Combined oral contraceptives — antimineralocorticoid progestin
ATC code: G03AA12 (Drospirenone and ethinylestradiol)
Brand names
Yasmin, Yaz, Beyaz
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.
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.
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.
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.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
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.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
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.
Discontinue on pregnancy. Inadvertent early use (before pregnancy confirmation) is theoretically safe but warrants discussion with a clinician.
Estrogen-containing COCs suppress lactation. Contraindicated in the first 6 weeks postpartum; thereafter — with caution. Alternatives: progestogen-only contraceptives or non-hormonal methods.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
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.
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.
FDA category X. Discontinue on pregnancy. Inadvertent early use (before pregnancy confirmation) is theoretically safe but warrants discussion with a clinician.
Estrogen-containing COCs suppress lactation. Contraindicated in the first 6 weeks postpartum; thereafter — with caution. Alternatives: progestogen-only contraceptives or non-hormonal methods.
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.
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.
'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.
fertility returns within 1–3 months after discontinuation. Long-term COC use even reduces ovarian and endometrial cancer risk.
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.