GP Connect Clinical Feature By Dr Alison Creagh – MBBS, DipRANZCOG, MHPE; Medical Educator at Sexual Health Quarters
While highlighting long acting reversible contraceptives (LARCs), due to their significantly higher efficacy and low to no hormones, it may be easy to forget to include progestogen only pills (POP) when discussing contraceptive choices*
The POPs available in Australia until recently had the major disadvantage of needing to be taken within three hours of the usual time, or they became much less effective. An alternative option with a 24-hour window is now available (see fig 1.1).
Like other available POPs, with the drospirenone POP:
- efficacy is around 93 per cent with typical use, and 99.3 per cent perfect use
- irregular bleeding is common
- acne and other hormonal side effects are uncommon (1 per cent had acne with drospirenone POP)
- contraindications include breast cancer, severe cirrhosis, and liver tumours
- liver enzyme inducing medications will reduce efficacy.
Possible metabolic effects of the drospirenone POP were well investigated, and in summary were:
- no increased risk of VTE, hypertension, adverse lipid or glucose changes or weight gain
- physiological oestrogen levels were maintained, and it was therefore assumed to have no impact on bone mineral density.
It was found to be equally effective for overweight and obese women as for those of normal weight.
Direct comparisons with other POPs available in Australia are not available, so it is suggested to use a similar pragmatic approach to those for other contraceptive pills – if side effects are experienced with one formulation of POP, try another and see what happens.
For information on starting the drospirenone POP, see the clinician guidance section of SHQ and other national family planning organisations, eg. Visit the
SHQ website and click on the link ‘For Clinicians’.
*Note: Some journal articles referenced below may be associated with pharmaceutical companies.
References:
- Family Planning Alliance Australia. In: Efficacy of contraceptive methods. 2019 Family Planning Alliance Australia.
- Palacios S, Colli E, Regidor PA. Bleeding profile of women using a drospirenone-only pill 4 mg over nine cycles in comparison with desogestrel 0.075 mg. PLoS One. 2020;15(6):e0231856-e0231856.
- Regidor P-A, Colli E, Palacios S. Overall and bleeding-related discontinuation rates of a new oral contraceptive containing 4 mg drospirenone only in a 24/4 regimen and comparison to 0.075 mg desogestrel. Gynecol Endocrinol. 2021;37(12):1121-1127.
- Palacios S, Regidor P-A, Colli E, Skouby SO, Apter D, Roemer T, et al. Oestrogen-free oral contraception with a 4 mg drospirenone-only pill: new data and a review of the literature. The European journal of contraception & reproductive health care. 2020;25(3):221-227.