Ask the Pharmacist

Q: Is there anything new for women to take to prevent pregnancy? Can you compare them to the many options that have been available for decades?

A: While many birth control methods remain the same (pills, IUDs, implants, patches, etc.), two available options have entered the contraceptive landscape in the last few years: Slynd and Nextstellis.

Slynd is a progestin-only oral contraceptive using drospirenone - four milligrams (mg). Compare this to the three-mg dose of drospirenone found in some combination oral contraceptives.

Slynd has its positives and negatives. On the plus side, it offers a great choice for those women who prefer to take an oral contraceptive and cannot take estrogen. Plus, drospirenone is far more forgiving for women who find it challenging to take their “pill” at the same time each day. However, progestins may cause some irregular bleeding and/or spotting. As well, drospirenone is linked to a risk of hyperkalemia (high potassium), especially if taking other potassium-raising medications. Therefore, potassium should be closely monitored in women taking Slynd.

Nextstellis is a relatively new combined oral contraceptive (COC) containing a novel estrogen (estetrol, “E4”) plus drospirenone as the progesterone. The same considerations apply to Nextstellis as they do with Slynd with respect to the hyperkalemia and irregular bleeding. Estetrol is touted as a “native” estrogen derived from plant sources, offering selective actions in tissues and potentially less impact on breast tissue and lipid levels. However, there is not enough proof that there is a reduction of breast cancer or blood clots.

Both Slynd and Nextstellis are indicated for prevention of pregnancy in women. Since Nextstellis is a COC, it comes with the following exceptions:
 

• Women over the age of 35 who smoke cigarettes
• Women with a history of hormone-dependent cancer
• Those with a high arterial thromboembolism risk
• Those with a high deep vein thrombosis risk
• Those with a high pulmonary embolism risk
• Those with a high cardiovascular risk (uncontrolled high blood pressure, recent heart attack)
• Those with severe migraine with aura
• Women with a BMI greater than 35 as it has not been studied but early thoughts suggest it may be less effective

Compared to other COCs, Nextstellis appears to have lower rates of side effects, such as acne, worsening of high blood pressure, weight gain and mood changes, but there have not been any direct head-to-head studies to confirm.

As with all oral birth control pills, they do not protect against sexually-transmitted infections (STI) and barrier methods must still be used for STI prevention. More on that in a future Ask the Pharmacist column.

HOW THEY COMPARE WITH TRADITIONAL BIRTH CONTROL METHODS

To put Nextstellis and Slynd in context, here is a rough comparison with more established birth control options:
 

Method	Typical Effectiveness*	Key Advantages	Key Considerations/Risks
Nextstellis (combined pill, drospirenone + estetrol)	~ 1–2 per 100 women per year (if taken correctly)	Modern estrogen, good cycle control, convenience	Risks of clotting, not suitable for smokers >35, BMI limitations, typical hormonal side effects, no STI protection
Slynd (progestin-only drospirenone pill)	Very low pregnancy rate when used correctly (Pearl Index ~ 0.2)	No estrogen, more forgiving missed-pill window, safer for some women	Daily adherence required; possible irregular bleeding; no STI protection
Standard combined pills/older POPs/patches/rings	Similar when used correctly (combined ~ 99.7% perfect use; typical use lower)	Broad experience base, many options, non-contraceptive benefits (cycle, acne, etc.)	Estrogen-related clot risk; adherence issues; side effects; no STI protection
Long-acting methods (IUDs, implants)	Among the most effective: <1% per year with typical use	“Set and forget,” very low user-failure risk, long duration	Insertion required; possible discomfort; side effects depend on type; no STI protection

* “Typical use” accounts for imperfect adherence (missed pills, delays, etc.) and real-world effectiveness tends to be lower than “perfect use.”

Though the oral contraceptives show a high effective rate to prevent pregnancy, very few women practise “perfect use” to maintain that effectiveness. More women are now opting for the peace of mind associated with IUDs and implants. There is something to be said for not having to contend with the reduced efficacy of being late or missing a dose of their oral contraceptive.

However, even though IUDs and implants are among the most effective at preventing pregnancy, it is important to note that they do not offer any protection against STIs. Practise safe sex and protect yourself by using a condom.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/.