Gynecology · Published 2026-07-11 · DOI 10.26442/20795696.2026.2.203740
Natalia I. Sviridova, Sergey V. Nedogoda, Alla S. Salasyuk, Inna A. Deleske, Anastasiia D. Sviridova
Background. The choice of combined hormonal contraception in overweight women of reproductive age requires an assessment of not only contraceptive efficacy but also metabolic safety, as abdominal obesity, atherogenic dyslipidemia, insulin resistance, and blood pressure are key modifiable cardiovascular risk factors. A monophasic combined oral contraceptive (COC) containing estetrol 15 mg and drospirenone 3 mg is considered a drug with a potentially more favorable metabolic profile compared to COCs containing synthetic ethinyl estradiol. However, data on the effect of Esteretta (estetrol 15 mg + drospirenone 3 mg) on metabolic parameters in overweight women in real-world clinical settings remain limited. Aim. To evaluate the dynamics of metabolic parameters and calculated indices of cardiovascular risk in women with normal and overweight body weight during the use of COC containing 15 mg estetrol and 3 mg drospirenone. Materials and methods. An open observational study was conducted at Clinical and Diagnostic Outpatient Clinic of Volgograd Regional Clinical Perinatal Center No. 2 in Volgograd. The study included 168 women of reproductive age seeking contraception. All patients were prescribed the COC Esteretta (estetrol 15 mg + drospirenone 3 mg). The study group included 82 overweight women (BMI 25.0–29.9 kg/m²), and the comparison group included 86 patients with normal body weight (BMI 18.5–24.9 kg/m²). The examination was conducted at baseline and after 3 and 6 months. Anthropometric parameters, blood pressure, lipid profile, fasting glucose, visceral adiposity index, triglyceride-to-high-density lipoprotein cholesterol ratio, plasma atherogenic index, triglyceride-glucose index, lipid accumulation index, and the presence of metabolic syndrome (MS) according to the 2026 RKO/RNMOT criteria were analyzed. Results. After 6 months, use of the Esteretta COC (estetrol 15 mg + drospirenone 3 mg) was associated with clinically insignificant changes in metabolic and calculated cardiometabolic parameters in both groups. The proportion of patients with age-related visceral adiposity index and triglyceride-to-high-density lipoprotein cholesterol ratio 1.196 did not increase and remained 0% at all visits in both groups. Using the 2026 RCO/RNMOT Consensus criteria, the estimated compliance with MS criteria in the overweight group was found in 13/82 (15.9%) patients at baseline and in 16/82 (19.5%) after 6 months, the change was not statistically significant (p = 0.250). In the normal weight group, the estimated compliance with MS criteria was not found in any patient at any visit. Conclusion. The use of the COC Esteretta (estetrol 15 mg + drospirenone 3 mg) for 6 months in overweight, non-obese women is not associated with a clinically significant deterioration in the cardiometabolic profile. However, regular (at least once every 6 months) monitoring of metabolic parameters and active lifestyle modification remain necessary in overweight women receiving hormonal contraception.
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Sviridova, N., Nedogoda, S., Salasyuk, A., et al. (2026). Metabolic profile dynamics and cardiovascular risk markers in normal- and overweight women of reproductive age taking a monophasic combined oral contraceptive containing estetrol 15 mg and drospirenone 3 mg: an open-label observational study. Gynecology. https://doi.org/10.26442/20795696.2026.2.203740