What are the guidelines for taking Slynd (drospirenone) as a contraceptive option?

Slynd (Drospirenone) Contraceptive Guidelines

Slynd is a progestin-only pill containing 4 mg drospirenone that can be started anytime if pregnancy is reasonably excluded, requires backup contraception for 7 days if started more than 1 day after menses begins, and offers more flexibility than traditional progestin-only pills with a 24-hour missed pill window. 1

Indications

Slynd (drospirenone 4 mg) is FDA-approved for:

• Prevention of pregnancy in females of reproductive potential 2
• Treatment of moderate acne vulgaris in women ≥14 years who desire oral contraception 2
• Treatment of premenstrual dysphoric disorder (PMDD) symptoms in women choosing oral contraception (note: this indication applies to combination drospirenone/ethinyl estradiol formulations, not Slynd specifically) 2

How to Start Slynd

Timing of Initiation

• Can be started anytime if the provider is reasonably certain the patient is not pregnant 1
• No examination or testing required before initiation 1

Backup Contraception Requirements

• If started ≤1 day after menses begins: No backup contraception needed 1
• If started >1 day after menses begins: Use backup contraception (condoms) or abstain from intercourse for 7 days 1

This represents a key difference from traditional norethindrone/norgestrel progestin-only pills, which require only 2 days of backup contraception 1.

Dosing Instructions

Daily Administration

• Take one tablet at the same time every day 2
• Can be taken with or without food 2
• Preferably after evening meal or at bedtime 2
• Failure rate increases with missed or incorrectly taken pills 2

Pill Pack Structure

The specific formulation referenced in FDA labeling (drospirenone/ethinyl estradiol combination) contains:

• 24 active hormone tablets (brown to reddish-brown) 2
• 4 inactive tablets (white to off-white) on days 25-28 2

For Slynd specifically (drospirenone-only), the formulation differs but the same-time daily dosing principle applies 1.

Managing Missed Pills

Single Missed Pill

• Take the missed pill as soon as remembered 2
• Continue taking remaining pills at usual time (even if taking two pills same day) 2

Critical Timing Window

The drospirenone-only formulation requires 7 consecutive days of backup contraception if pills are missed beyond the first day after menses, which is longer than traditional progestin-only pills 1. This provides more flexibility than norethindrone/norgestrel POPs that have stricter timing requirements 3.

Switching from Other Methods

From Another Birth Control Pill

• Start Slynd on the same day a new pack of the previous pill would have been started 2

From Patch or Vaginal Ring

• Start when the next application would have been due 2

From Injection

• Start when the next injection would have been due 2

From IUD or Implant

• Start on the day of removal 2

Expected Bleeding Patterns

Withdrawal Bleeding

• Usually occurs within 3 days following the last active tablet 2

Breakthrough Bleeding or Spotting

• Continue taking pills as directed if spotting/breakthrough bleeding occurs 2
• This bleeding is usually transient and without significance 2
• If persistent or prolonged, consult healthcare provider 2

Missed Withdrawal Bleeding

• If one period is missed and dosing schedule was not followed: Consider pregnancy 2
• If two consecutive periods are missed even with adherence: Rule out pregnancy 2
• Discontinue if pregnancy is confirmed 2

Unique Advantages of Drospirenone

Pharmacologic Properties

• Drospirenone is a fourth-generation progestogen derived from spironolactone with antimineralocorticoid and antiandrogenic activity 4, 5
• Resembles natural progesterone more closely than traditional synthetic progestogens 5
• The 4 mg drospirenone-only formulation effectively inhibits ovulation without requiring an estrogen component 4

Clinical Benefits

• More favorable bleeding profile compared to traditional progestin-only pills 3
• Greater flexibility for delayed or missed pills while maintaining efficacy 3
• May prevent sodium retention and associated weight gain seen with some contraceptives 5, 6

Important Precautions

Pre-Initiation Assessment

• Blood pressure measurement required before starting combined hormonal contraceptives (though Slynd is progestin-only, this applies to combination drospirenone formulations) 7, 8
• No routine examination required for progestin-only pills if medical history is negative 8

Drug Interactions

• Certain anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) may reduce effectiveness 1
• Rifampin or rifabutin may reduce effectiveness 1
• St. John's wort may reduce effectiveness 1
• Broad-spectrum antibiotics, antifungals, and antiparasitics do not affect efficacy 1

Special Populations

• HIV medications: Most antiretrovirals are compatible with progestin-only pills 1
• Breastfeeding: Progestin-only pills can be started anytime postpartum, including immediately 1

Common Pitfalls to Avoid

• Do not delay initiation waiting for next menstrual period—can start anytime if not pregnant 1
• Do not confuse backup contraception requirements: Drospirenone POP requires 7 days (not 2 days like traditional POPs) if started >1 day after menses 1
• Do not discontinue for breakthrough bleeding in first 3-6 months—this is expected and usually resolves 7
• Do not assume pregnancy protection before 7 consecutive days of pills if not started within first day of menses 1, 2
• Emphasize STI protection: All contraceptives require consistent condom use for STI prevention 7