Eficacia y seguridad del drospirenona/etinilestradiol versus estetrol/drospirenona como método anticonceptivo en mujeres en edad fértil. Revisión sistemática

Abstract

Background: Given the increase in pregnancies among women of childbearing age in recent years, the scientific community has sought various contraceptive alternatives that offer greater efficacy in preventing unintended pregnancy while causing fewer adverse effects. Objective: To evaluate the efficacy and safety of drospirenone/ethinyl estradiol versus estriol/drospirenone as a contraceptive method in women of childbearing age. Methodology: Systematic review based on PRISMA 2020. Studies published in the last 12 years in English and Spanish related to both combined oral contraceptives were included. The search was conducted in Scopus, PubMed, Web of Science, SciELO, Taylor & Francis, the Cochrane Library, and Embase. Methodological quality and risk of bias were assessed using the NHLBI and Cochrane RoB2 tools. Results: The 64% of studies met all NHLBI quality criteria, and 64.1% had a low risk of bias. Both contraceptives were shown to be effective and safe. However, EE/drospirenone demonstrated greater contraceptive efficacy, with an average Pearl Index of 0.722 pregnancies per 100 woman-years, while E4/drospirenone had an average index of 1.424 pregnancies per 100 woman-years. Nevertheless, E4/drospirenone showed a lower incidence of adverse effects such as headache (7.2%), breast pain (0.75%), breakthrough bleeding (0.9%), and acne (3.10%), demonstrating better tolerability. Conclusion: The results show that EE/drospirenone is the most effective contraceptive option, while E4/drospirenone is safer. Keywords: fertility, drospirenone/ethinyl estradiol, estriol/drospirenone, efficacy, adverse effects