Drospirenone/Ethinylestradiol: A Review on Efficacy and Noncontraceptive Benefits

Estrogenic potency of endocrine disrupting chemicals and their mixtures detected in environmental waters and wastewaters

Endocrine disrupting chemicals such as natural and synthetic steroid hormones and bisphenols are among the most important pollutants in the aquatic environment. We performed an environmental chemical analysis of five Slovenian water samples, two rivers, one groundwater, and the influent and effluent of wastewater treatment plants, with a highly sensitive analysis of twenty-five endocrine-disrupting compounds belonging to the groups of natural hormones, synthetic hormones, and bisphenols. Since these compounds are simultaneously present in the environment, it is important to study their individual effects as well as the effects of mixtures. We investigated in vitro the estrogenic potency of selected natural and synthetic steroid hormones and bisphenols detected in surface, ground and waste water in Slovenia using the OECD-validated transactivation assay on the cell line Hela9903. We predicted their mixture effects using the concentration addition model and compared them with experimentally determined values. Two mixing designs were used: a balanced design in which chemicals were combined in proportion to their individual EC₅₀ values, and an unbalanced design with compounds in proportion to their measured concentrations in the environmental samples. The estrogenic effects of the experimental mixtures followed the concentration addition model. Real water samples exhibited weaker estrogenic effects, showing the great heterogeneity of the real water samples.

17α-Ethinylestradiol (EE2): concentrations in the environment and methods for wastewater treatment – an update

17α-Ethinylestradiol (EE2) is a frequently used drug and an endocrine disruptive substance. Adverse effects on biota have been reported when they are exposed to this substance in the environment. The last review on EE2 in the environment was published in 2014. Since then, well above 70 studies on EE2 and related substances have been published. The aim of this review was therefore to bring together recent data with earlier ones. The topics emphasized were observable trends of environmental levels of EE2 and methods to reduce EE2 levels in wastewater, before it can enter the environment. This should give an overview of the recent knowledge and developments regarding these environmental aspects of EE2. In the studies discussed, EE2 levels in surface waters were well detectable in many countries, both above and below the predicted no effect concentration (PNEC) of 0.035 ng L⁻¹, although analytical methods used for the quantification often are unsatisfactory regarding their limit of detection. To support the degradation of EE2 prior to entry into the environment, appropriate treatment methods could help to control the emissions of EE2. Several methods for the reduction of EE2 levels of up to 100% removal efficiency were reported recently and are of chemical, biological, adsorptive or ion-exchange nature. Depending on the required properties like initial EE2 concentration or treatment duration, several promising methods are available.

17α-Ethinylestradiol (EE2) is a frequently used drug and an endocrine disruptive substance.

Effects of different progestins on prostaglandin biosynthesis in human endometrial explants

OBJECTIVE

To compare the effects of chlormadinone acetate (CMA), dienogest (DNG) and drospirenone (DRSP) on prostaglandin biosynthesis in a human endometrial explants model.

STUDY DESIGN

Human endometrial explants obtained by aspiration curettage and human endometrial YHES cells were stimulated with interleukin-1β (IL-1β) and exposed to CMA, DNG, DRSP or dexamethasone (DEX; YHES cells). Cellular messenger RNA (mRNA) levels of cyclooxygenase-2 (COX-2) were analyzed by reverse-transcription quantitative real-time polymerase chain reaction. Concentrations of prostaglandin F_2α (PGF_2α) in culture supernatants were measured by enzyme-linked immunosorbent assay.

RESULTS

CMA exerted after IL-1β stimulation a stronger down-regulation of COX-2 mRNA compared to DNG and DRSP in human explants (-55% vs. -40% and 46%, respectively). The effect of CMA on COX-2 mRNA was significantly stronger (p=.025) than that of DNG. Moreover, the effect of CMA was independent from cycle phase or presence of endometriosis. In order to evaluate the impact of the investigated progestins on effector molecules, PGF_2α release was determined in supernatants. Again, CMA reduced the PGF_2α release significantly by an average of -60% (p<.01). In contrast, no significant reduction was found for DNG and DRSP. In YHES cells, only DEX but not the progestins under study exerted a significant down-regulating effect (-79%, p<.01) on COX-2 mRNA after IL-1β stimulation.

CONCLUSION

Among the tested progestins, CMA displayed the most consistent suppression of prostaglandin biosynthesis in human endometrial explants.

IMPLICATION

Among three tested progestins, chlormadinone acetate had the most consistent suppressive effect on prostaglandins in endometrial explants. These findings support clinical observations about the efficacy of chlormadinone acetate in dysmenorrhea treatment.

Comparing treatments for endometriosis-related pain symptoms in patients with migraine without aura

Endometriosis is a gynecological disorder defined by the presence of endometrial-like tissue outside the uterus. Several studies have found an epidemiological correlation between endometriosis and migraine, probably due to the association of both diseases with female hormones. Progestins or combined oral contraceptives are the first-line medical therapy in women with endometriosis; however, it is well known that in some women the use of combined oral contraceptives could exacerbate migraine. This observation poses a challenge to clinicians who must concomitantly treat endometriosis-related symptoms and migraine. This review summarizes the available literature on the medical treatment of endometriosis in women suffering concomitant migraine without aura until March 2012. Due to the lack of available studies on this topic, it is difficult to draw definitive conclusions. Further studies evaluating hormonal therapies are needed; in particular, progestin therapy should be reconsidered in women with migraine and concomitant endometriosis.

Pharmacology and clinical use of sex steroid hormone receptor modulators

Sex steroid receptors are ligand-triggered transcription factors. Oestrogen, progesterone and androgen receptors form, together with the glucocorticoid and mineralocorticoid receptors, a subgroup of the superfamily of nuclear receptors. They share a common mode of action, namely translating a hormone-i.e. a small-molecule signal-from outside to changes in gene expression and cell fate, and thereby represent "natural" pharmacological targets.For pharmacological therapy, these receptors have originally been addressed by hormones and synthetic hormone analogues in order to overcome pathologies related to deficiencies in the natural ligands. Another major use for female sex hormone receptor modulators is oral contraception, i.e. birth control.On the other side, blocking the activity of sex steroid receptors has become an established way to treat hormone-dependent malignancies, such as breast and prostate cancer.In this review, we will discuss how the experience gained from the classical pharmacology of these receptors and their molecular similarities led to new options for the treatment of gender-specific diseases and highlight recent progress in medicinal chemistry of sex hormone-modulating drugs.

Contraceptives with novel benefits

INTRODUCTION

Progesterone receptor (PR) agonists (progestins) and antagonists are developed for female contraceptives. However, non-contraceptive applications of newer progestins and PR modulators are being given more attention.

AREAS COVERED

The newer PR agonists including drospirenone, nomegestrol, trimegestone, dienogest and nestorone are being evaluated as contraceptives with health benefits because of their unique pharmacological properties. The selective PR modulators (SPRM; PR antagonists with PR agonistic properties) are under development not only for emergency contraception but also for other health benefits such as the treatment of endometritis and leiomyoma. After searching the literature from PubMed, clinicaltrials.gov and patent database, this review focuses on the effects and mechanisms of these progestins, and SPRMs as contraceptives with other health benefits.

EXPERT OPINION

PR agonists and antagonists that have novel properties may generate better contraceptive effects with other health benefits.