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Amazing women! | the art of menstruation | artists (non-menstrual) | asbestos | belts | bidets | founder bio | Bly, Nellie | MUM board | books: menstruation and menopause (and reviews) | cats | company booklets directory | contraception and religion | costumes | menstrual cups | cup usage | dispensers | douches, pain, sprays | essay directory | extraction | famous women in menstrual hygiene ads | FAQ | founder/director biography | gynecological topics by Dr. Soucasaux | humor | huts | links | masturbation | media coverage of MUM | miscellaneous | museum future | Norwegian menstruation exhibit | odor (olor)| pad directory | patent medicine | poetry directory | products, current | religion | your remedies for menstrual discomfort | menstrual products safety | science | shame | slapping, menstrual | sponges | synchrony | tampon directory | early tampons | teen ads directory | tour of the former museum (video) | underpants directory | videos, films directory | Words and expressions about menstruation | Would you stop menstruating if you could? | What did women do about menstruation in the past? | washable pads
More articles by Dr. Soucasaux: Anatomical drawings - Anovulatory cycles - Archetypal aspects of the female genitals - The breasts: some morphological aspects - Colposcopy - Comments on the corpus luteum and related aspects - Comments on some anatomical and symbolic aspects of the female pelvis - The curious relations between androgens and estrogens in women - Drospirenone Oral Contraceptives - Due to prohibition, Brazilian women don't have access to modern medicinal abortion - Endocrinology of menstruation - The Fallopian tubes - Female sexual response - The Gräfenberg Spot (G-Spot) - The Gynecologic Palpation (descendant of "The Touch") - Gynecological assistance: the three basic areas - Gynecology and Gynecologic Surgery - Gynecologist versus obstetrician: what lies behind the combination? - "Gyneco-obstetric-surgical" stubborness and the perpetuation of one of the greatest mistakes of women's medicine - Hypermenorrhea and/or Menorrhagia (Prolonged and/or Excessive Menstrual Bleedings) - Hypertrichosis, Hirsutism and Androgenic Manifestations in Women - Mayer-Rokitansky-Kuster-Hauser (MRKHauser) Syndrome - Menstrual toxin: An old name for a real thing? - Nature and the ovaries - On the Intimate, or Small-Scale, Mechanisms of Menstruation - On the Strange Nature of the Ovaries - Oral hormonal contraceptives (the "Pill") - The Ovaries: Some Functional and Archetypal Considerations - Peculiarities of the Female Genitals' Sensory Innervation - Physiology of menstruation - Polycystic ovaries syndrome - The Possibility of Becoming Pregnant, Its Implications for Women, and Abortion - Premenstrual congestion of the breasts - Premenstrual syndrome (PMS) - The Psychology of Gynecology part 1 (part 2) - Psychosomatic and symbolic aspects of menstruation - Psychosomatic gynecology - Some Details on the Function of the Hypothalamus-Pituitary-Ovaries Axis - Stanislav Grof's Perinatal Matrixes of the Unconscious and Women's Medicine - Symmetric Patterns in the Female Genitals - Thoughts on Female Sexual Psychology - Uninterrupted use of hormonal contraceptives for menstrual suppression: why I do not recommend it - The uterine cervix - Uterine contractility - The Uterus and the Female "Passive-Active" - Women's corporeal consciousness and experience - Women's Experience of the Breasts - Women's Undesired Pregnancies and Women's Right to Abortion and see his Art of Menstruation


Drospirenone Oral Contraceptives
(August 2007)

Dr. Nelson Soucasaux , Brazilian gynecologist

Some years ago a new progestin (synthetic progesterone) named drospirenone was synthesized and, associated with the widely-known estrogen ethinyl estradiol, is now giving rise to a new generation of oral contraceptives. When compared to the other ones, these new contraceptives seem to possess some slightly different metabolic effects due to drospirenone's particular properties. Even so, their contraceptive mechanisms (the ways they prevent pregnancy) are the same of all the other combined oral ones.

When compared to all the other existing synthetic progestins, drospirenone's progestogenic effect is said to be closer to that of natural progesterone, besides possessing a particular anti-mineralocorticoid and anti-androgenic activity. Curiously, drospirenone was chemically obtained having the anti-mineralocorticoid spironolactone as precursor (actually, drospirenone is considered a spironolactone analog. About that, see Note below.)

The slight anti-mineralocorticoid activity and its consequent also slight diuretic effect is due to the fact that, to some extent, drospirenone is able to reduce the effect of aldosterone. (Aldosterone is the main adrenal hormone responsible for controlling the retention of sodium and water in the body and, therefore, the hydric balance.) Thus by slightly reducing aldosterone's effect and stimulating natriuresis (the elimination of sodium and water by the kidneys), the new "Pills" containing drospirenone are said to be able to avoid or reduce the swelling frequently associated with most of the other oral contraceptives.

"Pills" containing drospirenone are also said to be potentially beneficial for women who exhibit the hydric retention and swelling typical of many cases of premenstrual syndrome (though in clinical practice the intensity of this effect may be still somewhat uncertain and, obviously, will depend on each woman's reaction to the product). Natural progesterone also possesses some diuretic effect.

As all the other progestins contained in the usual oral contraceptives do not possess anti-mineralocorticoid effects, the sodium and water retention sometimes induced by their estrogenic component is not counterbalanced. Conversely, "Pills" containing drospirenone, due to the anti-mineralocorticoid property of this new progestin, are said to be able to oppose this sodium and water retention sometimes related to the oral contraceptives' estrogenic component.

Drospirenone is also endowed with a considerable anti-androgenic effect, though it seems to be less than that of cyproterone (the widely-known anti-androgenic progestin used in some oral contraceptives especially developed for women with slight hypertrichosis , hirsutism and acne). In this way, drospirenone "Pills" can also be indicated for slight androgenic manifestations in women.

The first drospirenone oral contraceptive was released some years ago, consisting of 21 tablets, each one of them containing 0.03 mg of ethinyl estradiol and 3 mg of drospirenone and is to be administered as usual, with a 7-days interval between each series of 21 tablets. Nevertheless, if we look at it as a "Pill" released in the time of the "low-dose" ones (regarding their estrogenic component), it cannot be considered as such since each tablet still contains the 0.03 mg of ethinyl estradiol. (Over the last 10 years, "low-dose" oral contraceptives are those that contain 0.02 mg of ethinyl estradiol.) So, this first "Pill" containing drospirenone actually is "middle-dose."

But now finally we have the first "low-dose" drospirenone "Pill," and the manufacturers report a contraceptive efficacy of 99%. Including an important change not only in the number of tablets contained in each series but also in the interval between them, this new oral contraceptive consists of 24 tablets, each one of them containing 0.02 mg of ethinyl estradiol and 3 mg of drospirenone and is to be taken with a 4-day interval between the series. Thus, the number of tablets in each series was increased and the interval between them was reduced. Though this new product is being announced with a special emphasis as "the 'Pill' for women with premenstrual syndrome," I think that more clinical experience and time are needed so that we can be more about it (though theoretically and pharmacologically it seems to be correct). We always must have in mind that, even after their approval and release, all new medicines require a long period of further careful observation.

Despite all of this, an aspect of drospirenone's pharmacology deserves special attention: for antagonizing aldosterone's action, there is a potential for a slight raise in the blood levels of potassium. Though this alteration does not have any importance in normal women under normal conditions, special care is required in patients who are taking a large number of very common drugs that may raise the potassium levels (heightened potassium levels may be dangerous for possibly causing heart arrhythmias).

Among these drugs are potassium-sparing diuretics, angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin-II receptor antagonists and other aldosterone antagonists, including spironolactone itself (most of these drugs are used for the treatment of hypertension and related conditions). (As to the aforementioned relation between spironolactone and drospirenone, see Note below.) In this way, the use of drospirenone in women taking these medicines is not advisable or demands special care and constant control of the potassium levels (there is even a warning from the laboratory about that).

After saying all of this, I must emphasize that the recently released "low-dose" drospirenone oral contraceptive - containing 0.02 mg of ethinyl estradiol and 3 mg of drospirenone in series of 24 tablets to be taken with a 4-day interval between the series -, though possessing very, very interesting and important features, is still too new for any adequate and correct evaluation of their long-term effects in clinical practice. So, let's see what comes ahead.


Note: Curiously, drospirenone, which is a progestin, was chemically obtained by introducing some modifications on the spironolactone molecule. As synthetic sexual steroids, all previously existing progestins are also obtained having synthetic sexual steroids as precursors. In this way, the novel progestin drospirenone is a curious exception. As for spironolactone, it is a diuretic that functions by antagonizing aldosterone's effect, consequently causing natriuresis (the excretion of sodium and water by the kidneys). Besides, spironolactone is also endowed with an anti-androgenic property and, for that reason, has been also used for the treatment of hypertrichosis and hirsutism.

Considering all of this we can see that drospirenone - as a synthetic progesterone and, obviously, a sexual hormone -, very curiously was synthesized just having an anti-mineralocorticoid as precursor. Besides having acquired its remarkable and notorious progesteronic effects, drospirenone also retained the anti-mineralocorticoid and anti-androgenic effects of its chemical precursor spironolactone.

P.S.1: Please note that this article was written between July and August 2007 - that is, only a few months after the release of the first "low-dose" drospirenone oral contraceptive (though "middle-dose" drospirenone "Pills" have been available in the market for approximately 4 years). It is way too early for trying to arrive at any clinically firm conclusion regarding its effects. Nevertheless, its future seems to be optimistic.

P.S.2: See also my general article "Oral hormonal contraceptives" published both here, on the MUM, and also on my own site in 2002.

Copyright Nelson Soucasaux 2007

______________________________________________

Nelson Soucasaux is a gynecologist dedicated to clinical, preventive and psychosomatic gynecology. Graduated in 1974 by Faculdade de Medicina da Universidade Federal do Rio de Janeiro, he is the author of several articles published in medical journals and of the books "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology") and "Os Órgãos Sexuais Femininos: Forma, Função, Símbolo e Arquétipo" ("The Female Sexual Organs: Shape, Function, Symbol and Archetype"), published by Imago Editora, Rio de Janeiro, 1990, 1993. He has been working in his private clinic since 1975.

Web site (Portuguese-English): www.nelsonginecologia.med.br Email: nelsons@nelsonginecologia.med.br


NEWS | homepage | LIST OF ALL TOPICS | MUM address & What does MUM mean? | e-mail the museum | privacy on this site | who runs this museum?? |
Amazing women! | the art of menstruation | artists (non-menstrual) | asbestos | belts | bidets | founder bio | Bly, Nellie | MUM board | books: menstruation and menopause (and reviews) | cats | company booklets directory | contraception and religion | costumes | menstrual cups | cup usage | dispensers | douches, pain, sprays | essay directory | extraction | famous women in menstrual hygiene ads | FAQ | founder/director biography | gynecological topics by Dr. Soucasaux | humor | huts | links | masturbation | media coverage of MUM | miscellaneous | museum future | Norwegian menstruation exhibit | odor (olor)| pad directory | patent medicine | poetry directory | products, current | religion | your remedies for menstrual discomfort | menstrual products safety | science | shame | slapping, menstrual | sponges | synchrony | tampon directory | early tampons | teen ads directory | tour of the former museum (video) | underpants directory | videos, films directory | Words and expressions about menstruation | Would you stop menstruating if you could? | What did women do about menstruation in the past? | washable pads
More articles by Dr. Soucasaux: Anatomical drawings - Anovulatory cycles - Archetypal aspects of the female genitals - The breasts: some morphological aspects - Colposcopy - Comments on the corpus luteum and related aspects - Comments on some anatomical and symbolic aspects of the female pelvis - The curious relations between androgens and estrogens in women - Drospirenone Oral Contraceptives - Due to prohibition, Brazilian women don't have access to modern medicinal abortion - Endocrinology of menstruation - The Fallopian tubes - Female sexual response - The Gräfenberg Spot (G-Spot) - The Gynecologic Palpation (descendant of "The Touch") - Gynecological assistance: the three basic areas - Gynecology and Gynecologic Surgery - Gynecologist versus obstetrician: what lies behind the combination? - "Gyneco-obstetric-surgical" stubborness and the perpetuation of one of the greatest mistakes of women's medicine - Hypermenorrhea and/or Menorrhagia (Prolonged and/or Excessive Menstrual Bleedings) - Hypertrichosis, Hirsutism and Androgenic Manifestations in Women - Mayer-Rokitansky-Kuster-Hauser (MRKHauser) Syndrome - Menstrual toxin: An old name for a real thing? - Nature and the ovaries - On the Intimate, or Small-Scale, Mechanisms of Menstruation - On the Strange Nature of the Ovaries - Oral hormonal contraceptives (the "Pill") - The Ovaries: Some Functional and Archetypal Considerations - Peculiarities of the Female Genitals' Sensory Innervation - Physiology of menstruation - Polycystic ovaries syndrome - The Possibility of Becoming Pregnant, Its Implications for Women, and Abortion - Premenstrual congestion of the breasts - Premenstrual syndrome (PMS) - The Psychology of Gynecology part 1 (part 2) - Psychosomatic and symbolic aspects of menstruation - Psychosomatic gynecology - Some Details on the Function of the Hypothalamus-Pituitary-Ovaries Axis - Stanislav Grof's Perinatal Matrixes of the Unconscious and Women's Medicine - Symmetric Patterns in the Female Genitals - Thoughts on Female Sexual Psychology - Uninterrupted use of hormonal contraceptives for menstrual suppression: why I do not recommend it - The uterine cervix - Uterine contractility - The Uterus and the Female "Passive-Active" - Women's corporeal consciousness and experience - Women's Experience of the Breasts - Women's Undesired Pregnancies and Women's Right to Abortion and see his Art of Menstruation