Contraception and Hormonal Therapy

Introduction to Drospirenone

Drospirenone is a fourth-generation progestin derived from 17α-spirolactone, not from testosterone like earlier generations of progestins, and has unique properties compared to other progestins, including antimineralocorticoid activity and antiandrogenic properties 1

The American College of Obstetricians and Gynecologists may recommend drospirenone 3 mg with ethinyl estradiol (Yaz) for contraception, as it has a Pearl Index of 2.65 in the US and 0.44 in the EU, and may help mitigate the blood pressure-raising effects typically seen with other COCs due to drospirenone's antimineralocorticoid properties 2
The American Heart Association may note that drospirenone 4 mg alone (Slynd) has been associated with decreases in systolic blood pressure of 8 mmHg and diastolic blood pressure of 5 mmHg in patients with baseline elevated blood pressure 2

The American College of Cardiology recommends considering the risk of VTE when prescribing COCs, as users of drospirenone-containing COCs like Yaz have a VTE risk of about 10 per 10,000 woman-years, compared to a baseline risk of 1-5 per 10,000 woman-years in non-pregnant, non-COC users 3

Multiple large retrospective cohort studies have found no increased risk of hyperkalemia with drospirenone-containing COCs compared to other COCs, according to the Endocrine Society, and even concomitant use of spironolactone and drospirenone has not been associated with significant increased risk for hyperkalemia 4

Yaz is FDA-approved for contraception, treatment of premenstrual dysphoric disorder (PMDD), and treatment of moderate acne vulgaris in women at least 14 years old who desire contraception, as recommended by the American Academy of Dermatology
Slynd is approved for contraception and may be particularly beneficial for women who cannot use estrogen-containing contraceptives, have hypertension or risk factors for VTE, or experience estrogen-related side effects with combined hormonal contraceptives, according to the American College of Obstetricians and Gynecologists