Second Chapter
Dr. Álvaro Monterrosa Castro, MD
Drospirenone
Drospirenone shares the antimineralocorticoid property of natural endogenous progesterone, which counteracts the positive effect on aldosterone caused by estrogen.
This specific property of drospirenone is not found in any of the other progestins and may have a favorable clinical impact in terms of body weight and the effect on blood pressure (56).
Weight gain is usually one of the most frequent undesirable manifestations reported by women users of combined oral contraceptives. This increase is fundamentally due to fluid retention generated by the stimulus that estrogen induces on the renin-angiotensin-aldosterone system, and that most progestins are not able to neutralize.
It should be noted that all progestins used in combined oral contraceptives, except drospirenone and to a lesser extent Gestodene, lack antimineralocorticoid effect.
Oelkers et al (154) in a phase II, randomized and controlled study in 20 women with six cycles of follow-up in which the influence of 30 ug/day of ethinyl estradiol plus 150 mg/day of levonorgestrel in comparison with various combinations of ethinyl estradiol was evaluated. plus drospirenone, it was observed that with the first there was an increase of 0.68 kilograms of average weight while the average body weight decreased 0.78 kilograms in the group of 30 ug/day of ethinyl estradiol plus 3 mg/day of drospirenone.
(Read Also: Effects on Blood Pressure)
Impact on weight loss
In the same study, it was observed that the impact on weight loss is better if the combination is 15 ug/day of ethinyl estradiol plus 3 mg/day of drospirenone, which may suggest greater antimineralocorticoid than mineralocorticoid activity.
Nowadays, it is indicated in clinical generality that ethinyl estradiol plus drospirenone leads to a slight reduction in the user’s body weight (56). Huber (77) and Foidart (78) have compared the response to pills of 30 ug/day of ethinyl estradiol plus 3 mg/day of drospirenone with 30 ug/day of ethinyl estradiol plus 150 mg/day of desogestrel and evaluated the impact on weight. of the user.
After 26 cycles of use (78), it is observed that with desogestrel, after a slight weight reduction in the first four cycles, there is an increase in average body weight, which becomes persistent throughout the follow-up, until reaching At the end of the study an increase of 0.80 kilograms in weight.
With the drospirenone pill, the average body weight decreases steadily in the first three cycles, to achieve a weight reduction of 0.6 kilograms at thirteen follow-up cycles, and then a gradual increase occurs and at 26 follow-up cycles the effect is null with regarding variation in body weight.
The data from these studies (77,78) show that due to the specific antimineralocorticoid effect of drospirenone, there is an initial slight decrease in body weight and long-term stabilization in the majority of women.
Changes in body weight achieved with pills that include drospirenone:
Compared to those generated by other progestins, they tend to be different and with statistical significance. Users should be taught that the slight decrease in weight is not due to weight loss or loss of body fat, it is due to the reduction in the fluid retention capacity exerted by drospirenone.
This favorable impact on weight extends to a decrease in breast swelling and sensitivity, less swelling in fingers and hands, and a lower incidence of abdominal pain.
It may be very appropriate to state that drospirenone prevents the increase in body fluid retention caused by estrogen, rather than to point out its fundamental role in reducing body weight. (56).
The tendency to change body weight has individual properties and the sensitivity to fluid retention can also be very individual.
The aforementioned studies (77,78) show that weight gain of more than 2 kilograms at the end of the thirteenth cycle was observed in 14% of the women who received drospirenone and in 17% of those who received desogestrel, and the loss body weight greater than 2 kilograms occurred in 24% of those who received drospirenone and in 21% of those who received desogestrel.
With these figures the clinical effect can be assessed.
Dr. Álvaro Monterrosa Castro, MD
