A Guide to Drospirenone

by The Lowdown · May 24, 2021

by Dr Melanie Davis-Hall · May 24, 2021

Drospirenone is a synthetic progestin used alongside synthetic oestrogens in the combined pill.

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Drospirenone is a synthetic progestin used alongside synthetic oestrogens in the combined pill. A drospirenone-only pill is currently being trialled, and if results are successful, it could be available in a progestogen-only contraceptive pill in the future.

It is a fourth-generation progestogen (the latest model!) and is made from a ‘spironolactone’: a class of drugs with a range of uses that reduce androgens in the body.

You may have come across drospirenone if you’ve been prescribed the combined pill for acne, as it works with an oestrogen called ‘ethinylestradiol’ to reduce testosterone in the body. Combined pills containing drospirenone is also prescribed for premenstrual syndrome and premenstrual dysphoric disorder (a severe form of premenstrual syndrome), and the current evidence suggests it can be helpful in targeting these symptoms.

How does it work?

When combined with ethinylestradiol (an oestrogen) in the combined pill, drospirenone works by thickening your cervical fluid so that sperm can’t enter your uterus. It can also stop your follicles (which contains eggs) from ‘maturing’, which prevents ovulation, and can thin the lining of your uterus so that a fertilised egg can’t implant.

When drospirenone is prescribed for non-contraceptive reasons, it is usually because of its anti-androgenic properties, which can combat issues such as acne, as mentioned above.

What is it used in?

Combined pill

Is it androgenic?

No; drospirenone is anti-androgenic.(Check out our ‘Guide to Androgens’ blog for more info on what this means).

What are the side effects?

At the moment, drospirenone is only available in the combined pill, where it is mixed with oestrogen, so it’s virtually impossible say which side effects each individual hormone is responsible for. These are some of the side effects reported by people taking a combined pill containing drospirenone4:

  • Breast tenderness or enlargement
  • Changes in mood
  • Changes to periods
  • Headaches
  • Nausea
  • Increased vaginal discharge

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  1. Exeltis. PR Newswire. Exeltis Announces Positive Conclusion for the European Decentralised Procedure for a New Oestrogen-free Oral Contraceptive: Drospirenone Only Pill, 4mg. 22 October 2019. <> [Accessed on 13 August 2020]
  2. Lopez  LM, Kaptein  AA, Helmerhorst  FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database of Systematic Reviews. 2012. Issue 2. Art. No.: CD006586. DOI: 10.1002/14651858.CD006586.pub4. Available from:
  3. Mathur R, Levin O, Azziz R. Use of ethinylestradiol/drospirenone combination in patients with the polycystic ovary syndrome. Therapeutics and Clinical Risk Management. 2008. 4(2):487-492. Available from:
  4. 4. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press <> [Accessed on 13 August 2020]