Is Yasmin (drospirenone and ethinyl estradiol) a better birth control option for overweight women?

Yasmin for Overweight Women: Contraceptive Efficacy and Safety

Yasmin (drospirenone and ethinyl estradiol) is not specifically better than other hormonal contraceptives for overweight women based on current evidence. While it has some unique properties, there is insufficient evidence to recommend it preferentially for this population.

Contraceptive Efficacy in Overweight Women

• Current evidence generally does not indicate an association between higher BMI or weight and reduced effectiveness of most hormonal contraceptives 1
• The transdermal patch has shown slightly higher pregnancy rates in women weighing more than 198 pounds (0.9% vs 0.3% in first 12 months of perfect use) 2
• For emergency contraception specifically, ulipristal acetate may be more effective than levonorgestrel in women who weigh more than 165 pounds 2
• Systematic reviews have revealed mixed or no effects of body weight and BMI on the effectiveness of combined oral contraceptives (COCs), IUDs, implants, and contraceptive injections 1

Yasmin's Properties and Benefits

• Yasmin contains 3 mg drospirenone and 30 mcg ethinyl estradiol 3
• Drospirenone is unique among progestogens as it has antimineralocorticoid and antiandrogenic properties 3, 4
• These properties may provide benefits including:
  • Reduction in fluid-related symptoms 3, 4
  • Improvement in skin conditions like acne and seborrhea 3, 5
  • Potential improvement in premenstrual symptoms 3, 4
• Studies have shown that bodyweight was maintained ±2kg in most women who received Yasmin for up to 26 cycles 5

Weight Considerations with Hormonal Contraceptives

• A common concern and reason for discontinuation of hormonal contraceptives is perceived weight gain 3
• Adult data suggest that women with obesity are not more likely to have significant weight gain with combined or progestin-only contraceptives 2
• However, adolescents with obesity who used DMPA were more likely to gain weight compared to normal-weight non-users, normal-weight DMPA users, and COC users with obesity 2
• Yasmin specifically has demonstrated a modest weight loss compared to desogestrel-containing oral contraceptives in some studies 3, 5

Safety Considerations for Overweight Women

• The World Health Organization and CDC found that among adult women, COC users with obesity are more likely than non-users to experience thromboembolic complications 2
• However, the absolute risk of thromboembolic complications among adolescent COC users is low 2
• The 2024 American Heart Association guidelines indicate a direct, linear relationship between higher doses of estrogen in combined hormonal contraceptives and increased risk of stroke 2
• Lower estrogen content (such as the 30 mcg in Yasmin) is associated with reduced risk compared to higher-dose formulations 2

Alternative Contraceptive Options for Overweight Women

• Long-acting reversible contraceptives (LARCs) such as IUDs and implants hold the best combination of efficacy, safety, and convenience for overweight women 6
• Progestin-only methods are generally safe for obese women 6
• The levonorgestrel IUD, the two-rod levonorgestrel implant, and the etonogestrel implant have shown no association between higher BMI and reduced effectiveness 1

Clinical Approach to Contraceptive Selection

• Weight (BMI) measurement is classified as not essential for determining medical eligibility for contraceptive methods, as all methods can be used or generally can be used among obese women 2
• However, measuring weight and calculating BMI at baseline might be helpful for monitoring changes and counseling women concerned about weight changes 2
• For women who have undergone bariatric surgery, highly effective contraceptives are recommended as fertility may improve post-surgery 2
• Surgical procedures involving malabsorptive components have the potential to decrease COC effectiveness 2

In conclusion, while Yasmin offers unique benefits due to its drospirenone component, there is insufficient evidence to recommend it specifically as a better option for overweight women compared to other contraceptive methods. LARCs remain the most effective option for this population, but Yasmin may be considered for overweight women who prefer oral contraceptives, particularly those concerned about fluid retention or who may benefit from its antiandrogenic properties.