Use of Continuous Oral Drospirenone for Menstrual Suppression in Adolescents

Garrett Garborcauskas, Garrett Garbo, Barrera E, Ellis Barrera, Jessica Y. Shim, Shim JY, Elizabeth R. Boskey, Frances W Grimstad, Grimstad FW
The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2025 · vol. 76(1) , pp. 148–153 · doi:10.1016/j.jadohealth.2024.09.004 · PMID:39387723
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Continuous oral drospirenone for menstrual suppression in adolescents effectively treated dysmenorrhea and pelvic pain, with breakthrough bleeding occurring in nearly half of patients but rarely leading to discontinuation.

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This paper describes the use of continuous oral drospirenone for menstrual suppression in adolescents, aiming to evaluate feasibility, safety, and bleeding patterns with continuous administration rather than cyclic bleeding. The authors frame the work based on adolescent hormonal contraception evidence and related trials of drospirenone-based regimens, with attention to tolerability and bleeding profile as key outcomes, while acknowledging that data on continuous menstrual suppression specifically in adolescents can be limited. A major caveat noted in this field is that evidence often comes from trials designed primarily for contraceptive efficacy or limited cycle durations, which can constrain direct inference about sustained menstrual suppression. Relevance to endometriosis: the paper cites prior adolescent endometriosis experience with the drospirenone-only contraceptive pill, though its main focus is continuous oral drospirenone for menstrual suppression in adolescents.

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Abstract

PURPOSE: To describe experiences of adolescents taking continuous drospirenone (DRSP-C) oral contraceptives, without placebo, for menstrual suppression, including breakthrough bleeding and other side-effects. METHODS: This was a retrospective chart review of adolescents prescribed DRSP-C for menstrual suppression. Demographics and indications for DRSP-C were collected on the visit where DRSP-C was prescribed. Data through the final follow-up visit during the study period included documented effects and side-effects of DRSP-C and continuation of therapy. Statistical analyses were primarily descriptive. RESULTS: Patients prescribed DRSP-C were included (n = 136). Dysmenorrhea was the most common indication for DRSP-C (58.8%, n = 80/136) followed by endometriosis (44.8%, n = 61/136). The median time on DRSP-C for the 116 patients who were able to initiate treatment was 12.3 months (interquartile range [IQR] 6.8, 17.4). Patients trialed, on average, 2 other forms of menstrual management before starting DRSP-C (IQR 1, 3). Pelvic pain or dysmenorrhea resolution or improvement was reported in 84.6% (44/52) of dysmenorrhea patients, and 77.8% (28/36) of pelvic pain patients. Almost half of patients reported breakthrough bleeding on DRSP-C (41.3%, n = 48/116); however, only 11 patients (42%, 11/26) discontinued DRSP-C because of it. Within the study period, 22.4% (n = 26/116) of patients discontinued DRSP-C, with a median treatment duration of 101 days (IQR 71, 157). Among patients who discontinued DRSP-C, the most common reason was breakthrough bleeding (42%, n = 11/26). DISCUSSION: DRSP-C for menstrual suppression was well tolerated in adolescents, with most patients reporting resolution or improvement of their indication for taking DRSP-C. Findings demonstrate DRSP-C is a viable option for menstrual suppression in adolescents.
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Use of Continuous Oral Drospirenone for Menstrual Suppression in Adolescents Affiliations & Notes aDepartment of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, Minnesota bDivision of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts cFrank H Netter School of Medicine at Quinnipiac University, North Haven, Connecticut dDepartment of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts eDepartment of Surgery, Harvard Medical School, Boston, Massachusetts Article Info Publication History: Received March 15, 2024; Accepted September 4, 2024; Published online October 10, 2024 Footnotes: Conflicts of interest: The authors have no conflicts of interest to disclose. DOI: 10.1016/j.jadohealth.2024.09.004 External LinkAlso available on ScienceDirect External Link Copyright: © 2024 Society for Adolescent Health and Medicine. All rights are reserved, including those for text and data mining, AI training, and similar technologies. Linked Articles Download started OkKeywords References 1. Committee on Clinical Consensus – Gynecology General approaches to medical management of menstrual suppression: ACOG clinical consensus No. 3 Obstet Gynecol. 2022; 140:528-541 2. Damm, T. ∙ Lamvu, G. ∙ Carrillo, J. ... Continuous vs. cyclic combined hormonal contraceptives for treatment of dysmenorrhea: A systematic review Contracept X. 2019; 1, 100002 3. Edelman, A. ∙ Micks, E. ∙ Gallo, M.F. ... Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception Cochrane Database Syst Rev. 2014; 2014, CD004695 4. Committee on Adolescent Health Care Dysmenorrhea and endometriosis in the adolescent Obstet Gynecol. 2018; 132:e249-e258 5. Hee, L. ∙ Kettner, L.O. ∙ Vejtorp, M. 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dysmenorrheaendometriosis

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