Who Might Benefit Most from Slynd? (Part 2)
Welcome back! If you missed Part 1, I'd recommend starting there — it covers what Slynd is, how it works, and what makes it different from other progestin-only pills. Today we're diving into the groups of women I find benefit from Slynd most in my practice.
Because Slynd contains no estrogen, has a forgiving 24-hour missed pill window, and carries some nice added anti-androgenic and diuretic-like properties, it can be a particularly good fit for specific conditions and groups of women. Let's walk through them!
1. Women Who May Want to Avoid Oral Estrogen
As we covered in Part 1, Slynd's estrogen-free formulation makes it an important option for women who have contraindications to estrogen-containing contraceptives or simply prefer to avoid estrogen.
This includes:
Women who smoke and are over 35 — combined pills containing oral estrogen increase the risk of blood clots, stroke, and cardiovascular events in this group
Women with a personal history of blood clots (venous thromboembolism)
Women with migraine with aura — estrogen-containing pills are generally contraindicated
Breastfeeding women — progestin-only pills are generally considered compatible with breastfeeding, and Slynd's more forgiving 24-hour missed pill window makes it a particularly practical option during a season of life that is already so unpredictable and demanding
Women who experience side effects on estrogen — including nausea, breast tenderness, mood changes, or headaches
Women who simply prefer to avoid estrogen for personal or health reasons
For all of these women, Slynd offers an effective, estrogen-free option.
I did want to note the emphasis on oral estrogen here - transdermal estradiol via the estradiol patch or cream for HRT in peri/menopause does not have the same risks as oral estrogen! In fact, this form of estrogen is safe for most people (of course talk with your doctor who has been trained in HRT or join my waitlist). One of my favorite things to tell my patients is the fact that transdermal estradiol for HRT has the same clotting risk as your baseline clotting risk! That means it does NOT increase your risk of clotting.
2. Women with Heavy Menstrual Bleeding — Particularly in the Context of PCOS
Many women with PCOS suffer with heavy menstrual bleeding. PCOS is characterized by a combination of anovulation, hyperandrogenism, and polycystic ovarian morphology. Inheritantly, many women with PCOS often do not ovulate regularly – this demonstrated by the irregular menstrual cycles often seen in this group. Ovulation is essential for the formation of the corpus luteum, which makes progesterone during your luteal phase. In PCOS, with chronic anovulation, estrogen continues to be present, while progesterone is not. And these two hormones help balance each other out. Therefore, chronic anovulation leads to a relative progesterone deficiency and the negative effects of unopposed estrogen. One of these effects can be heavy menstrual bleeding as estrogen causes the endometrial lining to “build up”, and without progesterone to “thin it out”, the endometrial lining can continue to build, often resulting in irregular and heavy bleeding when the endometrial lining finally sheds. Slynd offers a simple, progestin-only option that may help tackle this imbalance. The levonorgestrel IUD is also an excellent option for heavy menstrual bleeding that I recommend a lot, but Slynd is a nice oral alternative for those who prefer to avoid an IUD.
3. Women with PCOS Seeking Hormonal Support
Beyond heavy bleeding, PCOS comes with a constellation of androgen-driven symptoms that can significantly affect quality of life including acne, excess facial or body hair (your doctor calls this hirsutism), hair thinning, and oily skin. These symptoms are driven by elevated androgens, which are a common hallmark of PCOS. This is where Slynd becomes a really exciting option!
Drospirenone, the progestin in Slynd, has some anti-androgenic activity. This means Slynd may offer added benefit for the androgen-driven symptoms that so many women with PCOS struggle with daily including acne, excess facial or body hair (your doctor calls this hirsutism), hair thinning, and oily skin. Of course, spironolactone is actually prescribed to treat these in practice, but many women find drospirenone offers this as an added benefit!
Combined OCPs (OCPS with an estrogen component) are a great option for PCOS and do carry their own anti-androgenic benefits — estrogen raises SHBG, which binds free testosterone and further reduces androgen activity. But for women looking to address the progesterone deficiency without added estrogen, Slynd may be a nice option. It's a progestin-only option that tackles two of PCOS's core issues — progesterone deficiency and androgen excess.
4. Women with PMDD
PMDD, or premenstrual dysphoric disorder, is a condition characterized by severe mood, behavioral, and physical symptoms that occur in the luteal phase of the menstrual cycle and resolve with the onset of menstruation. It goes well beyond typical PMS — for many women, it is genuinely debilitating.
Yaz, a combined OCP containing drospirenone and ethinyl estradiol, is actually FDA-approved for PMDD which I think is really cool. Yas is an amazing option for both the physical and emotional symptoms of PMDD, of which, speaking from prior experience, these both can be quite debilitating. For women seeking an estrogen-free option, Slynd contains the same progestin — drospirenone — without the estrogen. Many women find a lot of relief on Slynd for PMDD as well and this is one of my favorite medications to offer for women with PMDD.
*This one is near and dear to my heart, as I personally struggled with PMDD for about a year during medical school. This is a blog post for another time, but I say this to let anyone else out there that is struggling know that you are not alone, and better days are possible. I am grateful to say that I am no longer suffering with PMDD, and I pray and believe that the same is possible for you. The right doctor can make all the difference in your life. If you are struggling now, I definitely recommend finding a doctor that can support you and will take the time to listen. My clinic is opening in about a year now, which is too long to wait if you are actively suffering, but feel free to join my waitlist if this is an interest down the line. I’d be honored to assist you. You can join my waitlist here.
5. Women with a Uterus on HRT Who Don't Tolerate Micronized Progesterone
Perimenopause and menopause bring a significant shift in the hormonal landscape — estrogen, progesterone, and sometimes even testosterone decline, often bringing with them a constellation of symptoms including hot flashes, night sweats, sleep disruption, mood changes, brain fog, and genitourinary symptoms. Hormone replacement therapy (HRT, technically HT) is one of the most effective tools we have for addressing these symptoms, and for many women it is genuinely life-changing.
For women with an intact uterus, however, estrogen cannot be given alone. Unopposed estrogen — meaning estrogen without progesterone — significantly increases the risk of endometrial hyperplasia and endometrial cancer. This is because estrogen stimulates growth of the uterine lining, and without progesterone to counteract that effect, the lining can build up in a dangerous way. A progestogen is therefore non-negotiable for any woman with a uterus on systemic estrogen therapy.
Micronized progesterone (Prometrium) is often the first choice — and for many women, it's wonderfully tolerated and actually has beneficial effects. Micronized progesterone is metabolized to allopregnanolone, which enhances GABA activity in the brain and can support sleep and reduce anxiety for many women. Even in women who have had a hysterectomy and don’t “need” progesterone with their estrogen, I often still prescribe it for its benefits in this population! So, for the women who tolerate it well, Prometrium is a lovely addition to their HRT regimen.
But, there exists a subset of women that don't tolerate Prometrium well. Common complaints include excessive sedation, mood changes, anxiety, bloating, and breast tenderness. For these women, drospirenone may be a nice alternative for endometrial protection. Another excellent alternative is the levonorgestrel-IUD.
It's worth noting that using Slynd specifically as the progestogen component of HRT is an off-label application in the US — it is FDA-approved for contraception, not HRT. However, dedicated drospirenone-containing HRT combinations are available (one named Angeliq for reference), and some clinicians use Slynd in this context. This is absolutely a conversation to have with a knowledgeable provider who can evaluate your full hormonal picture.
The Bottom Line
Slynd is not a one-size-fits-all pill — but for the right woman, it can be a genuinely wonderful fit. Women with PCOS, heavy menstrual bleeding, PMDD, those who may want to avoid oral estrogen, and those on HRT who struggle with micronized progesterone are all populations worth having this conversation about with their trusted doctor.
As always, individual clinical context matters. If any of these scenarios resonate with you, I'd encourage you to bring Slynd up at your next appointment and ask whether it might be right for you.
If you'd like to work together, I'd love to support you in your health journey. You can schedule an Individualized Educational Consultation with me here, or join my waitlist here to be one of the first notified when I open my integrative women's health practice in 2027.
*This is educational content only. Not a substitute for medical care. Views are my own and separate from my institution and employer. Always discuss individual health concerns with your personal healthcare provider.
References
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Freeman EW, Kroll R, Rapkin A, Pearlstein T, Brown C, Parsey K, Zhang P, Patel H, Foegh M; PMS/PMDD Research Group. Evaluation of a unique oral contraceptive in the treatment of premenstrual dysphoric disorder. J Womens Health Gend Based Med. 2001 Jul-Aug;10(6):561-9. doi: 10.1089/15246090152543148. PMID: 11559453. https://pubmed.ncbi.nlm.nih.gov/11559453/
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Shulman LP. A review of drospirenone for safety and tolerability and effects on endometrial safety and lipid parameters contrasted with medroxyprogesterone acetate, levonorgestrel, and micronized progesterone. J Womens Health (Larchmt). 2006 Jun;15(5):584-90. doi: 10.1089/jwh.2006.15.584. PMID: 16796485. https://pubmed.ncbi.nlm.nih.gov/16796485/