Estelle and Heidi Oral Contraceptive Pills: A Comparison
No, Estelle and Heidi are not the same oral contraceptive pills. While both are combined hormonal contraceptives (CHCs), they contain different active ingredients and formulations 1.
Key Differences Between Estelle and Heidi
- Estelle: Contains estetrol (a natural estrogen) combined with drospirenone (a fourth-generation progestin) 2
- Heidi: Typically contains ethinyl estradiol (a synthetic estrogen) combined with a different progestin 2, 3
Composition and Clinical Implications
Estelle
- Contains estetrol (15mg) with drospirenone (3mg) 2
- Estetrol is a natural estrogen that may have fewer adverse effects on blood pressure 2
- In clinical trials, this combination showed minimal impact on blood pressure with HTN incidence attributable to drug use of only 0.2% 2
- Drospirenone has anti-mineralocorticoid effects that may actually help reduce blood pressure in some users 2
Traditional OCPs (like Heidi)
- Typically contain ethinyl estradiol (synthetic estrogen) in doses ranging from 15-35 μg 2
- Combined with various generations of progestins 2
- May be associated with small but significant elevations in blood pressure 2
- The estrogen component is primarily responsible for blood pressure changes 2
Clinical Considerations When Choosing Between OCPs
- Blood Pressure Effects: Newer OCPs with natural estrogens like estetrol (Estelle) may have less impact on blood pressure than traditional OCPs with ethinyl estradiol 2
- Thromboembolism Risk: Newer formulations were developed based on the premise that naturally occurring estrogens would have fewer associated adverse effects, particularly regarding venous thromboembolism (VTE) 2
- Progestin Component: The fourth-generation progestin drospirenone (in Estelle) has anti-androgenic and anti-mineralocorticoid activity that may provide additional benefits 2
Important Considerations When Prescribing OCPs
- Baseline Risk Factors: When a woman has multiple cardiovascular risk factors, OCP choice becomes particularly important as certain formulations may increase risk to unacceptable levels 2
- Hypertension Risk: Duration of OCP use is associated with hypertension risk, with approximately 13% higher risk for every 5 years of use 2
- Monitoring: Regular blood pressure monitoring is essential, especially during the first few months of use 2
- Alternative Options: For women with contraindications to combined hormonal contraceptives, progestin-only pills (POPs) are a valuable option as they are not associated with increases in blood pressure 4
Practical Prescribing Advice
- When choosing between different OCPs, consider the patient's cardiovascular risk profile 2
- Pills containing newer formulations with natural estrogens (like Estelle) may be preferable for patients with borderline hypertension or cardiovascular risk factors 2
- The American College of Obstetricians and Gynecologists supports patient or clinician requests for specific branded OCPs if the request is based on clinical experience or if the branded product is considered a better choice for that individual patient 1