From the Research
Nextstellis (drospirenone 3 mg and estetrol 14.2 mg) is not recommended as a first-choice contraceptive for a 48-year-old perimenopausal woman with a BMI of 37 due to the increased risk of venous thromboembolism associated with combined hormonal contraceptives in this population. The combination of advanced age (over 35) and obesity (BMI over 30) significantly increases the risk of venous thromboembolism with combined hormonal contraceptives like Nextstellis, as noted in a study published in the Expert Opinion on Drug Safety 1. Additionally, perimenopausal women often experience irregular bleeding patterns that may be exacerbated by combined hormonal methods.
For this patient, better contraceptive options would include:
- A levonorgestrel IUD (Mirena, Liletta), which provides excellent contraception while helping manage heavy perimenopausal bleeding
- Progestin-only methods like the depo-provera injection or progestin-only pills, which don't carry the same thrombosis risks, as supported by a systematic review published in Contraception 2
- Non-hormonal options like the copper IUD (Paragard), which could also be considered
A recent review published in Hematology: American Society of Hematology Education Program 3 highlights the importance of considering the thrombotic risk associated with hormonal contraceptives, particularly in women with risk factors such as obesity and advanced age. The patient should discuss these alternatives with her healthcare provider, who can help determine the most appropriate option based on her complete medical history, symptoms, and preferences.