What is Yazz (drospirenone and ethinyl estradiol) birth control?

What is Yaz Birth Control?

Yaz is a combined oral contraceptive pill containing drospirenone 3 mg and ethinyl estradiol 20 mcg, administered in a unique 24/4 regimen (24 active pills followed by 4 inactive pills), and is FDA-approved for three indications: pregnancy prevention, treatment of premenstrual dysphoric disorder (PMDD) in women who choose oral contraception, and treatment of moderate acne in women at least 14 years old who desire contraception. 1

Unique Formulation and Dosing

• Yaz contains the lowest commonly used dose of ethinyl estradiol (20 mcg) combined with drospirenone, a novel progestin structurally related to spironolactone 2, 3
• The 24/4 regimen (24 active pills, 4 inactive pills) differs from traditional 21/7 oral contraceptive regimens, providing a shortened hormone-free interval 2, 3
• Drospirenone has a half-life exceeding 30 hours, allowing its activity to extend into the shortened hormone-free interval 2

Distinctive Pharmacologic Properties

Drospirenone is the only progestin in oral contraceptives with both antimineralocorticoid and antiandrogenic properties, distinguishing it from all other synthetic progestins used in contraceptives 2, 4, 5

• These properties derive from drospirenone's structural similarity to 17α-spironolactone, making it closely resemble natural progesterone 2, 5
• The antimineralocorticoid effect may help prevent fluid retention and weight gain commonly associated with other oral contraceptives 6
• The antiandrogenic properties make it particularly effective for treating acne and other androgen-related conditions 7, 8

FDA-Approved Indications

Yaz has three distinct FDA-approved uses 1:

1. Contraception: Provides 99% contraceptive protection over one year of treatment 3
2. PMDD Treatment: The only oral contraceptive with large randomized controlled trials demonstrating efficacy for premenstrual dysphoric disorder 5
3. Moderate Acne: Approved for women at least 14 years old who have achieved menarche and desire oral contraception 1

Clinical Efficacy for Specific Conditions

Acne Treatment

• Drospirenone-containing pills demonstrate superior efficacy compared to other progestins in reducing androgen levels 8
• The American Academy of Dermatology recognizes Yaz/Yasmin as having specific antiandrogenic properties for acne treatment 7
• Median acne lesion counts decrease by approximately 62.5% after 9 cycles of treatment 6

PMDD Management

• Significantly improves both emotional and physical symptoms associated with PMDD over three treatment cycles 3
• Women reporting premenstrual symptoms before starting Yaz show improved Psychological General Well-Being Index scores 6

Blood Pressure Effects

Unlike most oral contraceptives that raise blood pressure, drospirenone-containing pills may actually lower blood pressure due to antimineralocorticoid effects 9

• Studies show mean systolic blood pressure decreases of 1-6 mmHg after 6-12 months of use 9
• Among women with baseline elevated blood pressure (SBP ≥130, DBP ≥85), drospirenone 4mg as a progestin-only pill decreased SBP by 8 mmHg and DBP by 5 mmHg 9

Critical Contraindications and Safety Concerns

Absolute Contraindications 9, 1:

• Renal dysfunction, adrenal insufficiency (due to hyperkalemia risk)
• Smoking in women ≥35 years old
• History of deep vein thrombosis or pulmonary embolism
• Breast cancer or other estrogen/progestin-sensitive cancers
• Uncontrolled hypertension
• Hepatic dysfunction or hepatic tumors
• Migraine with aura (especially if ≥35 years)
• Pregnancy

Hyperkalemia Risk

The antimineralocorticoid properties of drospirenone can increase serum potassium, creating serious cardiac risks in susceptible patients 1

• Patients should not take Yaz if they have kidney, liver, or adrenal disease 1
• First-month potassium monitoring is recommended if patients are on chronic daily treatment with: NSAIDs, potassium-sparing diuretics, ACE inhibitors, angiotensin-II receptor antagonists, or aldosterone antagonists 1
• However, routine potassium monitoring is not required in young, healthy women without kidney, liver, or adrenal disease 8

Venous Thromboembolism Risk

• Drospirenone-containing pills may have slightly higher VTE risk compared to other combined oral contraceptives 7
• VTE risk is approximately 10 per 10,000 woman-years (compared to 3-9 for standard COCs and 1-5 for non-users) 8

Common Adverse Effects

Typical side effects include 9:

• Cardiovascular: edema, increased risk of arterial thromboembolism, hypertension
• Gastrointestinal: nausea, abdominal bloating, vomiting
• Central nervous system: depression, migraine, mood changes
• Endocrine: breakthrough bleeding, breast tenderness, amenorrhea
• Dermatologic: melasma

Required Monitoring

Baseline Assessment 9:

• Pregnancy test
• Blood pressure measurement
• Breast and pelvic examinations, including Papanicolaou smear

Ongoing Monitoring 9:

• Blood pressure checks
• Assessment of potential health status changes

Important Drug Interactions

Yaz interacts with numerous medications that may either decrease contraceptive efficacy or increase hyperkalemia risk 9:

• Decreased efficacy: Anticonvulsants, antibiotics (cephalosporins, macrolides, penicillins, tetracyclines), HIV protease inhibitors, St. John's wort, rifampin
• Increased hyperkalemia risk: NSAIDs (when used long-term), potassium-sparing diuretics, ACE inhibitors, angiotensin-II receptor antagonists

Clinical Pearls

• Yaz is particularly useful for women seeking contraception who also experience PMDD symptoms or moderate acne 1, 5
• The shortened hormone-free interval (4 days vs. 7 days) may provide better cycle control and fewer withdrawal symptoms 2
• Weight is typically maintained within ±2 kg in most women using Yaz for up to 26 cycles 4
• Visible improvement in acne requires 6-12 months of continuous therapy 8