Expect Questions About Nextstellis for Contraception

Nextstellis (estetrol/drospirenone) will be the first oral contraceptive pill to contain a new estrogen in decades.

It contains estetrol 15 mg and drospirenone 3 mg...is taken for 24 days followed by 4 days of placebo...and seems as effective as other combo OCs.

Expect reps to say that estetrol, or "E4," is a plant-derived "NEST"...or "native estrogen with selective actions in tissues."

The theory is that estetrol may have less impact on certain tissues (breast, etc) or metabolic changes (lipids, etc) than ethinyl estradiol.

But there's not enough evidence to say if its "selectivity" reduces risks of breast cancer, blood clots, etc.

Note that the estetrol dose is in MILLIgrams...not MICROgrams like ethinyl estradiol. They can't be compared apples to apples.

Plus Nextstellis still has similar contraindications and precautions as other combo OCs. And it may be less effective in patients with a BMI of 30 or above.

Nextstellis costs $20/month...versus below $10 for generic OCs.

Don't jump to Nextstellis.

Instead, continue to recommend a contraceptive based on efficacy, safety, patient preference, etc. For example, suggest an IUD or implant as the most effective contraceptive.

Keep in mind, drospirenone-containing contraceptives have similar antimineralocorticoid effects as spironolactone 25 mg.

Advise checking potassium if any contraceptive with drospirenone is combined with other chronic potassium-raising meds (ACEIs, ARBs, etc).

Stay tuned...other meds containing estetrol are in the works for menopausal symptoms.

Review options in our chart, Comparison of Oral Contraceptives and Non-Oral Alternatives...and clarify pros and cons of various contraceptives in our FAQ, Choosing a Hormonal Contraceptive.

Key References

  • Contraception 2021;104(3):222-8
  • Expert Rev Clin Pharmacol 2020;13(4):327-30
Pharmacist's Letter Canada. September 2021, No. 370913

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