In this article in the Drug and Therapeutics Bulletin (DTB), the authors discuss the place in therapy of drospirenone, a synthetic progestogen contained, with oestradiol, in the HRT product Angeliq®, for women following a natural menopause. The following topics are covered:

• Natural menopause

• HRT

• Benefits and risks

• Current recommendations for HRT

• Clinical efficacy: menopausal symptoms, bone density, BP, weight

• Unwanted effects

• Cautions and contraindications

• Cost

• Guidelines

The authors note that though drospirenone has anti-aldosterone activity, unlike other progestogens used in combined HRT preparations, and has been shown to reduce BP and weight and increase bone density, compared with placebo, these changes are modest and of arguable clinical significance. They add that many other combination HRT preparations are available at lower cost, and Angeliq has not been directly compared with them. Therefore they conclude “in the absence of evidence of superior efficacy or safety for Angeliq, less expensive alternatives are a better option for most women.”