Drospirenone + ethinylestradiol

Combined oral contraceptives — antimineralocorticoid progestin

ATC code: G03AA12(Drospirenone and ethinylestradiol)

Brand names: Yasmin, Yaz, Beyaz

Updated 12 Aug 2026 · Methodology

Indications

Combined oral contraception

First line

First-line hormonal contraception per MEC 2015 and CDC US-MEC. Pearl index 0.3 per 100 woman-years with perfect use, 7–9 with typical use due to missed pills. Drospirenone-containing COCs are preferred in patients with acne, mild hirsutism, or fluid retention tendencies. Contraindicated in prior VTE, severe migraine with aura, uncontrolled hypertension, and smokers over 35.

Sources

ICD-10: Z30.0 · ICD-11: QA21

Premenstrual dysphoric disorder (PMDD)

First line

Yaz (drospirenone 3 mg + ethinylestradiol 20 mcg, 24/4 regimen) is -approved for premenstrual dysphoric disorder (PMDD) in patients seeking oral contraception. The 2017 Cochrane meta-analysis confirms significant symptom reduction. In patients not needing contraception, SSRIs (cyclic or continuous) are first-line.

Sources

ICD-10: N94.3 · ICD-11: GA34.41

Acne vulgaris

Second line

Per 2024, COCs with antiandrogenic progestins (drospirenone, cyproterone, dienogest) are second-line for acne in women when topical therapy and systemic antibiotics are inadequate. Effect develops over 3–6 months. Prescribed when contraceptive and acne indications coincide.

Sources

AEMPS: Ficha técnica de Drospirenona + etinilestradiol (2024)

ICD-10: L70.0 · ICD-11: ED80

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Anti-aging and longevity

Not recommended

Drospirenone + ethinylestradiol is a combined oral contraceptive. It is prescribed for contraception, severe acne, and premenstrual dysphoric disorder (AEMPS Ficha Técnica). In anti-aging communities, combined oral contraceptives are promoted as anti-aging and appearance enhancement in healthy women. Combined oral contraceptive use without need for contraception or confirmed dermatologic/gynecologic indications is not justified: increased risk of venous thromboembolism (especially in smokers, obesity, age over 35), arterial thrombosis, breast cancer on long-term use, and gallbladder disease. If combined oral contraceptive was prescribed for anti-aging or appearance improvement without other indications, consider seeking a second opinion.

Sources

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

Combined oral contraceptive. Ethinylestradiol suppresses FSH secretion and prevents follicular maturation; drospirenone is a spironolactone derivative with progestogenic, antimineralocorticoid, and mild antiandrogenic activity. Suppresses ovulation, alters cervical mucus and endometrium. Antimineralocorticoid effect reduces fluid retention and associated weight gain; antiandrogenic effect improves acne and mild hirsutism.

Safety

Boxed warning

FDA black box: women over 35 who smoke face increased risk of serious cardiovascular events on COCs, including MI and stroke. COCs are contraindicated in this group.

Contraindications

Personal history of venous or arterial thromboembolism
Known thrombophilia (Leiden, protein C/S/AT-III deficiency)
Migraine with aura
Smoking more than 15 cigarettes/day in patients over 35
Uncontrolled hypertension
Coronary artery disease, prior MI
Diabetes with micro- or macrovascular complications
Active liver disease, liver tumors
Suspected or confirmed breast cancer
Undiagnosed vaginal bleeding
Pregnancy
Suspected or confirmed hyperkalemia (drospirenone-containing)
Severe renal impairment

Serious adverse effects

Venous thromboembolism (DVT, PE)
Arterial thrombosis (MI, ischemic stroke)
De novo hypertension
Hyperkalemia (drospirenone-containing, especially with ACEi, ARB, or potassium-sparing diuretics)
Depression, psychiatric worsening
Cholelithiasis, cholestasis
Hepatocellular adenoma (very rare)

Common adverse effects

Breakthrough bleeding and spotting (especially first 3 months)
Breast tenderness
Nausea
Headache
Decreased libido in some patients
Mood swings

Pregnancy: can you take Drospirenone + ethinylestradiol?

Discontinue on pregnancy. Inadvertent early use (before pregnancy confirmation) is theoretically safe but warrants discussion with a clinician.

Breastfeeding: can you take Drospirenone + ethinylestradiol?

Estrogen-containing COCs suppress lactation. Contraindicated in the first 6 weeks postpartum; thereafter — with caution. Alternatives: progestogen-only contraceptives or non-hormonal methods.

Calculate RID Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Once daily at the same time. Standard 21/7 (Yasmin): 21 active days, 7-day break. 24/4 (Yaz): 24 active, 4 placebo — shorter hormone-free interval provides a more stable profile and is used for PMDD. Missed pill under 12 hours — take when remembered, continue schedule. Missed pill over 12 hours — take when remembered (even if two pills land on one day) and use a barrier method for 7 days.

Monitoring

Baseline: VTE risk assessment (hereditary thrombophilia, prior VTE, migraine with aura, smoking over 35, BMI above 35), BP. At 3 months — BP and tolerability check. Annually thereafter. With pronounced early side effects, do not rush to switch — many resolve after adaptation. New migraine with aura, uncontrolled hypertension, or VTE episode — immediate discontinuation.

Common myths

Myth: 'COCs need cyclic discontinuation to let the body rest'. Fact: 'rest' from COCs is not supported by international guidelines. Breaks raise unplanned pregnancy risk and provide no medical benefit. In a healthy patient without contraindications, COC duration is not capped.

Myth: 'COCs cause infertility'. Fact: fertility returns within 1–3 months after discontinuation. Long-term COC use even reduces ovarian and endometrial cancer risk.

Myth: 'drospirenone-containing COCs are more thrombogenic than levonorgestrel-containing ones'. Fact: data are mixed. Absolute VTE risk on any COC in a young healthy woman is 9–10 per 10,000 patient-years vs 2–3 without COC and 30 in pregnancy. Drospirenone-containing COCs carry slightly higher relative risk than levonorgestrel-containing, but absolute risk remains low.

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Frequently asked

What is Drospirenone + ethinylestradiol used for?

Drospirenone + ethinylestradiol is evaluated for the following indications with varying evidence strength: Premenstrual dysphoric disorder (PMDD) (evidence tier A), Combined oral contraception (evidence tier A), Acne vulgaris (evidence tier B). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Drospirenone + ethinylestradiol?

Common side effects of Drospirenone + ethinylestradiol (≥ 1 in 100): Breakthrough bleeding and spotting (especially first 3 months), Breast tenderness, Nausea, Headache, Decreased libido in some patients, Mood swings. See the Safety section for uncommon and serious reactions.

Is Drospirenone + ethinylestradiol safe during pregnancy?

Discontinue on pregnancy. Inadvertent early use (before pregnancy confirmation) is theoretically safe but warrants discussion with a clinician.

Is Drospirenone + ethinylestradiol compatible with breastfeeding?

Estrogen-containing COCs suppress lactation. Contraindicated in the first 6 weeks postpartum; thereafter — with caution. Alternatives: progestogen-only contraceptives or non-hormonal methods.

Who should not take Drospirenone + ethinylestradiol?

Drospirenone + ethinylestradiol is contraindicated in: Personal history of venous or arterial thromboembolism; Known thrombophilia (Leiden, protein C/S/AT-III deficiency); Migraine with aura; Smoking more than 15 cigarettes/day in patients over 35; Uncontrolled hypertension. Full list in the Safety section.

Does Drospirenone + ethinylestradiol carry an FDA boxed warning?

FDA black box: women over 35 who smoke face increased risk of serious cardiovascular events on COCs, including MI and stroke. COCs are contraindicated in this group.

COCs need cyclic discontinuation to let the body rest

'rest' from COCs is not supported by international guidelines. Breaks raise unplanned pregnancy risk and provide no medical benefit. In a healthy patient without contraindications, COC duration is not capped.

COCs cause infertility

fertility returns within 1–3 months after discontinuation. Long-term COC use even reduces ovarian and endometrial cancer risk.

drospirenone-containing COCs are more thrombogenic than levonorgestrel-containing ones

data are mixed. Absolute VTE risk on any COC in a young healthy woman is 9–10 per 10,000 patient-years vs 2–3 without COC and 30 in pregnancy. Drospirenone-containing COCs carry slightly higher relative risk than levonorgestrel-containing, but absolute risk remains low.

Other drugs in this group

Dydrogesterone, Estradiol, Estradiol + Nomegestrol acetate, Estradiol valerate + Dienogest, Ethinylestradiol, Etonogestrel (implant), Norelgestromin + Ethinylestradiol (transdermal patch), Tongkat ali (Eurycoma longifolia)