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estradiol +levonorgestrel (Fem7 Plus / HRT, Merck)

✓ Approved

Merck KGaA · ESR1 · Small Molecule

What is estradiol +levonorgestrel?

estradiol +levonorgestrel is a small molecule developed by Merck KGaA. It is approved for therapeutic indications via topical or transdermal.

Drug Profile

Brand NamesFem7 Plus, HRT, Merck
CompanyMerck KGaA
Drug ClassSmall Molecule
Molecular TargetESR1, PGR
RouteTopical, Transdermal
StatusApproved
Sources: ClinicalTrials.gov, Merck KGaA

Mechanism of Action

Molecular Targets

estradiol +levonorgestrel acts on 2 molecular targets:

ESR1estrogen receptor 1 (ER, ESR)
PGRprogesterone receptor (NR3C3, PR)
Want deeper analysis?Noah AI can explain complex mechanisms and compare to similar drugs.

Therapeutic Indications

estradiol +levonorgestrel is developed for 1 unique indication across 1 therapeutic area.

Therapeutic AreaConditionPhase
Surgical and medical proceduresHormone replacement therapy✓ Approved

Related Research Articles

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Vertebral fractures in a young woman: the impact of hypogonadism, glucocorticoids and chronic disease.

Herath Madhuni M, Nguyen Hanh H HH, Milat Frances F, Ebeling Peter R PR

A premenopausal woman was reviewed for painful vertebral fractures in the context of prednisolone exposure for her newly diagnosed systemic lupus erythematosus. Known clinical risk factors for bone loss included exposure to depot medroxyprogesterone acetate for 12 yr, cigarette smoking, a family history of osteoporosis and ongoing inflammatory arthritis. Initial investigations also identified vitamin D deficiency and low bone mass for age and sex. She was treated with vitamin D and her contraception was changed to a levonorgestrel intrauterine device. In the context of further vertebral fractures confirmed with both MRI and bone scan and having had additional secondary causes of low bone mass excluded, she commenced targeted osteoporosis treatment. We discuss the complexities of managing bone fragility in young adults and the impact of depot medroxyprogesterone acetate, inflammatory disease (systemic lupus erythematosus) and glucocorticoid-induced osteoporosis on younger adults. In this woman, antiresorptive therapy with zoledronic acid was recommended; we also explore the existing evidence-base for antiresorptive and anabolic therapies in younger adults, with a particular focus on glucocorticoid-induced osteoporosis.

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Percutaneous Transcatheter Occlusion of Acquired Gerbode Defect After TAVR.

Miller Alec G AG, Monte Andrew A, Crinzi Elizabeth E, Fernandez Stanley S et al.

Acquired Gerbode defect is a rare complication of transcatheter aortic valve replacement (TAVR). Percutaneous transcatheter closure is a reasonable yet challenging approach to management. A 74-year-old man presented with decompensated heart failure after TAVR with a balloon-expanding bioprosthesis (Edwards Sapien). Right heart catheterization revealed left-to-right shunting. Transesophageal echocardiography identified a fistula tract from the left ventricular outflow tract to the right atrium (Gerbode defect). This was closed percutaneously with an Amplatzer atrial septal occluder device (Abbott). Device retrieval and replacement was later required given residual paradevice leak. Acquired Gerbode defect is a rare complication of TAVR. There are currently no well-defined predictors, but certain patterns of calcification can be a potential cause. The defect can be successfully closed percutaneously using an atrial septal occluder device. Operators should be aware of the risk of an acquired Gerbode defect after TAVR. Transesophageal echocardiography is required for accurate diagnosis, and the defect can be repaired with a percutaneous transcatheter approach.

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The influence of different bariatric surgeries on male sex hormones and semen parameters among infertile obese male patients: an observational study.

Azhary Mahmoud M, Ali Mohamed Hassan MH, AbdELsalam Mohamed Ahmed MA, Elshal Mohamed M et al.

This research examines the impact of bariatric procedures on male sex hormones and semen parameters in infertile men with obesity. Obesity adversely affects male fertility by causing hormonal imbalances and worsening semen quality. Metabolic and bariatric surgery (MBS) offers sustained weight loss and potential reversal of these abnormalities. This prospective case series included 43 infertile men with severe obesity who underwent sleeve gastrectomy, One-anastomosis gastric bypass (OAGB), or Roux-en-Y gastric bypass. All participants had a BMI ≥ 35 kg/m² and a history of infertility for over one year. Semen analysis and hormonal profiling (FSH, LH, total testosterone, estradiol [E2], and prolactin) were conducted preoperatively and at 3, 6, and 12 months postoperatively. Significant weight loss was observed at all follow-up points (p ≤ 0.003). Improvements were noted in semen motility, progressive motility, vitality, and abnormal forms (all p ≤ 0.003). Serum testosterone levels increased, while estradiol levels decreased significantly (p ≤ 0.003). Changes in FSH, LH, and prolactin were statistically insignificant. Metabolic and bariatric surgery (MBS) is associated with marked improvements in semen quality and serum testosterone levels, supporting its role as an effective therapeutic strategy for obesity-related male infertility. No pregnancies were recorded during the 12-month follow-up. Not applicable.

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PubMedGynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology2026-05-24

Restoring ovulation in functional hypothalamic amenorrhea: impact of polycystic ovarian morphology on hormonal response to pulsatile GnRH.

Boegl Magdalena M, Kasper Isabella I, Dewailly Didier D, Mayrhofer Daniel D et al.

Up to 50% of women with functional hypothalamic amenorrhea (FHA) exhibit polycystic ovarian morphology (PCOM) on ultrasound. We aimed to compare the hormonal response to ovulation induction with pulsatile GnRH therapy in FHA patients with and without PCOM. In this single-center observational study, 41 patients with FHA underwent 3 months of pulsatile GnRH therapy to induce ovulation. Patients were categorized into a PCOM group (n = 24) and a non-PCOM group (n = 17). Serum levels of Anti-Muellerian-hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, sex hormone-binding globulin (SHBG), testosterone, and thyroid-stimulating hormone (TSH) were assessed at baseline and after 3 months of treatment. At baseline, median AMH levels were significantly higher in the PCOM group (6.21 ng/ml [IQR 4.03-8.87]) compared to the non-PCOM group (1.7 ng/ml [IQR 1.14-2.20]; p < 0.001). After 3 months of pulsatile GnRH therapy, AMH levels significantly increased in the non-PCOM group (1.94 [IQR 1.39-2.49], p < 0.001), whereas no significant change was observed in the PCOM group (p = 0.218). LH, FSH, and estradiol levels increased in both groups. Pulsatile GnRH therapy effectively induced ovulation (1 dominant follicle in each patient), irrespective of ovarian morphology. The significant AMH rise in women with FHA without PCOM likely reflects restored folliculogenesis. In contrast, the absence of an AMH rise in the PCOM group was expected, given their already elevated baseline levels. Importantly, these findings suggest that pulsatile GnRH therapy does not exacerbate AMH levels in most patients.

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PubMedJournal of environmental management2026-05-24

Efficient progesterone removal from water using molybdenum disulfide nanoparticles.

Bessai Sam S, Falyouna Omar O, Mandai Toshihiko T, Xuening Feng F et al.

Water contamination by hormone-disrupting chemicals like progesterone (PGS) poses significant risks to environmental and human health. To our knowledge, this is the first systematic study of PGS removal by pure MoS2 nanoparticles, extending previous work on MoS2 for structurally related estrogen, 17β-estradiol [1]. Owing to their two-dimensional structure, high surface area, and good stability in water, MoS2 nanoparticles can achieve higher affinity toward organic molecules like PGS compared to conventional adsorbents such as activated carbon or metal oxides. Under optimized conditions ([MoS2] = 20 mg L-1, temperature = 25 °C, pH = 7, initial PGS concentration = 20 mg L-1), a maximum removal efficiency of 98% was achieved within 1 h. Variations in environmental factors, including temperature, pH, dosage, and initial PGS concentration, influenced the removal efficiency; however, MoS2 maintained high performance across a broad range of conditions. Mechanistic analysis revealed that van der Waals forces, hydrogen bonding, and electrostatic interactions were the dominant adsorption mechanisms, as confirmed by adsorption modeling. MoS2 also demonstrated excellent reusability, with minimal performance loss after multiple cycles. A preliminary cost analysis based on raw material prices suggest that MoS2 is economically competitive with conventional adsorbents under the tested conditions. These results indicate that MoS2 is a promising candidate for the treatment of hormone-contaminated water, although further techno-economic evaluation (TEA) at larger scales is required.

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PubMedBiomedicine & pharmacotherapy = Biomedecine & pharmacotherapie2026-05-24

Prostaglandin D2 reinforces mitochondrial quality control to enhance ovarian and embryonic competence.

Shim Yu Ha YH, An Jin Young JY, Ryu Ji Soo JS, Lee Hyun Seung HS et al.

Prostaglandin D2 (PGD2) is a bioactive lipid mediator implicated in ovarian physiology; however, its role in mitochondrial regulation and aging-associated reproductive dysfunction remains insufficiently defined. Here, we investigated whether PGD2 restores ovarian competence through coordinated mitochondrial and endocrine remodeling using human granulosa (KGN) cells, primary ovarian cells from aged mice, and preimplantation embryos. PGD2 significantly enhanced cellular viability and attenuated senescence-associated β-galactosidase activity. Structural and functional analyses demonstrated restoration of mitochondrial network integrity, increased mitochondrial membrane potential (ΔΨm), elevated basal respiration, spare respiratory capacity, and ATP production, together with reduced proton leak, indicating improved oxidative phosphorylation efficiency. Mechanistically, PGD2 activated a mitochondrial stress-adaptive axis characterized by upregulation of SIRT1 and PINK1 and suppression of PARP1, suggesting enhanced mitochondrial quality control and preservation of metabolic flexibility. Concomitantly, PGD2 promoted steroidogenic activation, evidenced by increased StAR and CYP11A1 expression and significantly elevated estradiol and progesterone secretion. Adaptive remodeling of gonadotropin receptor signaling was observed, with increased LHR/LHCGR and reduced FSHR and AMH expression, reflecting a shift toward an LH-responsive maturation-aligned phenotype. Importantly, these ovarian cellular improvements translated to the embryonic stage. PGD2 enhanced mitochondrial membrane potential, accelerated cleavage kinetics, and improved progression to the morula and blastocyst stages. Blastocysts exhibited transcriptional patterns consistent with maternal metabolic reprogramming, including increased StAR, CYP11a1, Sirt1, and LHCGR expression. Collectively, these findings demonstrate that PGD2 restores ovarian resilience through hierarchical mitochondrial reinforcement, endocrine activation, and adaptive receptor remodeling, thereby enhancing embryonic developmental competence. PGD2 may represent a potential therapeutic modulator for improving reproductive outcomes under aging-associated ovarian dysfunction.

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