From the Guidelines
Drospirenone alternatives for OCP include levonorgestrel, norethindrone, norgestimate, and desogestrel, with norgestimate being the best option for patients who require anti-androgenic properties for acne management, as supported by the most recent guidelines 1. When considering alternatives to drospirenone-containing OCPs, it's essential to evaluate the patient's individual needs, including their risk factors for blood clots, acne, and hirsutism.
- Levonorgestrel (like Levora or Seasonale) and norethindrone (like Loestrin or Ortho-Novum) are good alternatives for contraception, but they may have more androgenic effects compared to norgestimate.
- Norgestimate (like Ortho Tri-Cyclen) is a better option for patients who require anti-androgenic properties, as it has minimal androgenic effects and is FDA-approved for the treatment of acne in women who desire oral contraception 1.
- Desogestrel (like Desogen) is another alternative, but its anti-androgenic properties are not as well-established as norgestimate. For patients who were using drospirenone for its anti-mineralocorticoid effects, pills with lower estrogen doses (20mcg ethinyl estradiol) may help minimize bloating regardless of the progestin type.
- When switching from drospirenone to another progestin, patients can typically start the new pill immediately after finishing their current pack without requiring a break or backup contraception, as stated in the guidelines for the management of acne vulgaris 1. The choice between these alternatives should consider the patient's specific needs, side effect profile, and risk factors, with a focus on minimizing morbidity, mortality, and improving quality of life.
From the Research
Drospirenone Alternatives for OCP
- Drospirenone is a progestin-only pill that has been approved for use as an oral contraceptive without an estrogen component 2.
- It has antiandrogenic and antimineralocorticoid properties, and has been shown to be effective in inhibiting ovulation 3, 2.
- Alternatives to drospirenone for OCP include:
- Estetrol-drospirenone combination oral contraceptive, which has been shown to be effective and safe in clinical trials 4.
- Other progestin-only pills, such as those containing levonorgestrel or norethindrone 3.
- Combined oral contraceptives that contain estrogen and a progestin, such as ethinylestradiol and drospirenone 5, 6.
Comparison of Drospirenone with Other Progestins
- Drospirenone has a unique profile of pharmacological properties, including antiandrogenic and antimineralocorticoid activity 5.
- It has been shown to have a favorable bleeding pattern and low risk of cardiovascular side effects 3, 5.
- Compared to other progestins, drospirenone has been shown to have a lower risk of thromboembolic events and a more favorable effect on lipid metabolism 5, 6.
Clinical Implications
- Drospirenone is a viable alternative for women who cannot or do not want to use estrogen-containing oral contraceptives 3, 2.
- The estetrol-drospirenone combination oral contraceptive may be a good option for women who want a low-dose estrogen pill with a favorable bleeding pattern and low risk of side effects 4.
- Healthcare providers should consider the individual needs and medical history of each patient when selecting an oral contraceptive, and discuss the potential benefits and risks of each option 5, 6.