Co-cyprindiol 2000microgram/35microgram tablets

BackgroundNo conceptually new drugs for the safe and successful cure of endometriosis are likely to become available soon. Hormonal modulation of ovarian function and suppression of menstruation remain the pillars of disease control. However, existing drugs may be used following novel modalities to limit the consequences of endometriosis progression.ObjectivesThe aims of this review were to propose a pharmacological approach aimed at limiting the potential detrimental effects of the recent dramatic increase in postmenarcheal repetitive ovulatory menses and to define the type of hormones and the routes of administration that can be used to maximize safety and tolerability in the medical treatment of endometriosis.MethodsFor this narrative review, we selected the best quality evidence, prioritizing RCTs, systematic reviews, meta-analyses, network meta-analyses, and international guidelines, preferably published in the last decade.OutcomeMedical treatment of endometriosis should be included into all aspects of prevention. Very-low-dose combined oral contraceptives can be used for years to counteract the increased risk of ovarian cancer observed in patients with endometriosis. This primary prevention measure saves lives and can effectively integrate targeted risk-reducing surgery. Secondary pharmacological prevention, based on a working diagnosis of early onset adenomyosis-endometriosis selectively in adolescents with severe dysmenorrhea and heavy menstrual bleeding, can potentially impede the development of advanced disease forms, and reduce the need for management of complications due to a delay in diagnosis and treatment. Tertiary prevention, i.e., medical therapy of established disease, is based initially on the safest available estrogen-progestogen combinations and progestogen monotherapies. Whenever possible, ethinyl estradiol and cyproterone acetate should be avoided because of thromboembolic and meningioma risks, respectively. Estradiol can be administered transdermally. Switching to gonadotropin-releasing hormone agonists and antagonists should not be delayed when the first-line agents fail.Conclusions and outlookTwo-thirds of symptomatic endometriosis patients can be managed satisfactorily for many years using, with the right modality, the existing safe, effective, and well-tolerated medications. Despite the constant plea for new drugs, this already appears to be an excellent clinical outcome, unsurpassed when managing other human chronic inflammatory diseases. Cohort studies are needed to verify whether turning off the recurrent inflammation caused by repeated ovulation and menstruation could also affect the risk of systemic conditions associated with endometriosis.

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The widespread presence of estrogens in aquatic environments represents a One Health concern, as it simultaneously threatens environmental integrity, wildlife health, and human well-being. These compounds, widely used in human and veterinary medicine, are excreted in partially or unmetabolized forms and persist in the environment due to the inefficiency of conventional water treatment systems in removing them. This systematic review provides a global overview of the occurrence of estrogens in water resources. We synthesized data on study characteristics, estrogen compounds detected, their concentrations, types of water bodies, and geographic locations. In total, 39 estrogens, including natural, synthetic, and metabolite forms, were reported at concentrations ranging from 0.002 to 10,380,000.0 ng/L across 40 water body types in 59 countries on all continents. The most frequently detected compounds were estrone, estradiol, and ethinylestradiol. Estrogens were predominantly identified in wastewater treatment plant effluents, rivers, lakes, surface waters, and even drinking water sources. These findings underscore the estrogen contamination and its potential to disrupt endocrine functions across species, posing serious implications for ecosystems. Within the One Health framework, this review highlights the urgent need for integrated strategies to improve water quality monitoring, develop advanced treatment technologies, and update regulatory standards to address the multifaceted risks posed by estrogenic contaminants.

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BackgroundMeningiomas are the most common primary brain tumours in adults. Concerns have emerged about a possible link between progestogen use and intracranial meningioma; we assessed this association.MethodsIn this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, Cochrane Library, EPI-PHARE database (from inception up to November 01, 2025), pharmacovigilance reports, and backward snowballing. Eligible publications were English or French epidemiological studies, reporting associations between progestogens and intracranial meningiomas. We excluded non-original reports, abstracts-only, and studies without eligible progestogen exposure or meningioma outcomes. We extracted summary data from published reports. Risk of bias was assessed with the Newcastle-Ottawa Scale, and certainty of evidence with GRADE. The primary outcome was intracranial meningioma. Secondary outcomes were malignancy, location, and regression. Random-effects models were used, and heterogeneity was assessed with I2; a narrative synthesis was also performed.FindingsOf 542 records screened, 78 studies were included in the review, and 14 high-quality observational studies in meta-analysis; all 14 were NOS high quality, although residual confounding and potential outcome misclassification cannot be excluded. Cyproterone acetate (CPA) was associated with increased meningioma risk (5 studies; 1047 exposed; pooled-OR 12.36 (95% CI: 7.47-20.45); I2: 73.8%; GRADE: moderate). Depot medroxyprogesterone acetate was also associated (6 studies; 842 exposed; pooled-OR 2.68 (95% CI: 1.72-4.19); I2: 92.7%; GRADE: low). Chlormadinone acetate (CMA), nomegestrol acetate (NOMAC), promegestone, medrogestone, and desogestrel showed signals of increased risk (CMA 3 studies, 164-683 exposed; NOMAC 3, 171-969; promegestone 1, 83; medrogestone 1, 42; desogestrel 2, 115-287). We did not pool these estimates due to sparse, heterogeneous evidence. No signal was found for norgestrel, levonorgestrel, progesterone, dydrogesterone, or spironolactone; evidence for dienogest and hydroxyprogesterone was insufficient. Regression after withdrawal was reported for CPA and NOMAC. Tumours were predominantly anterior/middle skull base, and malignant meningiomas were more frequent with CPA, CMA, and NOMAC.InterpretationThe certainty of evidence was limited by the observational design, residual confounding, heterogeneity, and imprecision for some exposures. Use of specific progestogens, particularly high dose macroprogestogens may be associated with an increased risk of intracranial meningioma. Transparent patient information and careful clinical and, where appropriate, imaging follow-up are essential.FundingNone.

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ObjectiveTo evaluate the hemostatic profile of estetrol/drospirenone (E4/DRSP) compared with ethinylestradiol/drospirenone (EE/DRSP) in adult women.MethodsA systematic review and meta-analysis of randomized controlled trials (RCTs) was performed according to PRISMA guidelines. Eligible studies compared E4/DRSP with EE/DRSP in adult women and assessed coagulation, anticoagulation, or fibrinolytic markers. Three RCTs (n=183) met inclusion criteria. Data were extracted independently, and pooled mean differences (MD) were calculated using random-effects models.ResultsCompared to EE/DRSP, E4/DRSP was associated with higher protein S activity (MD = 21.23; 95% CI: 11.83 to 30.64; pConclusionE4/DRSP demonstrates a more favorable hemostatic profile than EE/DRSP, potentially reducing thrombotic risk. Despite the limited number of RCTs, consistency across markers supports E4 as a safer estrogenic component for contraceptive formulations, with implications for women at increased risk of venous thromboembolism.PROSPERO registry: #CRD420251074961.

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