Combination oral contraceptives have changed considerably since they were introduced, in 1960. Although ethinyl estradiol has been the primary estrogen in combination oral contraceptives for years, a number of progestogenic agents have been developed. All of the progestins currently used in combination oral contraceptives are derived from 19-nortestosterone. The exception is a new progestin derived from 17 alpha-spirolactone--drospirenone. As compared with that of other progestins used in combination oral contraceptives, drospirenone pharmacology more closely resembles the pharmacology endogenous progesterone. Its antiandrogenic and antimineralocorticoid activities result in special benefits--e.g., improvement in androgen-related disorders (such as acne and hirsutism) and avoidance of estrogen-related fluid retention.