Is Yas (drospirenone) as effective as Sprintec (norgestimate) in preventing pregnancy?

Effectiveness of YAZ vs Sprintec for Pregnancy Prevention

Both YAZ (drospirenone) and Sprintec (norgestimate) are equally effective at preventing pregnancy, with typical use failure rates of approximately 6-9% per year. However, they differ in their side effect profiles and non-contraceptive benefits.

Contraceptive Effectiveness

• Both YAZ and Sprintec are combined oral contraceptives (COCs) with similar contraceptive efficacy
• All COCs have comparable effectiveness for pregnancy prevention when used correctly 1
• Perfect use failure rate: approximately 2% for all COCs
• Typical use failure rate: approximately 6-9% for all COCs

Key Differences Between YAZ and Sprintec

Progestin Component

• YAZ contains drospirenone (fourth-generation progestin) with:

  • Anti-androgenic properties
  • Anti-mineralocorticoid effects
  • Potent progestogenic activity 2

• Sprintec contains norgestimate (third-generation progestin) with:

  • Minimal androgenic activity
  • Peripheral anti-androgenic properties 2, 3

Estrogen Component

• YAZ: 20 μg ethinyl estradiol
• Sprintec: 35 μg ethinyl estradiol

Dosing Schedule

• YAZ: 24 active pills/4 placebo pills (24/4 regimen) 4
• Sprintec: 21 active pills/7 placebo pills (21/7 regimen)

Side Effect Considerations

Venous Thromboembolism (VTE) Risk

• Drospirenone-containing COCs (YAZ) have a slightly higher VTE risk compared to norgestimate-containing COCs (Sprintec)
• VTE risk with drospirenone: approximately 9-10 per 10,000 woman-years
• VTE risk with norgestimate: approximately 6 per 10,000 woman-years 1, 2
• Baseline VTE risk in non-COC users: 2 per 10,000 woman-years 1

Water Retention and Weight

• YAZ may cause less water retention due to drospirenone's anti-mineralocorticoid effects 5
• Some studies show weight loss or less weight gain with drospirenone-containing pills compared to other progestins 5

Mood Effects

• YAZ may have more positive effects on mood symptoms during the menstrual phase compared to levonorgestrel-containing pills 6
• Drospirenone has been shown to alleviate negative affect symptoms better than other progestins 6

Additional Benefits

Acne Treatment

• Both YAZ and Sprintec are FDA-approved for acne treatment 2
• Trials comparing drospirenone-containing COCs to other COCs have generally favored the drospirenone-containing COC for acne treatment 1
• The proportion of subjects with acne decreased from approximately 55% to 45% with drospirenone, while remaining static at approximately 60% with levonorgestrel in comparative studies 6

Premenstrual Symptoms

• YAZ is FDA-approved for treatment of premenstrual dysphoric disorder (PMDD) 2
• Drospirenone-containing COCs may improve premenstrual symptoms that result in functional impairments in women with PMDD 7

Clinical Decision Algorithm

1. For patients with normal BMI and no risk factors for VTE:

   • Either YAZ or Sprintec is appropriate

2. For patients with acne or PMDD:

   • YAZ may provide better symptom relief 1, 2, 7

3. For patients with water retention concerns:

   • YAZ may be preferable due to drospirenone's anti-mineralocorticoid effects 5

4. For patients with VTE risk factors:

   • Sprintec may be safer due to slightly lower VTE risk 1, 2

5. For patients sensitive to estrogen side effects:

   • YAZ contains a lower dose of ethinyl estradiol (20 μg vs 35 μg)

Important Cautions

• Both medications are contraindicated in women with:

  • History of VTE or thrombophilia
  • Ischemic heart disease
  • Cerebrovascular disease
  • Migraines with aura
  • Age ≥35 years who smoke
  • Active liver disease 1, 2

• The risk of VTE, while elevated with both medications compared to non-users, remains low in absolute terms and is lower than the VTE risk associated with pregnancy 1