Overview of Approved Contraceptives: Drospirenone


Jenna Beckham, MD, MSPH, FACOG, and Thomas Kimble, MD, provide an overview of newly approved contraceptive modalities.

Jenna Beckham, MD, MSPH, FACOG: Let's switch and we're going to start talking about some of the more recent products that have been released into the marketplace in the last few years. We'll talk just about sort of how they're used, their mechanism of action and go through each of them. Tell me about the newer version of the progestin only pill.

Thomas Kimble, MD: Drospirenone is now used as a progestin only pill. It is the first new progestin only pill in decades. Historically we would call the norethindrone pill the mini pill, that was what was often prescribed immediately postpartum and in women who were breastfeeding or who had other risk factors where they shouldn't get estrogen, some of them that we discussed earlier. This is a new option. Drospirenone has been around since about 1976 but was first introduced in the market as a combined form of birth control back in the early 2000s. It gained a lot of traction. It was very popular. Now it is available without the estrogen component to it and it's another option that is progestin only. The way that it works is that it inhibits ovulation. It causes changes in the cervical mucus, some minor changes in the endometrium. One interesting tidbit that's gaining a little traction is we've always wondered how does the sperm find the egg? There's a theory that's gaining more traction that sperm are swimming up a progesterone gradient. When someone takes an exogenous progesterone that is throwing off that GPS signal and all of a sudden.

Jenna Beckham, MD, MSPH, FACOG: What is that?

Thomas Kimble, MD: The sperm are getting that signal, turn right and they don't know where to go. That's gaining some traction it's great though that we have a new progestin only pill. Drospirenone is an analog of spironolactone that is antimineralocortacoid. It affects hormones that deal with salt and water metabolism. Spironolactone was originally introduced as a diuretic and drospirenone has some of those same properties. It has antimineralocortacoid properties. In addition, it's got anti-androgenic properties it's a good option for women who maybe have acne or hirsutism because it does lower androgens more than other forms of birth control, all do it, but this may be a little bit more. One difference from spironolactone is that drospirenone is a progestogenic and that's where the contraceptive effect comes in.

Jenna Beckham, MD, MSPH, FACOG: The other thing that's great about this one is that it has a little bit of a longer half-life the downside as we all know for those patients taking the mini pill is that- as we just were talking about sort of the challenges sometimes of taking your pill every single day, that there's such little forgiveness with that progestin only mini pill that if you are few hours late or certainly if you miss a whole day you kind of have to reset and start over. This one gives you more of that wiggle room so a little bit of improved contraceptive efficacy and because of that longer half-life although some of the studies are still mixed but showing maybe an improved bleeding profile and not as much breakthrough bleeding as we've seen with the mini pill. It's exciting to have more than one option there in the progestin only pill arena for our patients.

Transcript edited for clarity

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