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Progestogen (anti-mineralocorticoid, anti-androgenic) Pregnancy: Contraindicated — but inadvertent exposure during early pregnancy not associated with teratogenicity.

Drospirenone

Brand names: Slynd (POP), Yasmin (with EE), Yaz (with EE), Eloine (with EE), Lucette (with EE)

Adult dose

Dose: POP (Slynd): 4 mg OD continuously — 24 active + 4 placebo days, then no break. COC (Yasmin): 3 mg drospirenone + 30 mcg ethinylestradiol OD for 21 days, 7-day break. Yaz/Eloine: 3 mg + 20 mcg EE; 24/4 regimen.
Route: Oral
Frequency: Once daily
POP missed-pill rules: Slynd has 24-hour window (cf. 3 hr for traditional POPs) — significant adherence advantage.

Clinical pearls

  • Slynd is the first 'oestrogen-free' POP that allows a 24-hour missed-pill window (vs 3 hours for traditional POPs e.g. Cerazette/desogestrel) — significant adherence advantage.
  • Anti-mineralocorticoid effect (drospirenone is structurally derived from spironolactone): does not cause fluid retention, reduces premenstrual oedema, mild antihypertensive effect.
  • Anti-androgenic — useful first-line combined contraceptive for women with acne or PCOS-related hirsutism.
  • VTE risk with drospirenone-EE COCs is ~2× that of levonorgestrel COCs (per MHRA review). Use as first-line is acceptable but counsel about risk; switch to levonorgestrel-containing COC if VTE risk factors emerge.
  • Yaz/Eloine 24/4 regimen reduces hormone-free interval — fewer withdrawal symptoms (headache, mood) and better cycle control than 21/7 regimens.
  • Hyperkalaemia is rarely clinically significant in healthy women; check K+ if on ACEi/ARB/spironolactone or with renal impairment.

Contraindications

  • Pregnancy
  • Severe hepatic impairment, hepatic tumours
  • Acute renal impairment
  • Adrenal insufficiency
  • Hyperkalaemia (mineralocorticoid antagonism)
  • Hormone-dependent malignancy (breast, endometrial — current or history)
  • Undiagnosed vaginal bleeding
  • Active VTE or history of unprovoked VTE (combined products)
  • Migraine with aura (combined products — UKMEC 4)
  • Smokers ≥35 yrs (combined products — UKMEC 4 if ≥15/day)
  • Severe hypertension, cardiovascular disease (combined products)

Side effects

  • Hyperkalaemia (especially with K-sparing diuretics, ACEi/ARB, NSAIDs — anti-mineralocorticoid effect)
  • Breast tenderness, headache, mood changes
  • Irregular bleeding (POP — common in first 3 months)
  • Acne improvement (POP and combined — anti-androgenic)
  • Weight neutral (less weight gain than older progestogens)
  • VTE (combined products — drospirenone-EE has slightly higher VTE risk than levonorgestrel-EE — MHRA risk-benefit reviews)
  • Hypertension (combined products)
  • Reduced libido (uncommon)

Interactions

  • K-sparing diuretics, ACEi, ARB, NSAIDs, K supplements: ↑ hyperkalaemia (esp. with high doses) — check K+ if combined
  • CYP3A4 inducers (rifampicin, carbamazepine, phenytoin, St John's wort, efavirenz): ↓ contraceptive efficacy — add barrier method
  • Antibiotics (other than rifamycin): NO clinically significant interaction (MHRA 2011 — myth busted)
  • Lamotrigine (combined products): ↓ lamotrigine levels by ~50% during active pill phase — seizure risk

Monitoring

  • BP at baseline, 3 months, then annually
  • K+ if on interacting drugs or renal impairment
  • BMI annually
  • Bleeding pattern (POP — usually settles by 3 months)

Reference: BNF 90; SmPC Slynd / Yasmin / Yaz; FSRH UK MEC 2016 (amended 2019); MHRA Drug Safety Update Feb 2014 (COCs and VTE). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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