Safety, Compliance and Pharmacokinetics of Estetrol Monohydrate/Drospirenone 15/3 mg in Post-menarchal Female Adolescents

To evaluate the safety, compliance, and pharmacokinetics profile of estetrol monohydrate (E4) 15 mg combined with drospirenone (DRSP) 3 mg in post-menarchal participants between the age of 12 and 17 years + 2 months.

This is a Phase 3, open-label, non-controlled study in healthy post-menarchal female participants who will be enrolled to receive once daily E4/DRSP 15/3 mg for six (6) 28-day cycles in a 24/4-day regimen (i.e. 24 days of active tablets followed by 4 days of placebo tablets \[4-day hormone-free interval\]). The study will include 6 visits:

At screening visit (Visit 1), informed consent will be signed by the participants and their parent(s) or legal representative(s) and the screening procedures will be performed. The site will also complete an Eligibility confirmation phone call to the participant after Visit 1. During the enrollment visit (Visit 2, between Days 12 and 19 of the pre-treatment cycle), eligibility criteria will be reviewed and the participant participation will be confirmed. Participants will be trained in the use of an electronic diary and will receive the study drug. A follow-up call will be performed after Visit 2, within 7 days following the first investigational product intake. Afterwards, the participants will attend 3 on-treatment visits at the clinical site \[between Days 14 and 21 of the Cycle 1(Visit 3), Cycle 3 (Visit 4), and Cycle 6 (Visit 5)\] and one visit after end of Cycle 6 (Visit 6).

For participants who consent to participate in a pharmacokinetics sub-study, blood samples for this sub-study will be taken at Visit 3 and Visit 5.

Adverse events will be followed throughout the study.

Eligibility Criteria:
Inclusion Criteria:

1. Post-menarchal female participant requesting combined oral contraceptive (COC) either for contraceptive or for therapeutic use.
2. Negative serum pregnancy test at screening and negative urine pregnancy test at enrollment.
3. Aged 12 to 17 years and 2 months (inclusive) \[Estonia-specific: 15 to 17 years and 2 months (inclusive)\] at the time of signing the informed consent.
4. Willing to use the investigational product for 6 consecutive cycles.
5. Good physical and mental health on the basis of medical, surgical and gynecological history, physical examination, clinical laboratory, and vital signs.
6. Body mass index (BMI) below or equal to the percentile 97 (P97) on the local pediatric BMI curves.
7. Able to fulfill the requirements of the protocol, undergo all study procedures including e-diary and questionnaires completion.
8. Having indicated the willingness to participate in the study by providing written assent.
9. Having parent(s) or legal representative(s) willing and able to provide written informed consent.

Exclusion Criteria:

1. For participants who are not using hormonal contraception at screening, a menstrual cycle length shorter than 21 days or longer than 45 days.
2. Currently using an injectable or a dermally implantable hormonal method of contraception.
3. Known hypersensitivity to any of the investigational product ingredients.
4. Currently pregnant or breastfeeding or with the intention to become pregnant during the course of the study.
5. Less than 6 weeks since last delivery/2nd trimester abortion and before spontaneous menstruation has occurred following a delivery or 2nd trimester abortion.
6. Any condition representing a contraindication / precaution to the use of COCs, including but not limited to:

   1. dyslipoproteinaemia,
   2. diabetes mellitus with vascular involvement (nephropathy, retinopathy, neuropathy, other),
   3. arterial hypertension (controlled and uncontrolled)
   4. personal or first-degree family history of deep vein thrombosis or pulmonary embolism,
   5. current or planned prolonged immobilization,
   6. known inherited or acquired hypercoagulopathies or thrombogenic mutations (e.g. Factor V Leiden mutation),
   7. current treatment with anticoagulants,
   8. presence or history of arterial thromboembolism,
   9. complicated valvular heart disease,
   10. systemic lupus erythematosus,
   11. presence or history of migraine with aura,
   12. symptomatic gallbladder disease,
   13. porphyria.
7. Within the past 6 months, undiagnosed (unexplained) abnormal vaginal bleeding, or any abnormal bleeding that could possibly recur during the study.
8. Presence or history of recurrent pelvic inflammatory disease.
9. Any clinically relevant lower genital tract infection (including gonorrhea and chlamydia infections) until successfully treated, in the opinion of the Investigator.
10. Presence or history of hepatic disease as long as liver function values have not returned to normal.
11. Renal impairment
12. Hyperkalemia or presence of conditions that predispose to hyperkalemia such as renal impairment, hepatic impairment, adrenal insufficiency and daily, long-term treatment for chronic conditions or diseases with medications that may increase serum potassium concentration (e.g. angiotensin-converting-enzyme (ACE) inhibitors, angiotensin-II receptor antagonists, potassium-sparing diuretics, potassium supplementation, heparin, aldosterone antagonist and non-steroidal anti-inflammatory drugs).
13. History of organ transplantation within 5 years before screening or chronic disease potentially necessitating organ transplantation during the anticipated course of the study.
14. Presence or history of sex hormone-related malignancy.
15. History of non-hormone-related malignancy within 5 years before screening.
16. Current regular use or regular use within 1 month prior to Visit 2 of drugs potentially triggering interactions with COCs including but not limited to:

    1. Cytochrome P450 3A4 (CYP 3A4) inducers: barbiturates, primidone, bosentan, felbamate, griseofulvin, oxcarbazepine, topiramate, carbamazepine, phenytoin, rifampicin, St John's wort (Hypericum perforatum L).
    2. CYP 3A4 inhibitors: azole antifungals excluding topical fluconazole, phenylbutazone, modafinil, cimetidine, verapamil, macrolides excluding azithromycin, diltiazem and grapefruit juice.
    3. Human immunodeficiency virus (HIV)/Hepatitis C virus (HCV) protease inhibitors and non-nucleoside reverse transcriptase inhibitors.
17. History of alcohol or drug abuse (including laxatives) within 12 months prior to screening.
18. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of drugs.
19. Uncontrolled thyroid disorders.
20. Participation in another investigational drug clinical study within 1 month (30 days) or have received an investigational drug within the last month (30 days) prior to screening.
21. Sponsor, Contract Research Organization (CRO) or Investigator's site personnel directly affiliated with this study.
22. The participant is judged by the Investigator to be unsuitable for any reason.
23. \[Estonia-specific: Subjects who are at a gynecologist visit for the first time in their life may not sign the informed consent during this first visit.\]