Does Nextstellis cause water retention? The role of its unique progestin

October 10, 2025 •

4 min read

In clinical studies, women on Nextstellis reported a significant reduction in premenstrual water retention symptoms. This is notably different from the typical estrogen-induced bloating associated with many other combination birth control pills and directly addresses whether Nextstellis causes water retention.

Quick Summary

Nextstellis, a combined oral contraceptive, contains drospirenone, a progestin with diuretic properties that can counteract fluid retention. Many users report an improvement in bloating and related symptoms compared to other birth control options, though individual experiences may vary. Clinical trial data indicates a low incidence of weight gain, potentially linked to temporary water weight, which often subsides over time.

Key Points

Drospirenone acts as a diuretic: The progestin in Nextstellis, drospirenone, has anti-mineralocorticoid activity similar to a mild diuretic, helping to prevent salt and water retention.
Counteracts estrogen's effects: This diuretic effect helps counterbalance the natural tendency of the estrogen component to cause fluid retention, leading to less bloating for many users.
Supported by clinical trials: Phase 3 studies showed that new Nextstellis users reported a significant reduction in symptoms of premenstrual water retention.
Less likely to cause bloating: Nextstellis may be a better option for women concerned about water retention compared to combined oral contraceptives with different progestins.
Initial effects are often temporary: Any initial bloating or weight gain experienced by some users is often temporary and subsides within the first few months as the body adjusts.
Lifestyle changes can help: Reducing salt intake, staying hydrated, and exercising regularly can help manage or prevent fluid retention.
Individual responses vary: As with all medication, individual experiences differ, and it is important to consult a healthcare provider with persistent concerns.

Understanding the Hormones in Nextstellis

Nextstellis is a combined oral contraceptive (COC) that uses a unique combination of two hormones: estetrol (E4) and drospirenone (DRSP). Unlike older COCs that use ethinylestradiol, Nextstellis utilizes estetrol, a naturally occurring estrogen. The key to understanding its effect on fluid balance, however, lies in its progestin component, drospirenone.

The Role of Drospirenone (DRSP)

Drospirenone is a synthetic progestin that is a close analogue of spironolactone, a known diuretic. This gives drospirenone unique anti-mineralocorticoid properties. In simpler terms, it acts to counteract the body's salt- and water-retaining effects, much like a mild diuretic.

In typical COCs, the estrogen component can stimulate the renin-angiotensin-aldosterone system (RAAS), which can lead to increased salt and water retention. This is a common cause of bloating and temporary weight gain for many women on hormonal birth control. With Nextstellis, the drospirenone is included specifically to offset this effect, reducing the potential for fluid accumulation. As a result, some users, particularly those who are prone to water retention during their natural menstrual cycle, may experience less bloating or even a slight reduction in fluid weight.

How Clinical Studies Address Water Retention

Clinical trials have provided evidence supporting drospirenone's positive effect on fluid balance and related symptoms. In a Phase 3 trial of estetrol/drospirenone, participants who were new to hormonal contraception reported significant improvements in premenstrual and menstrual water retention symptoms. This suggests that for many individuals, the formulation actively helps to reduce bloating rather than causing it.

Findings from Clinical Trials

Symptom Reduction: A 2003 study on a drospirenone-containing pill showed a significant reduction in the incidence and severity of somatic symptoms, including abdominal bloating and breast tension.
Stable Body Weight: Some research indicates that drospirenone can have a neutral or slightly positive impact on body weight and blood pressure, in contrast to the effects sometimes seen with other combined pills.
Minimal Weight Gain Reported: While about 3% of clinical trial participants on Nextstellis reported weight gain, it's important to note that this was a small fraction and a direct cause-and-effect relationship wasn't established. Any initial gain may be temporary fluid retention that resolves as the body adjusts, typically within the first few months.

Comparing Nextstellis to Other Birth Control Pills

Not all birth control pills are created equal when it comes to potential side effects like water retention. The type of progestin and the dose of estrogen play significant roles. The following table compares Nextstellis with a typical ethinylestradiol (EE)-based pill and a progestin-only pill.


Feature	Nextstellis (Estetrol + Drospirenone)	EE-Based Combination Pill	Progestin-Only Pill (Mini-Pill)
Hormones	Estetrol and Drospirenone	Ethinylestradiol and Progestin	Progestin only
Effect on Water Retention	Reduces/Neutral due to drospirenone's diuretic effect.	Can increase due to estrogen's stimulation of the RAAS.	Minimal/Neutral impact, as there is no estrogen to cause fluid retention.
Associated Bloating	Often improved, especially for those sensitive to fluid shifts.	Potential for increased bloating, especially initially.	Not typically associated with bloating.
Common Progestins	Drospirenone.	Levonorgestrel, norethindrone.	Norethindrone, drospirenone.

Strategies for Managing Potential Bloating

Even with a formulation designed to minimize water retention, some individuals may still experience temporary bloating. This is often an initial effect as the body adjusts to the new hormones. Here are some strategies that may help:

Reduce Sodium Intake: A high-salt diet can worsen fluid retention. Limiting processed foods and table salt can help manage bloating.
Stay Hydrated: Drinking plenty of water helps flush out excess sodium and can signal to your body that it does not need to retain fluids.
Incorporate Regular Exercise: Physical activity increases blood circulation and helps the body shed excess fluids through sweat and increased urination.
Monitor Your Symptoms: Keep a record of your symptoms to see if bloating improves over time. Most initial side effects of birth control resolve within the first few months.
Consider a Different Formulation: If bloating and fluid retention are persistent or severe, discuss switching to a different birth control option with your healthcare provider. Given the variety of hormonal contraceptives available, there may be a better fit for your body.

Conclusion

So, does Nextstellis cause water retention? The answer is complex, but generally, it is less likely to cause bloating and fluid retention compared to combined oral contraceptives that use a different progestin. The key is its inclusion of drospirenone, a progestin with diuretic properties that counteract the fluid-retaining effect of the estrogen component. While some individuals may still experience temporary bloating as their body adjusts, clinical evidence suggests a favorable effect on water retention for many users. As with any medication, individual reactions can vary, and open communication with a healthcare provider is the best way to address any concerns. If you experience significant or persistent fluid retention, consult your doctor to determine the underlying cause and explore alternative solutions.

For more detailed information on drospirenone's properties, review the entry on ScienceDirect topics.

Frequently Asked Questions

Nextstellis contains the progestin drospirenone, which has anti-mineralocorticoid properties. This means it acts like a mild diuretic, helping the body shed excess sodium and water, thus counteracting the fluid-retaining effects typically associated with estrogen.

Yes, Nextstellis can be a good option for individuals who experience premenstrual syndrome (PMS)-related bloating. Clinical trials have shown that users reported significant improvements in premenstrual water retention symptoms while on the medication.

While it is less likely to cause significant water retention than other pills, individual reactions vary, and some people may experience temporary bloating, especially during the first few months. This often resolves as the body adjusts to the new hormone levels.

There is no scientific evidence that Nextstellis or drospirenone cause weight loss. Drospirenone can lead to a slight decrease in water weight due to its diuretic effect, but it does not cause fat loss.

If you are concerned about fluid retention or other side effects, contact your healthcare provider. They can help determine if the medication is the cause and suggest lifestyle adjustments or an alternative contraception method if necessary.

Older, higher-dose birth control pills were more likely to cause noticeable water retention due to higher estrogen levels. Nextstellis, with its unique drospirenone component, is specifically designed to minimize this effect, offering a better option for those sensitive to fluid shifts.

Yes, maintaining a healthy lifestyle is beneficial regardless of your medication. Reducing salt intake, drinking plenty of water, and exercising regularly are all effective strategies for managing fluid balance and can help mitigate any potential bloating.