Sexual function and quality of life of women using combined oral contraceptives based on esthetrol and drospirenone
AbstractCombined oral contraceptives (COCs) are one of the most convenient, common and effective methods of hormonal contraception. However, often during the use of COCs, adverse events may occur, one of which is impairment/decrease in sexual function. A high level of quality of sexual life determines the mental state of women of the XXI century and, accordingly, the quality of life in general. At the same time, despite the fact that the issue of the direct negative impact of COCs on the sexual function of women remains extremely controversial, it is necessary to develop a new COC that has a neutral endocrine-metabolic profile and can reduce potential risks. In this regard, a COC based on innovative estrogen – esthetrol (E4) and drospirenone was recently registered in the Russian Federation, effect of which on sexual function and quality of life has not been fully studied.
The aim of the study was to evaluate sexual function and quality of life of women using combined oral contraceptives based on drospirenone and esthetrol.
Study design: open, independent, prospective observational study.
Material and methods. The study involved 251 somatically healthy women of reproductive age (average age 25.30±2.82 years). All of them applied to the clinical bases of the Department of Obstetrics and Gynecology with a course of perinatology at the Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba in order to receive medical consultation on selection of a contraceptive method (ICD-10: Z30.0 General counselling and advice on contraception, Z30.4 Surveillance of contraceptive drugs).
All studied women (n=251) were assessed at each visit to the doctor for sexual function using the SQOL-F questionnaire and an assessment of the overall quality of life using the modified SF-36 questionnaire over time (after 6 and 12 months). At the same time, at the 6th and 12th month of using COCs, the compliance indicator in women was assessed using the modified Morisky–Green scale.
Results. When using COCs based on 15 mg of esthetrol and 3 mg of drospirenone, women in the study cohort showed consistently high levels of sexual function throughout the study according to the SQOL-F scale (p>0.05). Similar results were obtained when studying the quality of life indicators of participants according to the modified SF-36 questionnaire (p>0.05). When studying the indicators obtained according to the modified Morisky–Green scale, women in the study cohort had a stable compliance profile both at the 6th and 12th months of the study (p>0.05).
Conclusion. The results obtained in this study demonstrate a favorable profile of COCs based on 15 mg esthetrol and 3 mg drospirenone in relation to sexual function, overall quality of life and compliance in women.
Keywords:esthetrol; drospirenone; COCs; quality of life; sexual function
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Orazov M.R., Radzinsky V.E., Khamoshina M.B., Orekhov R.E., Ermakov V.V., Dolgov E.D. Sexual function and quality of life of women using combined oral contraceptives based on esthetrol and drospirenone. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2024; 12. Supplement: 59–68. DOI: https://doi.org/10.33029/2303-9698-2024-12-suppl-59-68 (in Russian)
REFERENCES
1. Kalachikova O.N., Gruzdeva M.A. Changes in the reproductive and mating behavior of the Russian population (based on an analysis of sample research by Rosstat). Sotsial’noe prostranstvo [Social Space]. 2018; 2 (14). DOI: https://doi.org/10.15838/sa.2018.2.14.1 (in Russian)
2. WHO. Defining sexual health. Report of a technical consultation on sexual health, 28–31 January, 2002. Geneva, 2006: 26 p.
3. WHO. Education and treatment in human sexuality. The training of health professionals. Report of a WHO Meeting (WHO Technical Report Series, No. 572). 1975.
4. Hall K.S., Trussell J. Types of combined oral contraceptives used by US women. Contraception. 2012; 86 (6): 659–65.
5. United Nations, Department of Economic and Social Affairs, Population Division. World contraceptive use. 2011.
6. Huang M., Li G., Liu J., Li Y., Du P. Is there an association between contraception and sexual dysfunction in women? A systematic review and meta-analysis based on female sexual function index. J Sex Med. 2020; 17 (10): 1942–55.
7. Davis S.R., Bitzer J., Giraldi A., Palacios S., Parke S., Serrani M., et al. Change to either a nonandrogenic or androgenic progestin-containing oral contraceptive preparation is associated with improved sexual function in women with oral contraceptive-associated sexual dysfunction. J Sex Med. 2013; 10: 3069–79.
8. Pastor Z., Holla K., Chmel R. The influence of combined oral contraceptives on female sexual desire: a systematic review. Eur J Contracept Reprod Health Care. 2013; 18 (1): 27–43.
9. Graham C.A., Bancroft J., Doll H.A., Greco T., Tanner A. Does oral contraceptive-induced reduction in free testosterone adversely affect the sexuality or mood of women? Psychoneuroendocrinology. 2007; 32 (3): 246–55.
10. Casado-Espada N.M., de Alarcón R., de La Iglesia-Larrad J.I., Bote-Bonaechea B., Montejo Á.L. Hormonal contraceptives, female sexual dysfunction, and managing strategies: a review. J Clin Med. 2019; 8: 908.
11. Orazov M.R., Radzinsky V.E., Dolgov E.D., Ermakov V.V. Contraceptive with esthetrol: «Show must go on» or the ideal COC. Zhenskaya klinika [Women’s Clinic]. 2022; (2): 16–23. (in Russian)
12. Orazov M.R., Radzinsky V.E., Dolgov E.D., Ermakov V.V. Endocrine-metabolic effects of oral contraceptives containing esthetrol and drospirenone. Voprosy ginekologii, akusherstva i perinatologii [Problems of Gynecology, Obstetrics and Perinatology]. 2022; 21 (4): 146–50. DOI: https://doi.org/10.20953/1726-1678- 2022-4-146-150 (in Russian)
13. Harlow S.D., Gass M., Hall J.E., Lobo R., Maki P., Rebar R.W., et al.; STRAW+10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging. Climacteric. 2012; 15 (2): 105–14. DOI: https://doi.org/10.3109/13697137.2011.650656 Epub 2012 Feb 16. PMID: 22338612; PMCID: PMC3580996.
14. Ministry of Health of the Russian Federation. Instructions for safe use of the drug Esteretta (in Russian)
15. Maasoumi R., Lamyian M., Montazeri A., Azin S.A., Aguilar-Vafaie M.E., Hajizadeh E. The sexual quality of life-female (SQOL-F) questionnaire: translation and psychometric properties of the Iranian version. Reprod Health. 2013; 10 (1): 1–6.
16. Finer L.B., Zolna M.R. Declines in unintended pregnancy in the United States, 2008–2011. N Engl J Med. 2016; 374: 843–52.
17. Johnson S., Pion C., Jennings V. Current methods and attitudes of women towards contraception in Europe and America. Reprod Health. 2013; 10: 7. DOI: https://doi.org/10.1186/1742-4755-10-7
18. Medical guide to contraception. In: V.N. Prilepskaya (ed.). 4th ed., suppl. Moscow: MEDpress-inform, 2017: 464 p.: il. ISBN 978-5-00030-504 (in Russian)
19. de Wit A.E., Booij S.H., Giltay E.J., Joffe H., Schoevers R.A., Oldehinkel A.J. Association of use of oral contraceptives with depressive symptoms among adolescents and young women. JAMA Psychiatry. 2020; 77 (1): 52–9.
20. Skovlund C.W., Morch L.S., Kessing L.V., Lange T., Lidegaard O. Association of hormonal contraception with depression. JAMA Psychiatry. 2016; 73 (11): 1154–62.
21. Zethraeus N., Dreber A., Ranehill E., Blomberg L., Labrie F., von Schoultz B., et al. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2016; 107 (5): 1238–45.
22. Di Carlo C., Gargano V., Sparice S., Tommaselli G.A., Bifulco G., Nappi C. Effects of an oral contraceptive containing estradiol valerate and dienogest on circulating androgen levels and acne in young patients with PCOS: an observational preliminary study. Gynecol Endocrinol. 2013; 29: 1048–50.
23. Caruso S., Cianci S., Cariola M., Fava V., di Pasqua S., Cianci A. Improvement of low sexual desire due to antiandrogenic combined oral contraceptives after switching to an oral contraceptive containing 17β-estradiol. J Womens Health. 2017; 26: 728–34.
24. De Leo V., di Sabatino A., Musacchio M.C., Morgante G., Scolaro V., Cianci A., et al. Effect of oral contraceptives on markers of hyperandrogenism and SHBG in women with polycystic ovary syndrome. Contraception. 2010; 82: 276–80.
25. Casey P.M., MacLaughlin K.L., Faubion S.S. Impact of contraception on female sexual function. J Womens Health. 2017; 26: 207–13.
26. Coelingh Bennink F., Holinka C.F., Visser M., Coelingh Bennink H.J.T. Maternal and fetal estetrol levels during pregnancy. Climacteric. 2008; 11: 69–72.
27. Fruzzetti F., Fidecicchi T., Montt Guevara M.M., Simoncini T. Estetrol: a new choice for contraception. J Clin Med. 2021; 10 (23): 5625. DOI: https://doi.org/10.3390/jcm10235625
28. Gallez A., Dias Da Silva I., Wuidar V., et al. Estetrol and mammary gland: friends or foes? J Mammary Gland Biol Neoplasia. 2021; 26: 297–308. DOI: https://doi.org/10.1007/s10911-021-09497-0
29. Gérard C., Arnal J.-F., Jost M., Douxfils J., Lenfant F., Fontaine C., et al. Profile of estetrol, a promising native estrogen for oral contraception and the relief of climacteric symptoms of menopause. Expert Rev Clin Pharmacol. 2022; 15 (2): 121–37. DOI: https://doi.org/10.1080/17512433.2022.2054413
30. Gemzell-Danielsson K., Apter D., Zatik J., Weyers S., Piltonen T., Suturina L., et al. Estetrol-drospirenone combination oral contraceptive: a clinical study of contraceptive efficacy, bleeding pattern and safety in Europe and Russia. BJOG. 2022; 129 (1): 63–71.
31. Creinin M.D., Westhoff C.L., Bouchard C., Chen M.J., Jensen J.T., Kaunitz A.M., et al. Estetrol-drospirenone combination oral contraceptive: North American phase 3 efficacy and safety results. Contraception. 2021; 104 (3): 222–8.