Amenorrhea While Taking Freya 28 (Drospirenone/Ethinyl Estradiol)
Amenorrhea during Freya 28 use is a common and benign side effect that does not require medical treatment and should be viewed as reassurance rather than concern. 1
Causes of Amenorrhea with Combined Hormonal Contraceptives
Amenorrhea during combined hormonal contraceptive (CHC) use like Freya 28 occurs due to several mechanisms:
Endometrial suppression: The consistent hormonal levels from drospirenone and ethinyl estradiol lead to thinning of the endometrial lining, resulting in reduced or absent menstrual flow 1
Ovarian suppression: CHCs prevent ovulation by suppressing the hypothalamic-pituitary-ovarian axis, which can contribute to amenorrhea 2, 3
Duration of use: Amenorrhea becomes more common with continued use of hormonal contraceptives, particularly after several months of use 1
Unique properties of drospirenone: Drospirenone has antimineralocorticoid and antiandrogenic properties that differ from other progestins, which may contribute to its side effect profile including amenorrhea 2, 4
Clinical Significance and Management
Assessment
- Amenorrhea while taking Freya 28 does not require any medical treatment 1
- If a woman's regular bleeding pattern changes abruptly to amenorrhea, consider ruling out pregnancy if clinically indicated 1
- Amenorrhea with CHCs is not harmful and does not indicate a problem with the contraceptive's effectiveness 1
Management Approach
- Provide reassurance: Explain that amenorrhea during CHC use is common and not harmful 1
- Continue current regimen: No intervention is needed if the woman is comfortable with amenorrhea 1
- Alternative options: If amenorrhea persists and the woman finds it unacceptable, counsel her on alternative contraceptive methods 1
Important Considerations
Distinguish from other causes: Amenorrhea can also be caused by other factors such as pregnancy, stress, excessive exercise, weight changes, or other medications like selective serotonin reuptake inhibitors 5
Counseling importance: Enhanced counseling about expected bleeding patterns (including possible amenorrhea) has been shown to reduce contraceptive discontinuation in clinical trials 1
Cycle control: The incidence of irregular bleeding with drospirenone/ethinyl estradiol typically decreases rapidly after the first cycle, with good cycle control established within a few months 3
Non-contraceptive benefits: Despite amenorrhea, drospirenone/ethinyl estradiol continues to provide benefits including improvement in premenstrual symptoms and skin conditions 3, 4, 6
When to Seek Medical Attention
- If amenorrhea is accompanied by symptoms of pregnancy 1
- If there are other concerning symptoms such as severe headaches, visual changes, or significant mood alterations 1
- If amenorrhea persists after discontinuation of the contraceptive 1
Remember that amenorrhea with combined hormonal contraceptives like Freya 28 is generally considered a benign side effect and may even be viewed as a desirable outcome by some women 1.