The brand name Estelle can be confusing, as it is used for two separate and unique hormonal medications. The traditional version, Estelle-35 (or Estelle-35 ED), is prescribed for women with androgen-dependent disorders like severe acne and excessive hair growth (hirsutism), while also providing contraception. A newer, separate medication also called Estelle, approved more recently, is a combined oral contraceptive that contains a naturally occurring estrogen called estetrol and is used exclusively for pregnancy prevention. Understanding the different active ingredients and primary indications is crucial for patients.
Estelle-35 for Androgen-Related Conditions
Estelle-35 is a combined hormonal tablet containing cyproterone acetate and ethinylestradiol. It is primarily indicated for treating conditions caused by an increased sensitivity or response to male hormones (androgens) in women.
Therapeutic Indications of Estelle-35
- Severe Acne: It is used for moderate to severe acne, especially when it is accompanied by oily skin (seborrhea), inflammation, or nodule formation and has not responded to other treatments like topical creams or oral antibiotics.
- Hirsutism: The medication can treat mild to moderate forms of hirsutism, which is the excessive growth of dark or coarse hair on areas of the body where hair doesn't normally grow or is typically fine.
- Androgenic Alopecia: It can be used for hair loss caused by androgen sensitivity in women.
- Contraception: As a combined oral contraceptive, Estelle-35 also provides effective birth control for women being treated for these androgen-dependent issues. However, it is not recommended for contraception alone.
The anti-androgenic effect of cyproterone acetate reduces the impact of androgens on skin and hair follicles, leading to a reduction in symptoms over time. Significant improvement may take several months, and treatment is often continued long-term, with periodic review by a doctor.
The Newer Estelle for Contraception
In 2021, a different hormonal birth control pill was approved, also called Estelle, which contains a unique combination of hormones.
Therapeutic Indications of Newer Estelle
- Pregnancy Prevention: This formulation's sole purpose is to prevent pregnancy. It contains estetrol, a natural estrogen derived from a plant source, and the progestin drospirenone.
- Reduced Side Effects: Clinical trials suggest that this newer Estelle may have a lower risk profile compared to older combination pills that use artificial estrogen, particularly regarding the risk of blood clots. Users have also reported less breast tenderness and spotting between periods.
Mechanism of Action
Both versions of Estelle work by altering hormone levels to achieve their desired effects, but through slightly different mechanisms:
- Estelle-35: The combination of ethinylestradiol and cyproterone acetate suppresses ovulation, making it difficult for an egg to be fertilized. The anti-androgen properties of cyproterone acetate are crucial for treating acne and hirsutism by blocking androgen receptors and reducing androgen levels.
- Newer Estelle (estetrol/drospirenone): This pill works primarily by inhibiting ovulation, thickening cervical mucus to impede sperm, and altering the uterine lining to prevent implantation. The natural estetrol component is thought to act more selectively on the body's tissues, which is why it may lead to fewer side effects.
Comparison of Estelle Formulations
| Feature | Estelle-35 (Cyproterone Acetate + Ethinylestradiol) | Newer Estelle (Estetrol + Drospirenone) |
|---|---|---|
| Active Ingredients | Cyproterone Acetate, Ethinylestradiol | Estetrol, Drospirenone |
| Primary Indication | Severe acne, hirsutism, androgenic alopecia | Contraception |
| Contraceptive Effect | Secondary, and not for contraception alone | Primary |
| Estrogen Type | Synthetic (Ethinylestradiol) | Natural (Estetrol) |
| Anti-androgen Effect | Strong, due to Cyproterone Acetate | Less pronounced than Estelle-35 |
| Risk of Blood Clots | Increased risk, similar to older COCs | Potentially lower risk than older COCs |
Important Considerations and Side Effects
As with any hormonal medication, taking any form of Estelle requires a thorough discussion of risks and benefits with a healthcare provider. Side effects vary between individuals and formulations.
Common Side Effects
- Nausea, headaches, and abdominal pain
- Breast pain or tenderness
- Mood changes or depression
- Breakthrough bleeding or spotting, especially during the first few months
- Weight changes
Serious Side Effects
- Blood Clots: Both forms increase the risk of blood clots, though the newer Estelle may have a lower risk. Symptoms include severe leg pain, chest pain, or shortness of breath.
- Liver Problems: Signs of liver issues include severe abdominal pain, yellowing of the skin or eyes (jaundice), and dark urine.
- Changes in Vision: Acute disturbances in vision are a reason to stop the medication immediately.
Contraindications
Estelle should not be used in women with a history of or active liver disease, blood clots, certain cancers, or severe diabetes with vascular problems. It is also contraindicated during pregnancy and breastfeeding.
Conclusion
When asked, "What is the drug Estelle used for?", the answer is complex because it depends on the specific formulation. Estelle-35/Estelle-35 ED is primarily an anti-androgen medication for treating conditions like severe acne and hirsutism, with a contraceptive benefit. In contrast, the newer Estelle containing estetrol and drospirenone is a combined oral contraceptive designed solely for birth control, potentially with a more favorable side effect profile. Patients must consult with their healthcare provider to determine the correct medication for their needs, carefully considering the risks and benefits of each specific formulation.
For more detailed information, patients should always refer to the specific consumer medicine information (CMI) or prescribing information provided by health authorities for their exact medication, such as the Medsafe datasheet for Estelle-35.
