Introduction
Yasmin is a combined oral contraceptive (COC) containing ethinyl estradiol (35 mcg) and drospirenone (3 mg). It is widely prescribed for contraception and has additional therapeutic benefits for certain conditions. As a fourth-generation progestin-containing formulation, Yasmin offers a unique pharmacological profile compared to earlier oral contraceptives.
Mechanism of Action
Yasmin works through multiple mechanisms to prevent pregnancy:
- Inhibition of ovulation: Suppresses gonadotropin secretion, preventing follicular development and ovulation
- Cervical mucus alteration: Progestin component thickens cervical mucus, creating a barrier to sperm penetration
- Endometrial effects: Creates an endometrial environment unfavorable for implantation
Drospirenone, the progestin component, possesses anti-mineralocorticoid and anti-androgenic properties, which contribute to its unique effects profile.
Indications
- Contraception: Prevention of pregnancy
- Moderate acne vulgaris: In women at least 14 years old seeking contraception, who have no known contraindications to oral contraceptive therapy and have achieved menarche
- Premenstrual Dysphoric Disorder (PMDD): For treatment of symptoms in women who choose to use oral contraception
Dosage and Administration
Standard regimen: One tablet daily for 21 consecutive days followed by 7 tablet-free days Administration: Taken at approximately the same time each day, with or without food Missed dose protocol:- 1 missed tablet: Take as soon as remembered
- 2 consecutive missed tablets: Take 2 tablets daily for 2 days, then resume regular schedule
- 3 or more consecutive missed tablets: Discard pack, begin new pack on Sunday, use backup contraception for 7 days
- Hepatic impairment: Contraindicated
- Renal impairment: Contraindicated if creatinine clearance <30 mL/min
- Adolescents: May be used after menarche
Pharmacokinetics
Absorption: Ethinyl estradiol peak concentration reached in 1-2 hours; drospirenone peak in 1-2 hours Distribution:- Ethinyl estradiol: Extensive plasma protein binding
- Drospirenone: Binds primarily to albumin (no binding to SHBG or CBG)
- Ethinyl estradiol: Extensive hepatic metabolism via CYP3A4
- Drospirenone: Metabolized to inactive acid forms
- Ethinyl estradiol: Terminal half-life ~24 hours
- Drospirenone: Terminal half-life ~31 hours
- Excretion: Primarily renal and fecal
Contraindications
- Current or history of thrombophlebitis or thromboembolic disorders
- Cerebrovascular or coronary artery disease
- Known or suspected estrogen-dependent neoplasia
- Undiagnosed abnormal genital bleeding
- Cholestatic jaundice of pregnancy or jaundice with prior pill use
- Hepatic impairment or tumors
- Known or suspected pregnancy
- Hypersensitivity to any component
- Major surgery with prolonged immobilization
- Smokers over 35 years old (>15 cigarettes/day)
Warnings and Precautions
Boxed Warning: Cigarette smoking increases risk of serious cardiovascular side effects; women over 35 who smoke should not use COCs Cardiovascular risks:- Increased risk of venous thromboembolism (VTE)
- Increased risk of arterial thromboembolism
- Increased blood pressure
- Hepatic adenomas and carcinomas
- Gallbladder disease
- Carbohydrate and lipid metabolic effects
- Drospirenone may increase potassium levels; monitor in women taking chronic medications that may increase potassium
- Increased risk of VTE compared to levonorgestrel-containing COCs
Drug Interactions
Enzyme inducers: Rifampin, carbamazepine, phenytoin, St. John's wort (may decrease efficacy) CYP3A4 inhibitors: Ketoconazole, itraconazole, clarithromycin (may increase hormone levels) Drugs that increase potassium: ACE inhibitors, ARBs, potassium-sparing diuretics, NSAIDs (increased risk of hyperkalemia) Antibiotics: Some may decrease estrogen enterohepatic recirculationAdverse Effects
Common (>10%):- Headache
- Breast pain/tenderness
- Irregular uterine bleeding
- Nausea
- Abdominal pain
- Venous thromboembolism
- Myocardial infarction
- Stroke
- Hepatic tumors
- Hypertension
- Gallbladder disease
Monitoring Parameters
Baseline assessment:- Blood pressure
- Body mass index
- Personal and family history
- Lipid profile (if indicated)
- Liver function tests (if indicated)
- Potassium levels (in women at risk for hyperkalemia)
- Annual blood pressure measurement
- Regular assessment of side effects
- Signs and symptoms of thromboembolism
- Serum potassium in women taking medications that affect potassium balance
- Liver function if symptoms suggest hepatic dysfunction
Patient Education
Key counseling points:- Take at the same time daily to maintain effectiveness
- Use backup contraception during first 7 days of initial use
- Report severe abdominal pain, chest pain, headaches, eye problems, or leg pain immediately
- Inform healthcare providers about Yasmin use before any surgical procedures
- Do not smoke while taking Yasmin
- Be aware of potential drug interactions
- Understand warning signs of blood clots: persistent leg pain, chest pain, sudden shortness of breath, sudden severe headache
- Yasmin does not protect against HIV or other sexually transmitted diseases
- Keep detailed instructions readily available
- Have backup contraception available
References
1. FDA Prescribing Information: Yasmin (drospirenone and ethinyl estradiol). 2022 2. Curtis KM, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep. 2016 3. Stegeman BH, et al. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ. 2013 4. Lidegaard Ø, et al. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med. 2012 5. ACOG Practice Bulletin No. 206: Use of Hormonal Contraception in Women with Coexisting Medical Conditions. Obstet Gynecol. 2019
This monograph is for educational purposes only and does not replace professional medical advice. Always consult with a healthcare provider for personalized medical recommendations.