Reduced hemostatic effects with drospirenone-based oral contraceptives containing estetrol vs. ethinyl estradiol

Contraception. 2017 Feb;95(2):140-147. doi: 10.1016/j.contraception.2016.08.018. Epub 2016 Sep 1.

Abstract

Objective: The effects of estetrol (E4), a natural fetal estrogen, combined with drospirenone (DRSP) were evaluated on plasma levels of sex hormone-binding globulin (SHBG), angiotensinogen and 12 hemostasis markers.

Study design: Combinations of 3 mg DRSP with 5 or 10 mg E4 were compared with YAZ® (20 mcg ethinyl estradiol and 3 mg DRSP; EE/DRSP) in parallel groups of 15-18 healthy young women. Main outcome was the relative change from pretreatment to the end (day 24±1) of the third treatment cycle.

Results: All E4 combinations showed low estrogen impact compared to EE/DRSP. Effects on SHBG and angiotensinogen of 10 mg E4 combined with DRSP were 15%-20% that of EE/DRSP. Both E4/DRSP combinations reduced D-dimer level and the 5 mg E4/DRSP combination also decreased fragment 1+2.

Conclusions: The reduction in coagulation markers suggests an anticoagulant effect from DRSP. The indications of a low thrombosis risk for E4 preparations should be validated in larger studies. IMPLICATION STATEMENT.

Keywords: Drospirenone; Estetrol; Estrogenicity; Ethinyl estradiol; Hemostasis; SHBG.

MeSH terms

  • Adolescent
  • Adult
  • Androstenes / administration & dosage*
  • Angiotensinogen / blood
  • Anticoagulants
  • Biomarkers / blood
  • Blood Coagulation / drug effects
  • Contraceptives, Oral / administration & dosage*
  • Estetrol / administration & dosage*
  • Ethinyl Estradiol / administration & dosage*
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Hemostasis / drug effects*
  • Humans
  • Sex Hormone-Binding Globulin / analysis
  • Young Adult

Substances

  • Androstenes
  • Anticoagulants
  • Biomarkers
  • Contraceptives, Oral
  • Fibrin Fibrinogen Degradation Products
  • Sex Hormone-Binding Globulin
  • fibrin fragment D
  • Angiotensinogen
  • Ethinyl Estradiol
  • Estetrol
  • drospirenone