Progestin-only oral contraceptives (usually referred to as minipills) are related in efficacy to mixture oral contraceptives containing estrogen and a progestin and are used predominantly by breastfeeding ladies and in conditions the place estrogen is poorly tolerated or contraindicated. In 2020, the FDA accepted a progestin-only oral contraceptive containing drospirenone (marketed as Slynd). Up till this level, progestin-only oral contraceptives out there within the US have all contained norethindrone. Drospirenone (DRSP) is a chemical analogue of spironolactone; it’s extra prone to suppress ovulation and is much less prone to have androgenic negative effects (e.g., pimples, hair progress) than norethindrone. As well as, for ladies who expertise premenstrual temper adjustments, drosperinone can also have useful results on temper and is mixed with ethinyl estradiol within the oral contraceptive Yaz, which is FDA-approved for the remedy of premenstrual dysphoric dysfunction (PMDD).
Though progestin-only contraceptives are generally provided to breastfeeding ladies on the 6-week postpartum go to, we usually don’t advocate using the norethindrone-containing minipill on this setting to ladies at elevated threat for postpartum despair–for instance, these with a historical past of PPD or recurrent despair. This suggestion is predicated on earlier research indicating an elevated threat of PPD in ladies receiving depot formulations of progestogens after supply. To my data, no research have investigated the consequences of the norethindrone-containing minipill on temper. A latest potential, non-randomized, open-label examine examined the consequences of Drospirenone solely tablet (DOP) 4 mg, in a 24 energetic/4 placebo routine, on the temper of postpartum ladies electing to make use of a hormonal contraceptive.
Girls obtained counseling on the advantages of progestin-only contraception and its security throughout breastfeeding on the childbirth preparation course at 26–34 weeks of being pregnant. Earlier than enrollment into the examine, every girl was assessed for temper problems. Girls with reasonable or extreme depressive signs on the postpartum go to had been excluded from the examine. A complete of 71 ladies obtained the drospirenone solely tablet at 2 weeks postpartum, and 78 ladies within the management group. Depressive signs had been measured utilizing the Edinburgh Postnatal Despair Scale (EPDS) on the childbirth preparation course (T0), and at the week 2 (T1), week 12 (T2), and week 24 (T3) postpartum follow-up visits.
In each teams, depressive signs elevated from T0 to T1. On the T2 follow-up (week 12), EPDS scores had decreased within the group utilizing drospirenone however not within the management group. Equally, on the T3 follow-up, the rating was statistically decreased within the DRSP group however not within the management group.
Encouraging Findings However Additional Research Wanted
That is the primary examine to look at the impact of a drospirenone-only contraceptive on postpartum temper. Whereas the ladies taking drospirenone skilled a lower in EPDS scores, the management group continued to have elevated EPDS signs. The noticed lower in depressive signs in ladies taking drospirenone was statistically important, however comparatively small. Whereas this examine is essential, it might be untimely to conclude that drospirenone decreases the danger of postpartum despair. This examine didn’t point out the variety of ladies assembly standards for PPD at follow-up visits. Typically, the common EPDS scores had been low and wouldn’t be in keeping with the scores usually measured in ladies with PPD. Moreover, the examine excluded ladies with reasonable to extreme depressive signs at week 2.
Nonetheless the findings are promising in that we are able to proceed to discover using drospirenone in postpartum ladies. Drosperinone doesn’t negatively have an effect on breastfeeding, and this examine signifies that, at the least in ladies with no or delicate depressive signs, there isn’t any worsening of postpartum temper signs and perhaps even some enchancment. Efficient postpartum contraception is important, and this examine means that the drospirenone-only tablet is perhaps an appropriate possibility for a lot of ladies.
Given the salutary results of drospirenone on hormonally mediated temper signs noticed on this examine, and in earlier research of PMDD, will probably be fascinating to see future research the place the drospirenone-only contraception is utilized in ladies with elevated threat of PPD or in postpartum ladies who may have already got depressive signs. As well as, utilizing neuroimaging and different methods to look at how drospirenone and other progestins affect the female brain could assist to refine the remedy of hormonally mediated temper signs.
Ruta Nonacs, MD PhD
References
Caruso S, Caruso G, Bruno MT, Minona P, Di Guardo F, Palumbo M. Effects of Drospirenone only pill contraception on postpartum mood disorders: A prospective, comparative pilot study. Eur J Obstet Gynecol Reprod Biol. 2023 Jul 6; 288:73-77.
