What is Slynd (drospirenone) used for?

What Slynd Is Used For

Slynd (drospirenone 4 mg) is a progestin-only oral contraceptive pill approved by the FDA specifically for pregnancy prevention in women who choose to use an oral contraceptive. 1, 2

Primary Indication

• Contraception is the sole FDA-approved indication for Slynd, distinguishing it from combination drospirenone formulations that have additional approved uses. 1, 2

Key Distinguishing Features from Other Progestin-Only Pills

• Slynd contains drospirenone 4 mg as a standalone progestin without any estrogen component, making it the first drospirenone-only pill approved in the United States. 1, 2
• Slynd offers greater flexibility for missed pills compared to traditional progestin-only pills while maintaining contraceptive efficacy, addressing a major limitation of older progestin-only formulations. 2
• The 4 mg dose of drospirenone reliably inhibits ovulation on its own, which is the mechanism that allows for this extended missed-pill window. 1

Unique Pharmacologic Properties Relevant to Clinical Use

Antimineralocorticoid Activity

• Drospirenone is a spironolactone analogue with antimineralocorticoid properties that can lower systolic blood pressure by approximately 8 mmHg in women with baseline systolic BP ≥130 mmHg. 3
• This blood pressure-lowering effect makes Slynd particularly suitable for women who need contraception and would benefit from modest BP reduction. 3

Antiandrogenic Properties

• Unlike testosterone-derived progestins, drospirenone has antiandrogenic activity, which may provide benefits for acne and hirsutism, though these are not FDA-approved indications for the progestin-only formulation. 3, 4

Important Safety Considerations

Thrombotic Risk Profile

• Drospirenone-containing products carry a 50-80% higher VTE risk compared to levonorgestrel-containing contraceptives, with an incidence of approximately 10 events per 10,000 woman-years. 5, 3
• This elevated VTE risk is specifically attributed to the drospirenone component itself, not the estrogen. 5
• The absolute VTE risk remains low but is clinically significant when selecting among contraceptive options. 5

Absolute Contraindications

• History of deep vein thrombosis or pulmonary embolism. 6
• Uncontrolled hypertension (though controlled hypertension may actually benefit from drospirenone's BP-lowering effects). 6
• Active or severe liver disease. 6
• Current breast cancer or other hormone-sensitive malignancies. 6

Hyperkalemia Monitoring

• Serum potassium should be checked during the first treatment cycle in women taking potassium-increasing medications (ACE inhibitors, ARBs, potassium-sparing diuretics, NSAIDs, or heparin). 6
• Routine potassium monitoring is not required in healthy women without these risk factors. 6

Clinical Decision Algorithm for Slynd Selection

Choose Slynd when:

• The patient desires progestin-only contraception (e.g., due to estrogen contraindications such as migraine with aura, smoking over age 35, or breastfeeding concerns). 6
• The patient has elevated blood pressure that would benefit from the antimineralocorticoid effect. 3
• The patient needs more flexibility with missed pills than traditional progestin-only pills allow. 2
• The patient has no VTE risk factors or history. 5

Avoid Slynd when:

• The patient has any VTE risk factors or history, in which case levonorgestrel-containing options are safer. 5
• The patient is taking multiple potassium-increasing medications without ability to monitor potassium levels. 6
• The patient has any absolute contraindications listed above. 6

Common Pitfalls to Avoid

• Do not assume Slynd has the same indications as combination drospirenone products (Yaz, Vestura)—those formulations are FDA-approved for moderate acne vulgaris and PMDD, but Slynd is approved only for contraception. 6, 7, 8
• Do not overlook the elevated VTE risk when counseling patients, even though Slynd contains no estrogen; the drospirenone component itself carries this risk. 5
• Do not prescribe without screening for potassium-increasing medications, as the combination requires monitoring. 6