Can oral contraceptive pills (OCPs), specifically Yaz (drospirenone and ethinyl estradiol), contribute to hypertriglyceridemia and hypercholesterolemia in an obese patient?

From the Guidelines

Yaz (drospirenone and ethinyl estradiol) can contribute to hypertriglyceridemia and hypercholesterolemia in an obese patient, and I strongly recommend switching to a progestin-only contraceptive option to mitigate this risk. According to the most recent guideline from the American Heart Association/American Stroke Association 1, combined oral contraceptives, such as Yaz, can increase the risk of stroke, which is also associated with hypertriglyceridemia and hypercholesterolemia. The guideline highlights that combined oral contraception with ≤20 µg ethinyl estradiol and all progestin can have a mild increase in stroke risk, while higher doses of ethinyl estradiol and certain progestins can have a moderate to severe increase in stroke risk.

The mechanism behind this association is thought to be mediated through the estrogenic component's effect on lipid metabolism, as estrogen increases hepatic production of triglycerides and can alter lipid metabolism 1. Progestin-only methods, on the other hand, avoid this estrogen effect and are generally considered safer options for patients with lipid abnormalities. Therefore, I recommend switching to a progestin-only contraceptive option such as Norethindrone 0.35mg daily (mini-pill), Depo-Provera injections every 3 months, or a levonorgestrel IUD like Mirena or Kyleena.

Some key points to consider when switching contraceptives include:

• Weight management through diet and exercise should be encouraged to help improve lipid profiles
• Follow-up lipid panels should be conducted after switching contraceptives to monitor improvement
• If lipid levels remain elevated despite changing contraception, further evaluation for other causes and possible lipid-lowering medication may be necessary
• The patient's overall cardiovascular risk profile should be assessed and taken into consideration when selecting a new contraceptive method.

From the FDA Drug Label

• Carbohydrate and lipid metabolic effects: Monitor prediabetic and diabetic women taking drospirenone and ethinyl estradiol tablets. Consider an alternate contraceptive method for women with uncontrolled dyslipidemia. (5. 8)

The use of Yaz (drospirenone and ethinyl estradiol) may have carbohydrate and lipid metabolic effects. It is recommended to monitor women, especially those who are prediabetic or diabetic, and consider an alternate contraceptive method for those with uncontrolled dyslipidemia.

• Key points:
  • Monitor prediabetic and diabetic women
  • Consider alternate contraceptive for uncontrolled dyslipidemia Based on this information, it can be inferred that Yaz may contribute to hypertriglyceridemia and hypercholesterolemia in an obese patient, particularly if they have uncontrolled dyslipidemia or are at risk for lipid metabolic effects 2.

From the Research

Metabolic Effects of Yaz (Drospirenone and Ethinyl Estradiol)

• The study 3 found that drospirenone-only pill decreased cholesterol (total, HDL, and LDL) and triglyceride levels, suggesting a potential beneficial effect on lipid profiles.
• However, the study 4 noted that the combination of ethinylestradiol and drospirenone may lead to metabolic alterations, including changes in triglyceride and cholesterol levels.
• The study 5 compared the metabolic effects of different oral contraceptive formulations, including those with ethinyl estradiol and norethindrone, and found that the increase in triglycerides was slightly less in the groups receiving the compounds with 30 or 35 micrograms estrogen.

Effects on Lipid Profiles

• The study 6 found that formulations containing low-androgenic progestins, such as drospirenone, lower LDL cholesterol and increase HDL cholesterol, which may be beneficial for cardiovascular health.
• The study 4 noted that the combination of estetrol and drospirenone had a less pronounced effect on metabolic parameters, including lipid profiles, compared to the combination of ethinylestradiol and drospirenone.
• The study 7 found that the combination of drospirenone and ethinylestradiol (Yasmin) had a positive effect on various parameters associated with well-being, including acne and menstrual symptoms, but did not specifically examine the effects on lipid profiles.

Considerations for Obese Patients

• The study 3 did not specifically examine the effects of drospirenone-only pill in obese patients, but found that the pill decreased cholesterol and triglyceride levels in the overall study population.
• The study 4 noted that the metabolic effects of drospirenone may be influenced by the presence of estrogen, and that the combination of ethinylestradiol and drospirenone may lead to metabolic alterations, including changes in triglyceride and cholesterol levels, which may be relevant for obese patients.
• There is limited evidence available to specifically address the question of whether Yaz (drospirenone and ethinyl estradiol) contributes to hypertriglyceridemia and hypercholesterolemia in obese patients, and further research is needed to fully understand the effects of this medication in this population 3, 5, 6, 4, 7.