From the Guidelines
Drospirenone works differently than other oral contraceptive pills (OCPs) with progestin due to its unique antimineralocorticoid and antiandrogenic properties, which can help reduce symptoms like bloating, breast tenderness, and weight gain, as well as benefit women with androgen-related conditions like acne or hirsutism. Unlike other progestins such as levonorgestrel or norethindrone, drospirenone is structurally similar to spironolactone, which gives it the ability to block aldosterone receptors, counteracting estrogen-induced fluid retention 1. Additionally, drospirenone has stronger antiandrogenic activity than most other progestins, which can be beneficial for women with acne or hirsutism, as it decreases androgen production and increases sex hormone-binding globulin, binding free circulating testosterone and rendering it unavailable to bind and activate the androgen receptor 1.
Some key points to consider when prescribing drospirenone-containing OCPs include:
- They may increase potassium levels, so should be used cautiously in women with kidney, liver, or adrenal disease and those taking medications that can raise potassium 1
- They have been shown to reduce acne lesions and are approved by the FDA for the treatment of acne in women who also desire contraception 1
- They may have a lower risk of hypertension compared to other OCPs, with some studies showing decreases in systolic blood pressure after 6-12 months of use 1
- They have a unique pharmacological profile that makes them particularly suitable for women who have experienced fluid retention or androgenic side effects with other progestin formulations 1
It is essential to weigh the benefits and risks of drospirenone-containing OCPs, including the increased risk of venous thromboembolic events (VTEs) and cardiovascular risks, against the risks of the condition being treated or prevented, such as acne or pregnancy 1. Overall, drospirenone-containing OCPs can be a valuable option for women who require contraception and have androgen-related conditions or experience fluid retention with other OCPs.
From the FDA Drug Label
Drospirenone is a spironolactone analogue with anti-mineralocorticoid and antiandrogenic activity. The main difference in how drospirenone works compared to other OCPs with progestin is its anti-mineralocorticoid and antiandrogenic activity, which is due to its spironolactone analogue properties. This sets it apart from other progestins used in oral contraceptive pills (OCPs).
- Key differences:
- Anti-mineralocorticoid properties
- Antiandrogenic properties These properties may contribute to its unique effects on the body, such as its potential impact on acne and hyperkalemia. 2
From the Research
Mechanism of Action
- Drospirenone works differently than other Oral Contraceptive Pills (OCPs) with progestin due to its unique derivation from spirolactone, which gives it antimineralocorticoid activity 3.
- This antimineralocorticoid activity causes decreased salt and water retention, leading to a lowering of blood pressure 3, 4.
- Drospirenone also exhibits partial antiandrogenic activity, which may counteract the negative effects of androgens on hair growth, lipid changes, insulin, and body composition in postmenopausal women 3.
Comparison to Other Progestins
- Drospirenone has a distinct pharmacological profile compared to other progestins, with a higher affinity for the mineralocorticoid receptor and no androgenic effects 3.
- Its antiandrogenic potency is about 30% of that of cyproterone acetate, a progestin with potent antiandrogenic activity 3.
- Drospirenone's pharmacodynamic properties are similar to those of progesterone, making it a suitable component of combined oral contraceptives and hormone replacement therapy preparations 3, 4.
Clinical Effects
- Drospirenone-containing OCPs have similar efficacy and safety profiles to other low-dose OCPs but may offer improved tolerability regarding weight gain, mood changes, acne, and premenstrual dysphoric disorder 4, 5, 6.
- Drospirenone has been shown to reduce vasomotor symptoms, maintain bone mass, and have a beneficial effect on body weight and blood pressure in postmenopausal women 4, 7.
- The unique dosing regimen of drospirenone/ethinyl estradiol (24/4) has been demonstrated to be effective in preventing pregnancy and improving symptoms of premenstrual dysphoric disorder and moderate acne vulgaris 6.