From the FDA Drug Label
WARNINGS AND PRECAUTIONS • Headache: Evaluate significant change in headaches and discontinue drospirenone and ethinyl estradiol tablets if indicated. (5.9)
11 Headache The onset or exacerbation of migraine or development of headache with a new pattern which is recurrent, persistent, or severe requires discontinuation of oral contraceptives and evaluation of the cause.
The recommended progestins in Oral Contraceptive Pills (OCPs) for managing headaches are not explicitly stated in the provided drug labels. However, both labels mention that significant changes in headaches or the onset of migraine require evaluation and possible discontinuation of the OCP.
- Bleeding irregularities Breakthrough bleeding and spotting are sometimes encountered in patients on oral contraceptives, especially during the first three months of use
For spotting, the desogestrel label suggests that breakthrough bleeding and spotting may occur, especially during the first three months of use, and that non-hormonal causes should be considered and adequate diagnostic measures taken to rule out malignancy or pregnancy.
There is no information in the provided drug labels that directly supports the use of specific progestins in OCPs for managing Polycystic Ovary Syndrome (PCOS).
Key points:
- Headaches: Evaluate and possibly discontinue OCPs if headaches worsen or change pattern 1 2
- Spotting: Breakthrough bleeding and spotting may occur, especially during the first three months of use, and non-hormonal causes should be considered 2
- PCOS: No direct information is available in the provided drug labels to recommend specific progestins in OCPs for managing PCOS 1 2
From the Research
For managing PCOS, spotting, and headaches with OCPs, drospirenone (found in Yaz, Yasmin) is the most recommended progestin due to its low androgenic activity and additional anti-androgenic and anti-mineralocorticoid properties. This is based on the most recent and highest quality study available, which suggests that drospirenone can improve premenstrual symptoms, including functional impairment, and has a good safety profile 3.
Some key points to consider when prescribing OCPs for these conditions include:
- Progestins with low androgenic activity, such as drospirenone, norgestimate, and desogestrel, are preferred for managing PCOS symptoms
- Drospirenone has additional benefits, including anti-androgenic and anti-mineralocorticoid properties, which can help with bloating and acne
- For patients experiencing spotting, pills containing norethindrone acetate or levonorgestrel may provide better cycle control, though they have higher androgenic activity
- Monophasic pills with stable hormone levels throughout the cycle are preferable to triphasic formulations for headache management
- Starting with a lower estrogen dose (20-30 mcg ethinyl estradiol) combined with one of these progestins can help minimize headaches
It's also important to note that treatment should continue for at least 3-6 months to allow for adaptation to the hormonal changes and to see full benefits, as seen in studies such as 4 and 5. Additionally, older studies like 6 and 7 provide further evidence for the effectiveness of drospirenone and other progestins in managing PCOS symptoms. However, the most recent and highest quality study 3 takes precedence in guiding clinical decision-making.