Multicenter, open-label trial to assess the safety and tolerability of drospirenone 4.0 mg over 6 cycles in female adolescents, with a 7-cycle extension phase

Use of the Drospirenone-Only Contraceptive Pill in Adolescents with Endometriosis

STUDY OBJECTIVE

To evaluate the efficacy and tolerability of a progestin-only pill containing 4 mg drospirenone (DRSP) as a hormonal therapy for the management of endometriosis-associated symptoms in adolescents and young adults.

DESIGN

Retrospective cohort study.

METHODS

A retrospective chart review was performed of all adolescents who were prescribed DRSP continuously (without placebo) for treatment of endometriosis at a single pediatric tertiary care center between 2019 and 2022. Electronic medical records were reviewed to obtain demographics and clinical characteristics of the patients. Measured outcomes included symptom resolution and medication discontinuation. The study was deemed IRB exempt.

RESULTS

A total of 61 patients with endometriosis were prescribed DRSP during the study period, with a median age of 18.9 years (SD 2.3). The majority (97%) were laparoscopically confirmed to have endometriosis, and 85% had stage I disease. Before DRSP use, the most common medications trialed were norethindrone (57%) and norethindrone acetate (68%), and 56% had at least one medical contraindication to receiving estrogen-containing therapy. Of those with follow-up, 52% established an absence of bleeding/spotting, and 67% reported less pain at follow-up. One in 4 patients discontinued DRSP during the study period, most commonly due to breakthrough bleeding.

CONCLUSION

DRSP is a well-tolerated and effective option for the treatment of endometriosis-associated symptoms in adolescents and young adults.

Safety of Progestogen Hormonal Contraceptive Methods during Lactation: An Overview

BACKGROUND

Breastfeeding is a process for not only nourishing infants but also for building a unique emotional bond between mother and child. Therefore, the ideal contraception during lactation should not affect lactation (milk composition, milk volume) and offspring development.

OBJECTIVES

This study aims to analyze the literature on the safety of progestogen hormonal contraceptive methods during lactation.

METHODS

We conducted a thorough search across various databases, including the National Library of Medicine (PubMed), and the Cochrane Database, Drugs and Lactation Database (LactMed). Our search utilized specific phrases such as: "lactation" and "breastfeeding" and "oral contraception" with "drospirenone" or "desogestrel", with "subcutaneous etonogestrel implant" or "etonogestrel implant", with "levonorgestrel-releasing intrauterine system", and "emergency contraception", with "levonorgestrel" or "ulipristal acetate".

CONCLUSIONS

Based on published scientific reports, progestogen hormonal contraceptives can be considered a relatively safe solution for women desiring to continue feeding their infant with their milk while using hormonal contraception. It is important to seek guidance on selecting the best contraception method based on the latest medical knowledge, tailored to the individual needs and clinical circumstances of each woman and place of residence. A woman should always be informed of the potential risks of such a treatment and then allowed to make her own decision based on the knowledge received from a specialist.

The drospirenone (DRSP)-only pill: clinical implications in the daily use

OBJECTIVES

Progestins used in contraception are either components of combined hormonal contraceptives or are used as a single active ingredient. Progestins are highly effective in long-term contraception and have a very good safety profile with very few contraindications.

METHODS

An oestrogen-free ovulation inhibitor POP has been authorised in the USA and the EU. It contains 4 mg of drospirenone (DRSP). The hormone administration regimen of 24 days followed by a 4-day hormone-free period was chosen to improve bleeding control and to maintain oestradiol concentrations at early follicular- phase levels, preventing oestrogen deficiency.

RESULTS

Clinical trials have demonstrated high contraceptive effectiveness, a very low risk of cardiovascular risk events and a favourable bleeding pattern. Due to the long half-life of DRSP (30-34 h), the effectiveness is maintained even in case of a forgotten pill on a single occasion. Studies involving deliberate 4 days in one cycle 24-hour delays in taking a pill have demonstrated that ovulation inhibition is maintained if a single pill is missed.

CONCLUSIONS

This review article will describe the clinical impact in the daily use of the 4 mg DRSP only pill and the resulting data on the effectiveness and safety of this hormonal contraceptive.

Management of Menstruation in Transgender and Gender Nonbinary Adolescents

A growing number of adolescents in the United States identify as transgender and gender nonbinary, and many will seek medical management of menstruation. In this evidence-based review, we recommend a model of gender-affirming care grounded in the tenants of reproductive justice, emphasizing patient autonomy and the development of holistic management plans centered around the patient's unique goals for affirming their gender identity. We then review strategies for achieving menstruation suppression for transgender and gender nonbinary adolescents, including dosing considerations, menstruation, ovulation, contraceptive effects, and metabolic considerations specific to the adolescent population.

Perspective Chapter: Modern Birth Control Methods

This chapter focuses on various modern birth control methods, including combined oral contraceptives, progestogen-only pills, progestogen-only injectables, progestogen-only implants, intrauterine devices, barrier contraceptives, and emergency contraceptive pills. Each contraceptive method is covered in detail, including mechanism of action, effectiveness, health benefits, advantages, disadvantages, risks, and side-effects.

Identification of a fungal cytochrome P450 with steroid two-step ordered selective hydroxylation characteristics in Colletotrichum lini

Microbial hydroxylation reaction has greatly enriched the number of steroids and created many meaningful new compounds. The dihydroxylation of dehydroepiandrosterone (DHEA) by filamentous fungi produces an important product 3β,7α,15α-trihydroxy-5-androstene-17-one (7α,15α-diOH-DHEA), which can be used as a key intermediate for the synthesis of contraceptive drospirenone. The introduction of microbial hydroxylation reaction reduces the traditional chemical synthesis process by 4 steps and greatly improves the productivity and economic efficiency. Colletotrichum lini is an industrial strain producing 7α,15α-diOH-DHEA, but the related cytochrome P450 that plays hydroxylation effect has not yet been discovered. In this work, a combination of quantitative proteomics, qRT-PCR, and functional expression in Pichia pastoris was used to identify highly induced steroid hydroxylase from Colletotrichum lini ST-1. A novel fungal cytochrome P450 monooxygenase CYP68JX was identified. The biotransformation in recombinant yeast confirmed that the cytochrome P450 has steroid C7α and C15α hydroxylase activities. The hydroxylation of DHEA by CYP68JX is an ordered reaction, proceeding from the C7 to the C15 site of the steroidal nucleus. The cloning and identification of the CYP68JX gene provide useful information for deepening the understanding regarding the structural basis of its regional and stereoselectivity.

Oral Progestins in Hormonal Contraception: Importance and Future Perspectives of a New Progestin Only-Pill Containing 4 mg Drospirenone

Hormonal contraceptives are an effective and safe method for preventing pregnancy. Progestins used in contraception are either components of combined hormonal contraceptives (tablets, patches or vaginal rings) or are used as a single active ingredient in progestin mono-preparations (the progestin-only pill (POP), implants, intrauterine systems or depot preparations). Progestins are highly effective in long-term contraception when used properly, and have a very good safety profile with very few contraindications. A new oestrogen-free ovulation inhibitor (POP) has recently been authorised in the USA and the EU. This progestin mono-preparation contains 4 mg of drospirenone (DRSP), which has anti-gonadotropic, anti-mineralocorticoidic and anti-androgenic properties. The hormone administration regimen of 24 days followed by a 4-day hormone-free period was chosen to improve bleeding control and to maintain oestradiol concentrations at early follicular-phase levels, preventing oestrogen deficiency. Clinical trials have demonstrated a high contraceptive effectiveness, a very low risk of cardiovascular side effects and a favourable menstrual bleeding pattern. Due to the long half-life of DRSP (30 - 34 hours), the effectiveness of the preparation is maintained even if a woman forgets to take a pill on a single occasion. Studies involving deliberate 24-hour delays in taking a pill have demonstrated that ovulation inhibition is maintained if a single pill is missed. Following a summary of the current status of oestrogen-free contraception, this review article will describe the clinical development programme of the 4 mg DRSP mono-preparation and the resulting data on the effectiveness and safety of this new oestrogen-free oral hormonal contraceptive.

Advances in contraception research and development

PURPOSE OF REVIEW

In the past few years, there have been great advances in contraceptive technology and development. Here we review advances in contraception over the past two years including new medications, and technologies.

RECENT FINDINGS

Contraception must be discussed within the context of individual goals and context. New contraceptive options approved by the FDA in the past two years include a year-long vaginal ring, a progestin-only pill that is as effective as combined oral contraceptive pills, a new hormonal patch and a vaginal gel that may also help prevent sexually transmitted infections.There are still areas of contraceptive research that are very much unknown including biomarkers of contraceptive efficacy or side effects, how individuals or groups metabolize contraception, initiation around reproductive life events or the discontinuation of other methods.

SUMMARY

There have been many new contraceptives developed over the past few years to address challenges of existing contraception and create new methods; yet, there remain many unanswered questions in contraceptive research. Contraceptive technology has far-reaching consequences, and independent of technology itself, represents a great opportunity for truly personalized medicine.