Drospirenone 4 mg-only pill (DOP) in 24+4 regimen: a new option for oral contraception

Expert Rev Clin Pharmacol. 2020 Jul;13(7):685-694. doi: 10.1080/17512433.2020.1783247. Epub 2020 Jun 22.


Introduction: The use of progestin-only pills (POPs) is still relatively infrequent, mainly for their unpredictable effect on menstrual bleeding. A new POP consisting of 4 mg drospirenone (DRSP) for 24 days plus 4-day hormone-free interval has been developed to address this need. DRSP is a potent progestin analogue of spironolactone, with antiandrogenic and antimineralocorticoid properties.

Areas covered: This is a narrative review of the available data on the pharmacotherapy of the new DRSP-only pill. The research includes aspects of pharmacokinetics/pharmacodynamics of the compound: the main focus is on the clinical effects of DRSP-only pill in terms of contraceptive efficacy, haemostatic effect, safety, tolerability and bleeding patterns.

Expert opinion: The DRSP-only pill presents a similar Pearl Index to that of common combined hormonal contraceptives: it is a POP with a better bleeding profile than traditional POPs (higher rates of scheduled bleedings and much lower rates of unscheduled intracyclic bleeding/spotting) which could increase its acceptability and the panorama of possible users. For these reasons, DRSP-only pill represents a real step forward in oral contraception with only progestins, even if the bleeding patterns during its use are still different to oestrogen-containing products (i.e. lower rates of scheduled bleedings and higher rate of amenorrhea).

Keywords: Contraception; drospirenone; drospirenone-only pill; hemostasis; hormonal contraception; metabolism; pearl Index; pharmacotherapy; progestin-only pill; venous thrombosis.

Publication types

  • Review

MeSH terms

  • Androstenes / administration & dosage*
  • Androstenes / adverse effects
  • Androstenes / pharmacology
  • Animals
  • Contraceptives, Oral, Hormonal / administration & dosage*
  • Contraceptives, Oral, Hormonal / adverse effects
  • Contraceptives, Oral, Hormonal / pharmacology
  • Drug Administration Schedule
  • Female
  • Humans
  • Mineralocorticoid Receptor Antagonists / administration & dosage*
  • Mineralocorticoid Receptor Antagonists / adverse effects
  • Mineralocorticoid Receptor Antagonists / pharmacology


  • Androstenes
  • Contraceptives, Oral, Hormonal
  • Mineralocorticoid Receptor Antagonists
  • drospirenone