Drospirenone is a novel progestogen that possesses antimineralocorticoid activity. This activity is seen clinically in its effects on physiological parameters, body weight, general well-being and fluid-related symptoms. Clinical studies with an oral contraceptive containing 30 fig ethinylestradiol and 3 mg drospirenone (Yasmin (R), Schering AG, Berlin, Germany) and a new continuous combined oral hormone replacement therapy (HRT) containing 1 mg 17 beta-estradiol and 2 mg drospirenone (Angeliq (R), Schering AG) were all designed specifically to evaluate treatment effects on body weight and cardiovascular function, both of which can be influenced by aldosterone receptor antagonism. Weight gain during traditional oral contraceptive and HRT use has been one of the main reasons for poor compliance and discontinuation. Women receiving hormone therapy with I mg 17 beta-estradiol/2 mg drospirenone had either no weight change or a small decrease, while those receiving estradiol alone tended to increase in weight. Mean body weight after 1 year of treatment with 1 mg 17 beta-estradiol/2 mg drospirenone decreased by 1.2 kg (p < 0.001). Studies using different drospirenone doses in combination with estradiol indicate that the effect on body weight is dependent on the dose of drospirenone, and that this is due to drospirenone's antimineralocorticoid activity. These data are in agreement with previous studies that compared the changes in body weight in young women receiving for 13 or 26 cycles the oral contraceptives 30 mu g ethinylestradiol/3 mg drospirenone or 30 mu g ethinylestradiol/150 mu g desogestrel (Marvelon (R), Organon International); 30 mu g ethinylestradiol/3 mg drospirenone had a more favorable effect on body weight, with the mean body weight remaining lower than baseline for the majority of women. A variety of physical and emotional changes have been linked to hormonal fluctuations during the menstrual cycle. Fluid retention-related symptoms, such as breast tenderness, swelling, abdominal bloating and skin changes, may affect wellbeing and quality of life. Improvements in these cycle-dependent disorders, together with some psychological symptoms, such as fatigue and depressive mood, are well documented with the use of 30 mu g ethinylestradiol/3 mg drospirenone. Therefore, the effects of hormone therapy with 1 mg 17 beta-estradiol/2 mg drospirenone on quality of life were assessed in the Women's Health Questionnaire. Significant improvements were observed in quality of life during treatment with 1 mg 17 beta-estradiol/2 mg drospirenone, which also resulted in higher mean scores than estradiol alone. Improvements were mainly seen in somatic symptoms, anxiety/fears and cognitive difficulties. 1 mg 17 beta-estradiol/2 mg drospirenone has unique antimineralocorticold properties, which can be attributed to drospirenone. This combination prevents salt and water retention elicited by estrogens, and thereby prevents increases in blood pressure and maintains a stable body weight. Its additional beneficial impact on premenstrual symptomatology and health-related quality of life may improve well-being and clinical tolerance.
