How do I prescribe Slynd (drospirenone), a progestin-only pill, for continuous dosing to a female patient of reproductive age to improve menses control?

Prescribing Slynd for Continuous Dosing to Improve Menses Control

For continuous dosing with Slynd (drospirenone 4 mg), prescribe one tablet daily without any hormone-free interval—simply continue taking one pill every day without stopping between packs. This approach eliminates the 4-day placebo interval that comes with standard Slynd packaging and provides uninterrupted progestin coverage to suppress menstrual bleeding.

Dosing Instructions

Standard continuous regimen:

• Instruct the patient to take one 4 mg drospirenone tablet orally at the same time every day 1
• Skip the 4 placebo pills entirely and start a new pack immediately after finishing the 24 active pills 1
• This creates a true continuous dosing pattern without hormone-free intervals

Expected Bleeding Patterns

Breakthrough bleeding management:

• Expect higher rates of unscheduled breakthrough bleeding and spotting during the first 3-6 months compared to cyclic dosing 2
• Counsel patients that these bleeding irregularities are generally not harmful and typically improve with persistent use 2
• The drospirenone-only pill has better bleeding control than traditional progestin-only pills, with higher rates of amenorrhea over time 1

If breakthrough bleeding becomes problematic:

• Consider a brief 3-4 day hormone-free interval to allow withdrawal bleeding, which can reset the endometrium 2
• After the bleeding episode resolves (typically 11-12 days), resume continuous daily dosing 2
• This temporary interruption often improves subsequent bleeding patterns compared to continuing without interruption 2

Key Clinical Considerations

Contraceptive efficacy:

• Continuous dosing maintains the same contraceptive efficacy as cyclic dosing, with a Pearl Index similar to combined hormonal contraceptives 1
• Emphasize strict adherence to daily timing, as progestin-only pills have a narrower window for missed pills compared to combined pills 2

Advantages of drospirenone specifically:

• The antimineralocorticoid properties prevent sodium retention and may reduce bloating and weight gain associated with other hormonal contraceptives 3, 4
• Antiandrogenic effects can improve acne and hirsutism 4
• These properties make drospirenone particularly suitable for patients seeking menstrual suppression without estrogen-related side effects 1

Important Caveats

Contraindications to monitor:

• Avoid in patients with renal impairment, adrenal insufficiency, or those taking potassium-sparing medications due to drospirenone's antimineralocorticoid activity 2
• Screen for hyperkalemia risk factors before prescribing 2

Patient counseling priorities:

• Set realistic expectations: complete amenorrhea occurs in some patients, but irregular spotting is common initially 1
• Reassure that breakthrough bleeding does not indicate contraceptive failure 2
• Emphasize that continuous dosing is an off-label but clinically appropriate use of Slynd for menstrual suppression

When continuous dosing fails:

• If bleeding remains unacceptable after 6 months of continuous use, consider switching to alternative progestin-only methods (implant, IUD) or combined hormonal contraceptives if not contraindicated 5