Combined oral contraceptive (estetrol-based)

Drospirenone with estetrol

Brand names: Drovelis

Adult dose

Dose: 1 tablet OD for 24 days then 4 days placebo

Route: Oral

Frequency: OD (24/4 regimen)

Clinical pearls

Estetrol (E4) is a fetal oestrogen — first new oestrogen in CHC for decades
Theoretically lower hepatic impact than ethinylestradiol — VTE/lipid signals favourable in trials but real-world data still maturing
FSRH UKMEC and CHC guideline (consider as alternative)

Contraindications

Standard CHC contraindications
Severe renal impairment (drospirenone)
Adrenal insufficiency
Hypersensitivity

Side effects

Breakthrough bleeding
Headache
Mood change
Hyperkalaemia (rare; with RAAS-active drugs)
VTE risk profile estimated lower than ethinylestradiol-based COCs (still under post-marketing surveillance)

Interactions

RAAS inhibitors (hyperkalaemia)
Enzyme inducers
Lamotrigine

Monitoring

BP
Migraine
BMI
Potassium if on interacting drugs

Reference: BNF; FSRH CHC guideline; UKMEC; SmPC; https://bnf.nice.org.uk/drugs/drospirenone-with-estetrol/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways