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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.
Chinese abstract
醋酸氯地孕酮（Chlormadinone acetate, CMA）是一种孕酮的衍生物（17α-羟基-6-氯-孕甾-4，6-二烯-3，20-二酮醋酸），于1961年被合成。它起初被用于基于孕激素的激素替代治疗；从1999年起与炔雌醇（EE）联合被用于口服避孕药。CMA的孕激素效应较强，比内源性孕酮高出约1/3。CMA还有抗雌激素作用，未发现雄激素作用（在避孕剂量）。与孕酮不同，CMA有微弱的糖皮质激素作用，完全没有抗盐皮质激素作用。以上生物学特征使得CMA可被用于治疗痛经、高雄激素，以及避孕。此外，CMA还表现出对女性情绪有利的神经内分泌作用。通过风险受益分析，CMA-EE复合剂表现出卓越的避孕效果、高耐受性与依从性，且对于皮肤和头发有额外的受益，例如可减少皮脂溢与痤疮。CMA的代谢情况已被多个临床研究所阐述。目前，CMA的制剂为口服药片，一种包装为含21片0.03EE与2mgCMA复合片，此外含或不含7片安慰剂。另一种包装含24片0.02mg EE与2mg CMA复合片，4片安慰剂。
Acknowledgements
The authors would like to thank Grünenthal Latin America for its unrestricted support in the logistics for our meeting to take place.
Declaration of interest
None of the authors of this manuscript has received honoraria from Grünenthal Latin America. Grünenthal Latin America provided logistic support for the experts to be gathered. No honoraria or grants were received from any sponsor for this manuscript. Therefore, there is no conflict of interest.