Progestin-only oral contraceptives (often called minipills) are similar in efficacy to combination oral contraceptives containing estrogen and a progestin and are used predominantly by breastfeeding women and in situations where estrogen is poorly tolerated or contraindicated. In 2020, the FDA approved a progestin-only oral contraceptive containing drospirenone (marketed as Slynd). Up until this point, progestin-only oral contraceptives available within the US have all contained norethindrone. Drospirenone (DRSP) is a chemical analogue of spironolactone; it’s more prone to suppress ovulation and is less prone to have androgenic negative effects (e.g., pimples, hair growth) than norethindrone. As well as, for girls who experience premenstrual mood changes, drosperinone can also have useful effects on mood and is combined with ethinyl estradiol within the oral contraceptive Yaz, which is FDA-approved for the treatment of premenstrual dysphoric disorder (PMDD).
Although progestin-only contraceptives are commonly offered to breastfeeding women on the 6-week postpartum visit, we typically don’t recommend the usage of the norethindrone-containing minipill on this setting to women at increased risk for postpartum depression–for instance, those with a history of PPD or recurrent depression. This advice is predicated on previous studies indicating an increased risk of PPD in women receiving depot formulations of progestogens after delivery. To my knowledge, no studies have investigated the results of the norethindrone-containing minipill on mood. A recent prospective, non-randomized, open-label study examined the results of Drospirenone only pill (DOP) 4 mg, in a 24 lively/4 placebo regimen, on the mood of postpartum women electing to make use of a hormonal contraceptive.
Women received counseling on the advantages of progestin-only contraception and its safety during breastfeeding on the childbirth preparation course at 26–34 weeks of pregnancy. Before enrollment into the study, each woman was assessed for mood disorders. Women with moderate or severe depressive symptoms on the postpartum visit were excluded from the study. A complete of 71 women received the drospirenone only pill at 2 weeks postpartum, and 78 women within the control group. Depressive symptoms were measured using the Edinburgh Postnatal Depression 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 groups, depressive symptoms increased from T0 to T1. On the T2 follow-up (week 12), EPDS scores had decreased within the group using drospirenone but not within the control group. Similarly, on the T3 follow-up, the rating was statistically reduced within the DRSP group but not within the control group.
Encouraging Findings But Further Study Needed
That is the primary study to look at the effect of a drospirenone-only contraceptive on postpartum mood. While the ladies taking drospirenone experienced a decrease in EPDS scores, the control group continued to have elevated EPDS symptoms. The observed decrease in depressive symptoms in women taking drospirenone was statistically significant, but relatively small. While this study is vital, it might be premature to conclude that drospirenone decreases the danger of postpartum depression. This study didn’t indicate the number of ladies meeting criteria for PPD at follow-up visits. Basically, the typical EPDS scores were low and wouldn’t be consistent with the scores typically measured in women with PPD. Moreover, the study excluded women with moderate to severe depressive symptoms at week 2.
Nonetheless the findings are promising in that we are able to proceed to explore the usage of drospirenone in postpartum women. Drosperinone doesn’t negatively affect breastfeeding, and this study indicates that, no less than in women with no or mild depressive symptoms, there is no such thing as a worsening of postpartum mood symptoms and perhaps even some improvement. Effective postpartum contraception is significant, and this study suggests that the drospirenone-only pill could be an appropriate option for many ladies.
Given the salutary effects of drospirenone on hormonally mediated mood symptoms observed on this study, and in previous studies of PMDD, it should be interesting to see future studies where the drospirenone-only contraception is utilized in women with increased risk of PPD or in postpartum women who might have already got depressive symptoms. As well as, using neuroimaging and other techniques to look at how drospirenone and other progestins affect the feminine brain may help to refine the treatment of hormonally mediated mood symptoms.
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.