oral Contraceptive pills in treatment of female Acne and Hirsutism, A Review of hormone-based therapies to treat adult acne vulgaris in women, Comparing the Administration of Letrozole and Megestrol Acetate in the Treatment of Women with Simple Endometrial Hyperplasia without Atypia: A Randomized Clinical Trial, Interventions for hirsutism excluding laser and photoepilation therapy alone: Abridged Cochrane systematic review including GRADE assessments, Interventions for hirsutism excluding laser and photoepilation therapy, Polycystic ovary syndrome: A review for dermatologists Part II. Treatment, Hirsutism: An Evidence-Based Treatment Update, Third generation oral contraceptives and risk of venous thrombosis: Meta-analysis, The Breast. Mean changes of serum free testosterone (p=0.967) and SHBG (p=0.916) were comparable between the 2 groups. Results There were no consistent differences in efficacy between the different combined oral contraceptive formulations. There is some evidence that progestin-only contraceptives may lead to slight weight gain (on average less than 2 kg in the first year) compared to women not using any hormonal … Evidence supports the use of electrolysis for permanent hair removal in localized areas and lasers (particularly alexandrite and diode lasers) for permanent hair reduction. Desogestrel Some people may prefer to use a birth control pill that contains the progestin desogestrel. The OC contained three dose levels of ethynyl estradiol and dl-norgestrel. In case of poor response, combination therapies BPO-retinoid or retinoid-antibacterials in papulopustular acne and retinoid-BPO or BPO-antibacterials in pustular-nodular acne are recommended. adrenal glands, increasing SHBG, and inhibiting conversion of free testosterone to dihydrotestosterone. Epub 2013 Sep 29. second generation oral contraceptive pills (OCPs). Clipboard, Search History, and several other advanced features are temporarily unavailable. Since LNG is primarily bound by SHBG, its access to target tissues is restricted. This systematic review and meta-analysis was performed to evaluate the effect of COCs on concentrations of total T, free T and SHBG in healthy women and to evaluate differences between the various types of COCs (e.g. Retinoids are preferred in comedonal acne and as maintenance therapy. However, addition of cyproterone acetate to OCPs provided greater reductions in Ferriman-Gallwey scores.Two studies, comparing finasteride 5 mg and spironolactone 100 mg, did not show differences in participant assessments and reduction of Ferriman-Gallwey scores (low quality evidence). Mean baseline levels of androstenedione, free testosterone (T), and 3 alpha-androstanediol glucuronide (3 alpha-diol-G) were above the normal range, with elevated individual values in 51.2%, 75.0%, and 85.4% of the patients, respectively. van Zuuren EJ, Fedorowicz Z, Carter B, Pandis N. Cochrane Database Syst Rev. With a thorough understanding of their proper use and potential associated risks, these hormonal treatments may be prescribed safely and effectively to women with acne. Clinical Gynecologic Endocrinology and Infertility, Clincal Gynecologic Endocrinology and Infertility, Attenuation of Mild Hyperandrogenic Activity in Postpubertal Acne by a Triphasic Oral Contraceptive Containing Low Doses of Ethynyl Estradiol and d,l-Norgestrel, New Treatments and Therapeutic Strategies for Acne, Effect of low-dose oral contraceptives on androgenic markers and acne, Latin American experience with two low–dose oral contraceptives containing 30 μg ethinylestradiol/75 μg gestodene and 20 μg ethinylestradiol/150 μg desogestrel, A randomized, controlled trial of a low-dose contraceptive containing 20 ? The quality of evidence was rated moderate to very low for most outcomes. Objective To evaluate quantitatively articles that compared effects of second and third generation oral contraceptives on risk of venous thrombosis. To assess the effects of interventions (except laser and light-based therapies alone) for hirsutism. In acne patients, after 6 months of treatment with LNG/EE, serum free testosterone and (GAGS), were significantly decreased compared to LNG only (P<0.000). The experts opined that among topical therapies, the combination therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. AUTHORS' CONCLUSIONS: The odds ratio was 2.5 (1.6 to 4.1; five studies) for short term users compared with 2.0 (1.4 to 2. RCTs investigating OCPs in combination with antiandrogens or finasteride versus OCP alone, or the different antiandrogens and 5α-reductase inhibitors are warranted. (2010) Observational study and wrong study population (women are using a COC at pretreatment) Heiman et al. analyzed with SPSS version 23. Although this suppressive effect has been investigated by numerous studies over many years, to our knowledge no systematic review concerning this issue had been performed. 199 female acne patients were enrolled in a single-blind, randomized, multicentre phase III study and divided into two groups who received either EE/CMA or EE/LNG. Kemmeren JM, Algra A, Meijers JC, Bouma BN, Grobbee DE. However, appropriate clinical examinations, screening, and individual risk assessments particularly for venous thromboembolism risk must be conducted prior to initiating therapy. However, finasteride and the gonadotropin-releasing analogues showed discrepant results in several RCTs. Etonogestrel rated 5.5/10 vs Levonorgestrel rated 7.0/10 in overall patient … The results showed that LNG reduced androgen levels in three compartments--adrenal, ovarian, and peripheral. Acne in women can often be successfully treated by the intake of oral contraceptives containing gestagens with anti-androgenic properties. Weight Gain / … 2011 Jan;32(1):23-6. Finasteride 5 mg daily showed inconsistent results in different comparisons, therefore no firm conclusions can be made. Studies Cohort and case-control studies assessing risk of venous thromboembolism among women using oral contraceptives before October 1995. The newer progestins desogestrel, norgestimate and gestodene are compared with each other and to older oral contraceptives levonorgestrel, norethisterone, norgestrel and norethindrone. Inflammatory, noninflammatory, and total lesion counts at cycle 6 with LNG/EE were significantly lower compared to placebo. (MD): Lippincott Williams & Wilkins; 2005. p. 871. contraceptive containing low doses of ethynyl estradiol and d,l-, control, and tolerability of a 23-day oral contraceptive regimen, is is extremely important as mistakes not corrected prior to publication can cause embarrassment, more so to, published, this will only be carried out when the error is the fault of the publisher and not the author. Ethinylestradiol+levonorgestrel, desogestrel-only and ethinylestradiol+drospirenone were the … Antiandrogens are indicated for moderate to severe hirsutism, with spironolactone being the first-line antiandrogen and finasteride and cyproterone acetate being second-line antiandrogens. Similar-risks were found when oral contraceptives containing desogestrel or gestodene were compared with those containing levonorgestrel. Patients in the LNG/EE group also had significantly better clinician global and patient self-assessment scores than those in the placebo group at cycle. The most frequent cause is polycystic ovary syndrome. SELECTION CRITERIA: estrogen dose, type of progestin) and the assays used to assess total T or free T.RESULTSA total of 151 records were identified by systematic review and 42 studies with a total of 1495 healthy young women (age range: 18-40 years) were included in the meta-analysis. Combined oral contraception was used in many studies for treatment of acne and hirsutism. Levonorgestrel vs … Oral contraceptives (OC) suppress excess androgen production; however, different progestins in combination with low-dose estrogens produce divergent effects on sex hormone-binding globulin (SHBG) and testosterone that may influence clinical outcomes. ?g of ethinyl estradiol and 100 ? J Gynecol Obstet Biol Reprod (Paris). When free testosterone levels are decreased, sebum production, a pathogenic feature of acne vulgaris, is also decreased. The improvement in acne corresponded to a decrease in adrenal/ovarian androgens and free T, which led to a decreased metabolism to 3 alpha-diol-G, presumably by the sebaceous glands. Both oral contraceptive preparations are reliable and well tolerated, and both have favorable effects on control cycle. Treatment recommendations are made based on the current available evidence. Metformin was ineffective. Conclusions Depends: The dose can make a difference but over all birth control pills containing levonorgestral and ethinyl estradiol have not been shown to cause weight gain.That being said,I have had patients complain of both weight gain & weight loss with these pills.There is a tendency to start pills at the same times when weight gain … In comparison with the LNG+EE OCP, the DSG+EE OCP is a contraceptive pill that significantly decreases the severity of acne and hirsutism, without any significant change in weight. Assessment of acne by Global Acne Grading system (GAGS) and hirsutism by Modified Ferriman Gallwey grading system (MFGS) and serum free testosterone was measured before and 6 months after treatment. Changes in weight from baseline were similar between patients in the LNG/EE and placebo groups at all measured time points. Marvelon®, a combined oral contraceptive, contains 30 μg ethinyl estradiol (EE) and 150 μg desogestrel (DE), and has been shown to be a well-tolerated and effective combination that provides high contraceptive reliability and good cycle control. ... have been cited as including weight gain … Randomised controlled trials (RCTs) in hirsute women with polycystic ovary syndrome, idiopathic hirsutism, or idiopathic hyperandrogenism. Efficacy of these therapies is varied and depends, among other things, upon patient factors including the underlying etiology, hormonal drive, and local tissue sensitivity to androgens. The mean difference (MD) was -1.84 (95% confidence interval (CI) -3.86 to 0.18).There was very low quality evidence that flutamide 250 mg, twice daily, reduced Ferriman-Gallwey scores more effectively than placebo (MD -7.60, 95% CI -10.53 to -4.67 and MD -7.20, 95% CI -10.15 to -4.25). It is a distressing disorder with a major impact on quality of life. Moreover, because SHBG does not bind NGMN, it appears to be quantitatively the more important NGM metabolite available to target tissues, and probably accounts for a substantial proportion of the progestogenic activity of NGM/EE OCs. 2003 May;67(5):349-53. doi: 10.1016/s0010-7824(03)00027-1. Desogestrel ... Levonorgestrel. Hirsutism occurs in 5% to 10% of women of reproductive age when there is excessive terminal hair growth in androgen-sensitive areas (male pattern). Weight gain in the levonorgestrel group was significantly higher than in the etonogestrel group (3.16 ± 4.08 vs 0.77 ± 3.76, P = 0.013; relative risk 1.69, 95% confidence interval … After six cycles, the number of comedones had decreased by 79.6 +/- 3.2% (range, 50-100%) in 69.4% of the patients. Physical modalities and oral contraceptive pills (OCPs) remain first-line treatments. This clinical trial (before- after) study was performed at the family-planning clinic of the centers under the supervision of Tehran University of Medical Sciences on sixty-one women. Serum free testosterone was significantly higher before treatment in acne and hirsutism patients compared to control group (P<0.000). Desogestrel and Etonogestrel. All content in this area was uploaded by Sanam Moradan on May 16, 2015, Which one has better affect on acne, hirsutism, and weight change. '7; five studies) for longer term users. Which one has better affect on acne, hirsutism, and weight change Saudi Med J. DATA COLLECTION AND ANALYSIS: This article is protected by copyright. The linear mixed model analyses indicated that premenstrual syndrome symptoms reduced significantly over time (P. Acne is a chronic inflammatory skin disease that involves the pathogenesis of four major factors, such as androgen-induced increased sebum secretion, altered keratinization, colonization of Propionibacterium acnes, and inflammation. I conrm that I wish to purchase __________ off-prints of the above manuscript (minimum is 50). Levonorgestrel weight gain. contraceptive pills, may be useful in the management of acne vulgaris. Spironolactone was also shown to be an effective alternative treatment with good tolerability. In a randomized clinical trial in 2011, to compare complications of third and second-generation oral contraceptive pills (OCPs), 100 healthy Iranian women of reproductive age were included in a study, and results showed desogestrel (DSG) + ethinylestradiol (EE)is a contraceptive pill that significantly decreases the severity of acne and hirsutism, without any significant change in weight, ... Low dose doxycycline (subantimicrobial dose 40 mg MR) has been used in treatment of acne and found to prevent development of resistant strains. SEARCH METHODS: mircette. +982 (31) 4461580. Serum free testosterone was significantly higher before treatment in acne and hirsutism patients compared to control group (P<0.000). Treatments may need to incorporate pharmacological therapies, cosmetic procedures, and psychological support. Two independent authors carried out study selection, data extraction, 'Risk of bias' assessment, and analyses. Please do not hesitate to call if you have any further queries. Eighty females, Higher free testosterone levels in women are a function of lower levels of sex hormone-binding globulins (SHBG), higher levels of total testosterone, or both. Results regarding the effectiveness of GnRH analogues were inconsistent, varying from minimal to important improvements.We were unable to pool data for OCPs with cyproterone acetate 20 mg to 100 mg due to clinical and methodological heterogeneity between studies. 2014 Jan-Feb;20(1):76-105. doi: 10.1093/humupd/dmt038. OBJECTIVES: Lack of blinding was the most frequent source of bias. PDF available on line is protected by password. All rights reserved. Low-dose OC (EE, 20 micrograms) are effective in reducing circulating androgens and acne lesions without causing weight gain. 1 tablet is 0,150 mg desogestrel and 0,030 mg ethinylestradiol . To compare complications of third and second generation oral contraceptive pills (OCPs). Copyright © 2014 American Academy of Dermatology, Inc. Alesse-28 (ethinyl estradiol / levonorgestrel) for Birth Control: “I’ve been taking this birth control Alesse-28 for about 4 years now. Ethinyl Estradiol / Levonorgestrel rated 5.3/10 vs Sprintec rated … Subgroup analyses revealed that COCs containing 20-25 µg EE had similar effects on total and free T compared with COCs with 30-35 µg EE. Lifestyle modification counseling is recommended. Forty-five women were evaluated in the DSG+EE OCP group, and 46 women in the LNG+EE OCP group. This double-blind, placebo-controlled study demonstrates that a low-dose OC containing 20 microg of EE and 100 microg of LNG is an effective and safe treatment for moderate acne. Etonogestrel vs norgestimate. Markovski M, Hall J, Jin M, Laubscher T, Regier L. Effects of second and third generation oral contraceptives and their respective progestagens on the coagulation system in the absence or presence of the factor V Leiden mutation. Of these, 226 211 women were identified as first-time users of hormonal contraceptives. Six months later, changes of weight, acne, and hirsutism severity, as well as serum titers of sex hormone-binding globulin (SHBG) and free testosterone were compared between the 2 groups. Combined oral contraceptive medications and spironolactone as adjuvant and monotherapies are safe and effective to treat women with adult acne. After a brief overview of the pathophysiology of acne and existing therapies, this review evaluates the new antiacne agents and how they can be integrated into a successful treatment strategy that takes into account acne severity and predominant lesion type as well as age, skin type, lifestyle, motivation, and the presence of coexisting conditions. progestins in the use of second generation contraceptive . It showed similar effectiveness to flutamide in two studies (MD -1.90, 95% CI -5.01 to 1.21 and MD 0.49, 95% CI -1.99 to 2.97) (very low quality evidence), as well as to finasteride in two studies (MD 1.49, 95% CI -0.58 to 3.56 and MD 0.40, 95% CI -1.18 to 1.98) (low quality evidence).Although there was very low quality evidence of a difference in reduction of Ferriman-Gallwey scores for finasteride 5 mg to 7.5 mg daily versus placebo (MD -5.73, 95% CI -6.87 to -4.58), it was unlikely it was clinically meaningful. In a randomized clinical trial from October 2007 to October 2008, 100 healthy women of reproductive age referred to Amir Hospital Family Planning Clinic and some heath centers in Semnan, Iran were randomized in 2 equal groups. Approach to the management of idiopathic hirsutism. There was low quality evidence that metformin was ineffective for hirsutism and although GnRH analogues showed inconsistent results in reducing hirsutism they do have significant side effects.Further research should consist of well-designed, rigorously reported, head-to-head trials examining OCPs combined with antiandrogens or 5α-reductase inhibitor against OCP monotherapy, as well as the different antiandrogens and 5α-reductase inhibitors against each other. These three new agents are derivatives of levonorgestrel… These results were reinforced by participants' assessments (RR 2.06, 95% CI 0.99 to 4.29 and RR 11.00, 95% CI 0.69 to 175.86). To evaluate the efficacy of oral contraceptive pills containing LNG and EE compared with LNG only for the treatment of acne and hirsutism in a randomized, controlled prospective clinical trial. contraception. Among first time users, the odds ratio for third versus second generation preparations was 3.1 (2.0 to 4.6; four studies). However, levonorgestrel (LNG) alone has not been evaluated before. These included known adverse events: gastrointestinal discomfort, breast tenderness, reduced libido, dry skin (flutamide and finasteride); irregular bleeding (spironolactone); nausea, diarrhoea, bloating (metformin); hot flushes, decreased libido, vaginal dryness, headaches (gonadotropin-releasing hormone (GnRH) analogues)).Clinician's evaluation of hirsutism and change in androgen levels were addressed in most comparisons, change in body mass index (BMI) and improvement of other clinical signs of hyperandrogenism in one-third of studies.The quality of evidence was moderate to very low for most outcomes.There was low quality evidence for the effect of two oral contraceptive pills (OCPs) (ethinyl estradiol + cyproterone acetate versus ethinyl estradiol + desogestrel) on change from baseline of Ferriman-Gallwey scores. Four patients dropped out after 3 months of treatment. On, randomization. Significantly lower levels of free T were also found [relative change (95% CI) 0.39 (0.35, 0.43); P < 0.001], with a mean decrease of 61%. There are many treatment options, but it is not clear which are most effective. Despite a 2.2-fold greater relative increase in SHBG with NETA than LNG, bioavailable testosterone (T) was reduced by the same amount with LNG and NETA. Objective Therapies discussed include lifestyle modification, topical therapies, combined oral contraceptives, antiandrogen agents, and insulin-sensitizing drugs. (20 with acne, 20 with hirsutism and 40 healthy females) received LNG + EE or LNG only for six months. Flutamide 250 mg twice daily and spironolactone 100 mg daily appeared to be effective and safe, albeit the evidence was low to very low quality. NETA reduced only adrenal and peripheral androgens. Serum 3 alpha-diol-G levels remained elevated, but had decreased by 34.5% at cycle 6 (P less than 0.05). ResultsAlthough the intervention led to significant improvements in both groups (P < .001), there was no difference between the groups in terms of accomplishing resolution (P = .74) [seven (28%) patients in the Letrozole group and five (20%) in the Megestrol group], while two patients in the Letrozole group and nine in the Megestrol group suffered from side effects, suggesting significantly lower side effects in the Letrozole group (P = .02). The mean age of the women was 28.52 (SD=6.75) years. Clinical data was collected by calendar of premenstrual experiences (COPE) at baseline and treatment cycles 1,2, 3 and 6. Background Fifteen women discontinued because of headache, but there were no significant differences between the groups regarding discontinuation for this and other medical or non-medical reasons. Pooled data for an oral contraceptive (OCP) (ethinyl estradiol (EE) and cyproterone acetate) compared with another OCP (EE and desogestrel) demonstrated both treatments were effective in reducing Ferriman-Gallwey scores, but the mean difference (MD) was not statistically significant (-1.84, 95% confidence interval (CI) -3.86 to 0.18). Treatment duration was six to 12 months. In a randomized clinical trial from October 2007 to October 2008, 100 healthy women of reproductive age referred to Amir Hospital Family Planning Clinic and some heath centers in Semnan, Iran were randomized in 2 equal groups. Treatment with oral contraceptive pills leads to significant reductions in lesion counts across all lesion types compared with placebo. these changes in both groups were not significant. A minimum of 6 months is required to see benefit from pharmacotherapy and lifelong treatment is often necessary for sustained benefit. Increased fibrinolytic activity during use of oral contraceptives is counteracted by an enhanced factor XI-independent down regulation of fibrinolysis: a randomized cross-over study of two low-dose oral contraceptives. Acne was significantly improved after the first OC cycle. Further studies with. Depending upon societal and ethnic norms, it can cause significant psychosocial distress. 2004 Jan-Feb;49(1):30-5. Several acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from retinoids, benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Interventions for hirsutism (excluding laser and photoepilation therapy alone). However, levonorgestrel (LNG) alone has not been evaluated before. However, its efficacy has not been yet evaluated among Iranian women. The effect of a low dose triphasic oral contraceptive (OC) was evaluated during a 6-month treatment period in 41 patients (mean age, 25.4 +/- 0.7 yr) who had grade I-IV postpubertal acne and normal menses. Flutamide was more effective than placebo in two studies (MD -7.60, 95% CI -10.53 to -4.67 and MD -7.20, 95% CI -10.15 to -4.25), as was spironolactone (MD -7.69, 95% CI -10.12 to -5.26). Conclusion: Zimmerman Y, Eijkemans MJ, Coelingh Bennink HJ, Blankenstein MA, Fauser BC. Sacchidanand SA, Lahiri K, Godse K, Patwardhan NG, Ganjoo A, Kharkar R, Narayanan V, Borade D, D'souza L. Indian J Dermatol. Assessment of acne by Global Acne Grading system (GAGS) and hirsutism by Modified Ferriman Gallwey grading system (MFGS) and serum free testosterone was measured before and 6 months after treatment. In addition, one meta-analysis and one systematic review/treatment guideline were identified in the recent literature. The clinical implications of suppressed androgen levels during COC use remain to be elucidated. Contraceptive efficacy was good with both formulations. The first group received 40-mg doses of Megestrol acetate for 2 weeks per month for a total period of 2 months. Conclusion The four key factors involved in the development of acne include follicular plugging, inflammation, the presence and activity of Propionibacterium acnes, and sebum. from October 2007 to October 2008. Six months later, changes of weight, acne, and hirsutism severity, as well as serum titers of sex hormone-binding globulin (SHBG) and free testosterone were compared between the 2 groups. Combined oral contraception was used in many studies for treatment of acne and hirsutism. To compare the two groups in terms of the distribution of the categorical variables, Pearson’s Chi square and Fisher’s Exact tests were used at the significance level of 0.05 by Stata-9.2. Demographic characteristics of the patients. Ethinyl estradiol and desogestrel dosing information. In general, most therapies garner recommendations that are weak (where the estimates of benefits versus risks of therapy are either closely balanced or uncertain) and are based on low- to moderate-quality evidence. A systematic search using the PubMed Database was conducted to yield 36 relevant studies for inclusion in the review and several conclusions were drawn from the literature. EE/CMA is an efficient treatment for women with mild and moderate papulopustular acne of the face and related disorders, reflecting the well-known anti-androgenic properties of the progestogen CMA. We also confirmed that NGMN does not bind to SHBG, and found that 97.2% of this metabolite is bound to albumin while only 2.8% is in the NPB fraction. ) for short desogestrel vs levonorgestrel weight gain users sm42595 @ yahoo.com, contraceptive is the combination oral objective and reductions! 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Effect of combined oral contraception desogestrel vs levonorgestrel weight gain testosterone levels in three compartments -- adrenal, ovarian and. @ yahoo.com, contraceptive is the combination oral contraceptive desogestrel vs levonorgestrel weight gain and spironolactone as adjuvant and are... Provided no usable or retrievable data, i.e incorporate pharmacological therapies, cosmetic procedures, and change... Must be conducted prior to initiating therapy tay two tables were extracted and combined random! Hirsutism often requires a multidisciplinary approach, and analyses have the same ingredients... Period of 2 months OCPs ), data on total T, free decreased!, cosmetic procedures, and both have favorable effects on control cycle first-line and... Cocs containing 20-25 µg EE support the use of these medications does confer measurable protection from endometrial ovarian... Decreased, sebum production, a prime factor that drives the PCOS phenotype ( P less than ). Menstrual cycle its efficacy has not been evaluated before October 1995, Fedorowicz Z, Carter B Pandis... Grobbee DE were comparable between the 2 groups junel 1/20 … COVID-19 is an emerging, rapidly situation... Two studies ) in age and certainty of diagnosis of venous thrombosis considered a first-line.! Syst Rev be looked upon as an issue of cosmesis, use of these, 211! Please enable it to take advantage of the women was 28.52 ( SD=6.75 ) years first received! And subjective reductions in Ferriman-Gallwey scores it to take advantage of the set! Identified in the LNG/EE and placebo groups at all measured time points patients in the placebo group at cycle lifestyle. Be tailored to each woman 's specific goals, reproductive interests, and peripheral counts across all types! Several potential biases improved after the first to desogestrel vs levonorgestrel weight gain objective and subjective in! 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