Yasmin

Last reviewed 01/2018

• Yasmin is a combined oral contraceptive pill that contains the progestogen drospirenone (3mg) plus the oestrogen ethinylestradiol (30 µg)
• Yasmin causes an inhibition of ovulation by suppressing the hypothalamic-pituitary axis (like other COCs)
• drospirenone
  • evidence from in-vitro and animal experiments has shown that drospirenone has anti-androgenic (like progesterone) and antimineralocorticoid activity (unlike most progestogens). Ethinylestradiol is believed to cause fluid retention, via an interaction with the renin-angiotensin-aldosterone system. Thus, in theory, drospirenone may induce diuresis and thus counteract the fluid retention caused by ethinylestradiol; this may in turn help prevent weight gain and increases in blood pressure
• contraindications and precautions
  • drospirenone at a dose of 3mg has an antimineralocorticoid effect equivalent to a 25mg dose of spironolactone; therefore Yasmin might result in increased serum potassium concentrations if used concurrently with drugs with similar potential effects (e.g. potassium-sparing diuretics, ACE inhibitors, angiotensin-II receptor antagonists, long-term NSAIDS treatment)
  • otherwise warnings, drug interactions and contraindications are the same as for other COCs
• trial evidence has revealed that Yasmin causes increases in serum HDL concentrations (in one study with Microgynon 30, Yasmin led to a 9% increase vs a 12% fall with Microgynon 30) and triglyceride concentration (Yasmin led to a 47% increase compared with no change with Microgynon 30)
• Conclusions:
  • a Drugs and Therapeutics Bulletin review stated that "there is no compelling published evidence to suggest that Yasmin offers any advantages over other, longer-established, COCs with regards to weight gain, skin condition or premenstrual symptoms.......Yasmin's effects on cardiovascular risk (including venous thromboembolic disease) have not been quantified"
  • a further review revealed (2) "..risk of venous thromboembolic embolism (VTE) associated with use of Yasmin does not appear to differ from that associated with use of comparator COCs (levonorgestrel COCs and other COCs)...Yasmin is an option for those women suitable for a COC. However, current evidence indicates that on a population level Yasmin has no conclusive advantages over other standard strength COCs..."
    • more recent studies (two observational studies carried out in UK and USA) suggest that the relative risk of venous thromboembolism (VTE) in association with use of the combined oral contraceptive Yasmin is two to three fold higher when compared with COCs containing levonorgestrel (otherwise known as 'second generation') and may be similar to that of third generation COCs containing desogestrel or gestodene (3), however
    • these finding should not be used as a reason for women to stop taking COCs containing drospirenone or any other COC (3)
    • the risk of VTE with Yasmin remains very small and, like other oral contraceptives, is less than that associated with pregnancy
      

  The BNF, individual Summaries of Product Characteristics (available at www.medicines.org.uk) and the UK Medical Eligibility Criteria (UKMEC) for contraceptive use should be consulted for further information, including when a combined hormonal contraceptive would be absolutely contraindicated, and when expert clinical judgement and/or referral to a specialist contraceptive provider is necessary.

  Note:

  • although patient choice is considered to be an important factor when prescribing a contraceptive, COC containing levonorgestrel is the appropriate choice in women who want to start or switch contraception (due to its well known safety profile) (3)

  Reference:

  • (1) Drugs and Therapeutics Bulletin (2002);40(8):57-59.
  • (2) MeReC Bulletin (2006); 17(2):1-9.
  • (3) National Prescribing Centre (NPC). MeReC extra 2011;50
  • (4) MHRA: April 2010 Drug Safety Update