Drospirenone with estetrol

How it works

Inhibits ovulation by suppressing gonadotrophins; drospirenone additionally has antimineralocorticoid and antiandrogenic activity, while estetrol provides oestrogenic cycle control with a selective tissue action.

Prescribing in practice

• Avoid in women at high venous or arterial thrombosis risk and other UKMEC category 4 contraindications to combined hormonal contraception.
• Drospirenone has antimineralocorticoid activity, so use caution and consider potassium monitoring when co-prescribed with other potassium-raising drugs in those with renal or adrenal impairment.
• Efficacy is reduced by enzyme-inducing medicines.

Monitoring

Check blood pressure and review thrombotic and cardiovascular risk at follow-up; consider serum potassium where other potassium-raising drugs are co-administered.

Counselling the patient

• Report leg pain or swelling, chest pain, breathlessness, or sudden severe headache or neurological symptoms urgently.
• Follow the missed-pill guidance and take tablets at around the same time each day.
• It does not protect against sexually transmitted infections.

Evidence & guidelines

Combined hormonal contraceptive prescribing follows FSRH and MHRA risk guidance for thromboembolic and cardiovascular safety.