Does Nextellis (drospirenone and ethinyl estradiol) contain less estrogen than Marvelon (drospirenone and ethinyl estradiol)?

Nextellis Contains Less Estrogen Than Marvelon

Nextellis (drospirenone/ethinyl estradiol) contains less estrogen than Marvelon (desogestrel/ethinyl estradiol), with Nextellis containing 20 μg of ethinyl estradiol compared to Marvelon's 30 μg.

Estrogen Content Comparison

• Nextellis contains 20 μg of ethinyl estradiol, which is at the lower end of the typical range for combined oral contraceptives 1
• Marvelon contains 30 μg of ethinyl estradiol, placing it in the mid-range of ethinyl estradiol dosing 1
• The ethinyl estradiol (EE) content in modern combined oral contraceptives typically ranges from 10-50 μg 1

Clinical Implications of Lower Estrogen Content

Potential Benefits of Lower Estrogen Dose

• Lower estrogen doses are associated with reduced risk of venous thromboembolism (VTE) compared to higher-dose formulations 1
• For every 10 μg increase in ethinyl estradiol, there is an associated 19% increase in VTE risk (OR 1.19 [95% CI, 1.16-1.23]) 1
• The absolute risk of VTE is approximately 3-9 per 10,000 person-years in combined oral contraceptive users, compared to 1-5 in non-users 1

Progestin Component Considerations

• Both Nextellis and Marvelon contain different progestins which also impact their overall risk profiles 1
• Nextellis contains drospirenone, a fourth-generation progestin with antimineralocorticoid and antiandrogenic properties 2, 3
• Marvelon contains desogestrel, a third-generation progestin considered less androgenic than earlier generations 1
• Drospirenone-containing pills may have a slightly higher VTE risk (approximately 10 per 10,000 person-years) compared to other combined oral contraceptives 1

Therapeutic Considerations

• Lower estrogen formulations like Nextellis may be preferred for patients concerned about estrogen-related side effects 1
• Drospirenone in Nextellis has additional benefits for treating premenstrual symptoms and acne due to its antiandrogenic properties 4, 5
• The 24/4 regimen of Nextellis (24 active pills, 4 placebo) may provide better hormone stability compared to traditional 21/7 regimens 2
• Both formulations are highly effective contraceptives with Pearl indices indicating >99% effectiveness when used correctly 3, 5

Important Considerations and Cautions

• All combined oral contraceptives, regardless of estrogen dose, are contraindicated in women with certain risk factors such as:
  • History of venous thromboembolism 1
  • Hypertension, especially in women over 35 who smoke 1
  • Migraine with aura 1
• The absolute risk of VTE with any combined oral contraceptive is still lower than the risk associated with pregnancy (5-20 per 10,000 person-years in pregnancy) 1
• While lower estrogen doses generally have fewer side effects, individual responses to different formulations can vary significantly 3

In summary, when comparing these two contraceptives specifically on estrogen content, Nextellis contains 33% less ethinyl estradiol than Marvelon, which may be advantageous for women concerned about estrogen-related side effects or risks.