At 10 years of chlormadinone use in Latin America: a review

Abstract

Chlormadinone acetate (CMA) is a progesterone derivative (17α-acetoxy-6-chloro-4,6-pregnadiene-3,20-dione), first synthesized in 1961. It was used as progestin-based hormone replacement therapy; since 1999 it was first used for oral contraception combined with ethinyl estradiol (EE). CMA exerts a potent progestagenic effect, about one third higher than that observed with endogenous progesterone. CMA is also an anti-estrogen, showing no androgenic effects (at birth control dose). Unlike progesterone, it has a mild glucosteroidal effect with no anti-mineralocorticoid effect at all. These biological actions have allowed CMA to have a role for therapeutic use in dysmenorrhea, hyperandrogenism, and as a contraceptive agent. In addition, CMA has exhibited beneficial neuroendocrine effects on women's mood. CMA-EE combination has shown excellent contraceptive efficacy, high tolerability, and compliance due to its risk-benefit profile, having additional benefits on skin and hair, such as reduction of seborrhea and acne. Metabolic tolerance of CMA has been demonstrated in several clinical studies. Currently, CMA is formulated to be taken as oral caplets in a 21 caplets package containing 0.03 mg/EE and 2 mg CMA per pill with/without seven placebo additional pills. Another presentation has 24 caplets containing 0.02 mg/EE and 2 mg CMA plus four placebo pills.

Prospective study of fertility‐sparing treatment with chlormadinone acetate for endometrial carcinoma and atypical hyperplasia in young women

“…11,[14][15][16] In our study, no patient complained of weight gain or other adverse effects. No patients stopped treatment as the result of a lack of tolerance.Although CMA associated with ethinyl estradiol can increase DVT risk, this risk is comparable to that of other progestinsTA B L E 2 aValues are presented as number (percentage).…”

“…In clinical practice, because of these molecular effects, reduced weight gain, dysmenorrhea, bleeding, and acne or hirsutism are observed in response to CMA 11,14–16 . CMA also has a reduced impact on metabolic markers (low‐ and high‐density lipoprotein, insulin levels) in contrast to MPA 11–16 .…”

“…CMA also has a reduced impact on metabolic markers (low‐ and high‐density lipoprotein, insulin levels) in contrast to MPA 11–16 . Furthermore, CMA is the only progestin known to be safe and effective for women with high vascular risk, such as those with systemic lupus erythematosus and those with a history of venous thrombosis 13,14,17,18 …”

“…10,12,14 In clinical practice, because of these molecular effects, reduced weight gain, dysmenorrhea, bleeding, and acne or hirsutism are observed in response to CMA. 11,[14][15][16] CMA also has a reduced impact on metabolic markers (low-and high-density lipoprotein, insulin levels) in contrast to MPA. [11][12][13][14][15][16] Furthermore, CMA is the only progestin known to be safe and effective for women with high vascular risk, such as those with systemic lupus erythematosus and those with a history of venous thrombosis.…”

“…11,[14][15][16] CMA also has a reduced impact on metabolic markers (low-and high-density lipoprotein, insulin levels) in contrast to MPA. [11][12][13][14][15][16] Furthermore, CMA is the only progestin known to be safe and effective for women with high vascular risk, such as those with systemic lupus erythematosus and those with a history of venous thrombosis. 13,14,17,18 In the present prospective study, we aimed to confirm that the efficiency of 6 months CMA administration to obtain remission of AH or EC is comparable to that of the use of other fertility-sparing treatments described in the literature for patients wishing to conceive.…”