What is Yasmin (drospirenone and ethinyl estradiol)?

What is Yasmin (Yaz)?

Yasmin is a combined oral contraceptive pill containing drospirenone (a fourth-generation progestin with unique antimineralocorticoid and antiandrogenic properties) and ethinyl estradiol (a synthetic estrogen), FDA-approved for pregnancy prevention, treatment of moderate acne in women seeking contraception, and management of premenstrual dysphoric disorder (PMDD). 1

Hormonal Composition

Yasmin contains:

• Drospirenone 3 mg - a synthetic progestin derived from 17α-spirolactone with antimineralocorticoid and antiandrogenic activity similar to natural progesterone 2, 3
• Ethinyl estradiol 30 μg - a synthetic estrogen 3

Yaz (a related formulation) contains:

• Drospirenone 3 mg with a lower dose of ethinyl estradiol 20 μg in a 24/4 day regimen (24 active pills, 4 inactive) 2, 4

FDA-Approved Indications

The drospirenone/ethinyl estradiol combination is indicated for: 1

• Pregnancy prevention in females of reproductive potential
• Treatment of moderate acne vulgaris in women at least 14 years old who desire oral contraception
• Treatment of premenstrual dysphoric disorder (PMDD) in women who choose oral contraception

Unique Pharmacological Properties

Antimineralocorticoid Effects

Drospirenone's antimineralocorticoid activity distinguishes it from other progestins by potentially lowering blood pressure rather than raising it. 5, 2

• Studies demonstrate SBP decreases of 1-4 mmHg after 6 months of ethinyl estradiol 15-30 μg combined with drospirenone 3 mg 5
• One Turkish study showed mean SBP decreased from 109.2 mmHg to 103.4 mmHg after 12 months of use 5, 6
• When used as a progestin-only pill (drospirenone 4 mg), SBP decreases by 8 mmHg and DBP by 5 mmHg in individuals with baseline SBP ≥130 mmHg 5, 6

Antiandrogenic Effects

The antiandrogenic properties provide benefits for: 5

• Acne treatment - demonstrated significant reductions in inflammatory, non-inflammatory, and total acne lesions compared to placebo 5, 6
• Seborrhea reduction - median seborrhea decreased by 25.1% from baseline 7
• Improved skin condition - comparable efficacy to ethinyl estradiol 35 μg/cyproterone acetate 2 mg 3

Contraceptive Efficacy

Yasmin demonstrates high contraceptive efficacy with Pearl indices comparable to established low-dose combined oral contraceptives. 3

• Theoretical Pearl index: 0-0.07 3
• Corrected Pearl index: 0.41-0.71 3
• Pregnancy ratios: 0.3-0.84 in young, healthy women aged 18-35 years 3
• Efficacy is equal to ethinyl estradiol 30 μg/desogestrel 150 μg (corrected Pearl index 0.28-0.41) 3

Cycle Control and Tolerability

Yasmin provides excellent cycle control with rapidly decreasing intermenstrual bleeding after the first cycle. 3

• Intermenstrual bleeding (spotting/breakthrough bleeding) decreased from 9-18% in cycle 2 to 6% after 26 cycles 3
• Body weight maintained within ±2 kg in most women receiving treatment for up to 26 cycles 3
• Adverse events are typical of combined oral contraceptives and comparable to other formulations 3, 8

Additional Benefits

Premenstrual and Menstrual Symptoms

Drospirenone/ethinyl estradiol improves premenstrual symptoms including negative affect, water retention, and increased appetite. 3, 7

• Significantly better at alleviating negative affect symptoms during the menstrual phase compared to levonorgestrel-containing pills 9
• 60% of users reported improved physical well-being versus 46% with levonorgestrel formulations 9
• Improved scores on the Psychological General Well-Being Index 7

Well-Being Effects

Women report improvements in: 7, 9

• Overall sense of well-being
• Reduced bloating and fluid retention
• Decreased breast tenderness
• Improved mood and reduced irritability

Critical Safety Considerations

Venous Thromboembolism Risk

Drospirenone-containing oral contraceptives carry a significantly elevated VTE risk—approximately 50-80% higher than levonorgestrel-containing pills—and should be reserved for women who specifically benefit from drospirenone's unique properties and have no VTE risk factors. 6

• VTE incidence: 10 per 10,000 woman-years with drospirenone formulations 6
• Hazard ratio for VTE: 1.77 (95% CI 1.33-2.35) compared to low-dose estrogen comparators 6
• Compared to 3-9 per 10,000 woman-years for standard combined oral contraceptives 6

Absolute Contraindications

Drospirenone/ethinyl estradiol is absolutely contraindicated in: 5, 6

• History of deep vein thrombosis or pulmonary embolism
• Uncontrolled hypertension
• Women who smoke and are over 35 years old
• History of breast cancer or other estrogen/progestin-sensitive cancers
• Cerebrovascular or coronary artery disease
• Hepatic adenomas, carcinomas, or hepatocellular disease with abnormal liver function
• Pregnancy (Category X)

Cardiovascular Risk

Myocardial infarction risk is strongly associated with cigarette smoking, diabetes, and hypertension, but there is no increased MI risk in healthy, normotensive, nondiabetic nonsmokers at any age. 6

• Increased risk of both ischemic and hemorrhagic stroke, particularly with cigarette smoking, hypertension, and age ≥35 years 6

Clinical Decision Algorithm

Choose drospirenone-containing pills when: 6

• Patient specifically needs blood pressure reduction and desires oral contraception
• Patient has moderate acne and desires contraception
• Patient has PMDD and desires contraception
• Patient has no VTE risk factors

Choose levonorgestrel-containing pills when: 6

• Patient has any VTE risk factors
• Patient does not specifically need drospirenone's unique properties

Monitoring Requirements

Baseline monitoring: 5

• Pregnancy status assessment
• Blood pressure measurement

Ongoing monitoring: 5, 6

• Blood pressure at follow-up visits
• Assessment for VTE symptoms at each visit
• General health status changes

Common Pitfalls to Avoid

• Do not prescribe to women with any VTE risk factors without careful consideration of safer alternatives 6
• Do not assume all combined oral contraceptives have equivalent VTE risk—drospirenone formulations carry higher risk 6
• Do not overlook smoking status and age—combination is particularly dangerous in smokers over 35 6
• Do not prescribe for blood pressure benefits alone—the VTE risk may outweigh benefits in women not needing contraception 6