Nomegestrol Acetate or Chlormadinone Acetate Progestative Treatment in Women: Meningioma Behavior at Treatment Discontinuation

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Nomegestrol Acetate or Chlormadinone Acetate Progestative Treatment in Women: Meningioma Behavior at Treatment Discontinuation

Background: Associations between progestins and meningiomas is now well established. While the link between cyproterone acetate (CA) and meningioma was thoroughly studied, there is far less available data regarding the link between chlormadinone acetate (CHA) or nomegestrol acetate (NA) and risk of intracranial meningiomaMethods: We are presenting a series of 28 patients diagnosed with single or multiple meningiomas while treated with CHA-NA, in which the clinical and radiological course were analyzed after treatment discontinuation.Results: 28 women, with a mean age of 56 years old, were diagnosed with one or multiple meningioma while being treated with either CHA or NA. After stopping treatment, 89.3% showed either tumor shrinkage or tumor stabilization on follow-up MRIs. Multiple meningiomas were more likely observed in patients with long periods of treatment (>10 years, p 0.03) and seem to have a better clinical course (p 0.01). Most of the lesions were located on the skull base (55.4%). Four patients with multiple meningiomas showed discordant tumors evolution, with some tumors growing while others were decreasing. Most of the growing meningiomas were either convexity or midline lesions and more posteriorly located. Conclusion: Our study demonstrated a significant percentage of tumor diminution or stabilization after NA and CHA discontinuation. Therefore, treatment discontinuation with close monitoring should be the first measure taken if urgent surgery is not indicated. However, our results seem to be less encouraging than previously described in patients treated by CA, with more patients showing tumor growth despite treatment discontinuation. Further studies are needed to differentiate the effect of the different progestins treatment on meningiomas.

Role of adjuvant hormonal therapy in restoring reproductive function in women after endosurgical treatment of ovarian follicular cysts

In the structure of the causes of female infertility, follicular ovarian cysts make up 710% of cases. Despite the studies on the reproductive health of women undergoing endosurgical treatment of follicular ovarian cysts, the problem of restoring reproductive function has not yet been resolved. Aim. To assess the effectiveness of a preparation containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate in the restoration of reproductive function in women after endosurgical treatment of follicular ovarian cysts. Materials and methods. The study group included 100 women, of whom 70 patients (the main group) received adjuvant therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate after endosurgery, and a comparison group of 30 patients who did not receive adjuvant therapy. The diagnosis of follicular ovarian cysts was established on the basis of hormonal, ultrasound, endoscopic and immunohistochemical studies. The levels of gonadotropic hormones (LH, FSH), steroid hormones estradiol and progesterone were determined twice at the beginning of the follicular (35 day) and secretory phase (2022 day) of the menstrual cycle. An ovarian ultrasound was performed at the beginning of the follicular phase and on days 2022 of the menstrual cycle. Immunohistochemical studies of estrogen and progesterone receptors in the ovaries were carried out using a Bond-max immunostimulator from Leica (Germany) using monoclonal antibodies: clone 1D5 and clone 1A6 Dako (USA). Results. Menstrual irregularities were detected in 36 (51.4%) patients, of which: irregular menstruation in 18.0%, algomenorrhea in 15.1%, polymenorrhea in 11.0%, and menorrhea in 7.3% of patients, infertility was observed in 34 (48.6%) patients. Endosurgical treatment of follicular ovarian cysts was performed for all examined patients. Adjuvant hormone therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate was received by 70 patients. Menstrual function was restored in 70 (100%) patients. Pregnancy occurred in 60 (86.0%) of them. Conclusion. Adjuvant hormone therapy with a drug containing 0.03 mg of ethinyl estradiol and 2 mg of chlormadinone acetate allowed to restore menstrual function (100% of cases), pregnancy at 4.3 times (86.0% of cases), which confirms its high efficiency in the restoration of reproductive function in women after endosurgical treatment of follicular ovarian cysts.

Combined oral contraceptives and treatment of new coronavirus infection (COVID-19): aspects of drug interactions

This article discusses the problem of drug interactions between combined oral contraceptives on the example of Belara® (30 μg of ethinyl estradiol + 2 mg of chlormadinone acetate; Gedeon Richter, Hungary) and medications recommended for the treatment of new coronavirus infection (COVID-19) and concomitant disorders at the pharmacodynamic and pharmacokinetic levels with an assessment of the efficacy and safety of therapy for females. We described safe, potentially dangerous, and dangerous combinations of these drugs. Key words: new coronavirus infection (CAVID-19), combined oral contraceptives, antiviral drugs, antibacterial drugs, antiinflammatory drugs, anticoagulants, migraine drugs, antihypertensive drugs, oral hypoglycemic drugs, essential micronutrients, pharmacodynamic and pharmacokinetic interactions

Dose-Dependent Chlormadinone Acetate Can Suppress Premature LH Surge in Parallel with LH Value Reduction

Background: Progestin-primed ovarian stimulation (PPOS) protocol is reported as an alternative method of premature luteinizing hormone (LH) surge suppression. How much dosage of chlormadinone acetate (CMA), a synthetic progestin, is appropriate treatment for this phenomenon? Methods: Retrospective case control study was performed at private assisted reproductive technology (ART) clinic in Japan. Collected data was 231 cycles in patients who underwent either PPOS protocol using 12, 6, 4, or 2 mg of CMA, groups 6C, 3C, 2C, and 1C, respectively (total, 113 cycles), or gonadotropin-releasing hormone (GnRH) antagonist protocol, groups 6A, 3A, 2A, and 1A, respectively (total, 118 cycles). In the CMA group, CMA and human menopausal gonadotropin (hMG) or follicle-stimulating hormone (FSH) were administered simultaneously beginning on menstrual cycle day 3. Serum P, E2, and LH were determined on the day of human chorionic gonadotropin (hCG) administration. Occurrence of premature LH surge was compared between two groups. Pregnancy outcomes were also calculated. Results: Premature LH surge was completely suppressed in CMA groups 6C, 3C, and 2C. On the other hand, this phenomenon was detected in antagonist method groups (5.9%, 7/118). But spontaneous ovulation was not observed in any group, and clinical outcomes are equal to those of GnRH antagonist treatment. Conclusions: Controlled ovarian stimulation (COS) using CMA can be an appropriate alternative progestin for PPOS protocol. Since CMA is an oral medication, this method can be easy to conduct and cost-effective compared with the antagonist method. From our observation, we suggest 4 mg/day of CMA can control the egg retrieval cycle without LH surge occurrence as in other PPOS methods.