Endocrine Abstracts

Introduction and Objectives of the Study: Combined oral contraceptives (COCs) are frequently prescribed for fertility control, however sexual dysfunction has been reported as a common side effect. In 2020, a novel progestin-only pill containing Drospirenone (DRSP) was approved as an oral contraceptive. To date, here is a notable dearth of data on the impact of DRSP on sexual function and impact on hormones, particularly regarding steroids. This study aims to investigate the potential effects of DRSP on sexual function and hormonal profiles, with a focus on steroids, in a cohort of women referred to our ‘female endocrinology’ outpatient clinic.

Subjects and Methods: Prospective evaluations were conducted on women taking DRSP at baseline (T0), and at 3 (T1), 6 (T2), and 12 months of follow-up (T3). Blood samples were collected to obtain a comprehensive hormonal profile, and the Female Sexual Function Index (FSFI) questionnaire was administered to assess sexual function. At each timepoint, Ferriman-Gallwey (FG) and GAGS scores were evaluated along with anthropometrics, vital signs, menstrual patterns, and adverse events.

Results: The study population comprised 26 women taking DRSP, including 12 of them with an active sexual life through all the timepoints. The median age was 24 [IQR 21-26] years. Most women (73%) exhibited clinical and/or biochemical hyperandrogenism, with a baseline FG mean score of 9.0±7.0 points and a GAGS median score of 3.5 [IQR 0-11]. While no significant changes were observed in FSFI total scores at any timepoint, a noteworthy improvement in the satisfaction domain score was identified at T2 and T3 (P=0.01 and P<0.001, respectively). Regarding hormonal profile, there was a significant reduction in Δ-4-androstenedione levels at T2 (P=0.01), persisting at T3 (P=0.006), and a notable decrease in total testosterone levels at T2 (P<0.001). Conversely, no significant alterations were found in 17-β-oestradiol, gonadotropins, and SHBG levels during follow-up. Also, no significant alterations were found on hypothalamus-pituitary-adrenal axis hormones, thyroid hormones, and prolactin levels. Clinically, improvements in FG score were recorded at T3 (P=0.006) and in the GAGS score at T2 (P=0.008). No adverse events were reported, although 5 dropouts occurred due to abnormal menstrual profiles.

Conclusions: Preliminary data indicate that after 12 months of DRSP use, there was no worsening in sexual function, whereas there was a significant enhancement in sexual satisfaction. Furthermore, improvements were observed in clinical and biochemical markers of hyperandrogenism. Further assesments are warranted to validate these preliminary findings.