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Unlike other currently available progestogens, drospirenone (DRSP) has a pharmacological profile, which closely mimics that of endogenous progesterone, most notably potent anti-aldosterone and anti-androgenic effects. Consequently, DRSP, when combined with 17β-estradiol (E2) as hormone replacement therapy (HRT), offsets E2-related water and sodium retention by blocking the mineralocorticoid receptor. This review evaluates the potential benefits offered by DRSP as the progestin component of HRT with respect to its anti-aldosterone activity, which translates into positive effects on body weight and blood pressure in clinical trials of continuous, combined E2/DRSP in post-menopausal women. In a 1 -year, large-scale, randomised, controlled trial, E2 1 mg/DRSP 2 mg significantly decreased mean body weight by 1.2 kg versus baseline (P < 0.001), whereas patients receiving E2 1 mg gained weight. E2 1 mg/DRSP 2 mg also significantly lowered mean systolic blood pressure (SBP) by 9.0 mmHg from baseline (P < 0.05) versus 3.7 mmHg in the E2 1 mg group (P = 0.220) in a sub-group of hypertensive women. In addition, E2/DRSP was not associated with hyperkalemia (potassium ≥ 5.5 meq/L) irrespective of concomitant use of ACE inhibitors, angiotensin II receptor antagonists or non-steroidal anti-inflammatory drugs, and co-morbid diabetes mellitus. In summary, as well as effectively treating climacteric symptoms, DRSP 2 mg combined with E2 1 mg has shown positive effects on body weight and blood pressure in clinical trials, most likely due to DRSP's anti-aldosterone properties. This combination may therefore offer an alternative therapeutic option with additional benefits beyond current HRT agents for symptomatic postmenopausal women.
Unlike other currently available progestogens, drospirenone (DRSP) has a pharmacological profile, which closely mimics that of endogenous progesterone, most notably potent anti-aldosterone and anti-androgenic effects. Consequently, DRSP, when combined with 17β-estradiol (E2) as hormone replacement therapy (HRT), offsets E2-related water and sodium retention by blocking the mineralocorticoid receptor. This review evaluates the potential benefits offered by DRSP as the progestin component of HRT with respect to its anti-aldosterone activity, which translates into positive effects on body weight and blood pressure in clinical trials of continuous, combined E2/DRSP in post-menopausal women. In a 1 -year, large-scale, randomised, controlled trial, E2 1 mg/DRSP 2 mg significantly decreased mean body weight by 1.2 kg versus baseline (P < 0.001), whereas patients receiving E2 1 mg gained weight. E2 1 mg/DRSP 2 mg also significantly lowered mean systolic blood pressure (SBP) by 9.0 mmHg from baseline (P < 0.05) versus 3.7 mmHg in the E2 1 mg group (P = 0.220) in a sub-group of hypertensive women. In addition, E2/DRSP was not associated with hyperkalemia (potassium ≥ 5.5 meq/L) irrespective of concomitant use of ACE inhibitors, angiotensin II receptor antagonists or non-steroidal anti-inflammatory drugs, and co-morbid diabetes mellitus. In summary, as well as effectively treating climacteric symptoms, DRSP 2 mg combined with E2 1 mg has shown positive effects on body weight and blood pressure in clinical trials, most likely due to DRSP's anti-aldosterone properties. This combination may therefore offer an alternative therapeutic option with additional benefits beyond current HRT agents for symptomatic postmenopausal women.
The article contains sections titled: 1. Introduction 2. Natural Methods 2.1. Periodic Methods 2.2. Breast Feeding 3. Barrier Methods 3.1. Chemical Vaginal Contraceptives 3.2. Physical Barriers 4. Hormonal Methods 4.1. The Menstrual Cycle 4.1.1. The Regulatory System 4.1.2. Hormonal Effects on the Endometrium 4.1.3. Hormonal Effects on the Cervix 4.1.4. How Hormonal Contraceptives Work 4.2. Historical Survey on Hormonal Contraception and Combined Oral Contraceptives 4.2.1. The Estrogenic Component 4.2.2. The Progestogenic Component 4.2.3. New Regimen for Oral Contraceptives 4.3. Progestogen‐Only Oral Contraceptives 4.4. Long‐Acting Contraceptives – Drug Delivery Systems 4.5. Emergency Contraception 4.6. Benefits and Risks of Hormonal Contra‐ception 4.6.1. Cardiovascular Risks 4.6.2. Cancer 5. Intrauterine Contraception 5.1. Intrauterine Device (IUD) 5.2. Intrauterine System (IUS) 6. Sterilization 6.1. Male Sterilization (Vasectomy) 6.2. Female Sterilization 7. New Approaches 7.1. Hormonal Research 7.2. Nonhormonal Research 7.3. Contraceptive Vaccines 7.4. Male Fertility Control 7.4.1. Nonhormonal Research 7.4.2. Hormonal Research
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