Yasmin Tablet Uses, Benefits, Side Effects and Dosage

Yasmin is a combined oral contraceptive tablet, the type of medicine most people call a birth control pill. It contains two hormones: drospirenone 3 mg, which is a progestin, and ethinyl estradiol 0.03 mg, which is an estrogen. A pack is designed as 21 yellow hormone tablets followed by 7 white tablets that contain no hormones - the arrangement described in the manufacturer's prescribing information, so check the pack in your hand, because pack designs differ between countries.

Yasmin tablet is a combined oral contraceptive - a pill that uses two hormones together to prevent pregnancy. Drospirenone is the progestin part and ethinyl estradiol is the estrogen part. Both are synthetic versions of hormones your body makes naturally.

• Tablet in the pack: 21 yellow film-coated tablets; What it contains: drospirenone 3 mg + ethinyl estradiol 0.03 mg; What it does: The hormone tablets that prevent pregnancy
• Tablet in the pack: 7 white film-coated tablets; What it contains: No hormones (inactive); What it does: No contraceptive effect; they keep you in the daily habit and are part of the pack schedule

Because it is a combined pill, Yasmin is used by women of reproductive age, after puberty has started. It is not meant for use before the first period or after menopause.

Always check the strength printed on your own pack. Different pills that sound similar contain the same two hormones in different strengths - some contain 0.02 mg ethinyl estradiol instead of 0.03 mg - and they are not interchangeable.

A combined pill prevents pregnancy mainly by stopping ovulation, which is the release of an egg from the ovary. The estrogen and progestin in the tablet keep the body's hormone feedback loop switched on, so the pituitary gland stops sending the signal that ripens and releases an egg. The progestin also thickens the mucus at the neck of the womb, which makes it harder for sperm to swim through, and keeps the lining of the womb thin.

Drospirenone has one extra action that is worth knowing about. It is a spironolactone-type molecule that blocks the receptors that aldosterone acts on. Aldosterone is the hormone that makes the body hold on to salt and water. This action is why drospirenone can make the body lose a little more salt and water - and it is also why drospirenone can push up the potassium level in the blood of women whose kidneys, liver or adrenal glands are not working normally.

Drospirenone also blocks androgen receptors - the receptors that male-type hormones act on - which is why pills containing it can improve acne, though acne is not an approved use of Yasmin.

Yasmin has only one approved use: to prevent pregnancy. That licence is described in the manufacturer's prescribing information, and labelling can differ between countries - if your own pack lists another approved use, follow your doctor's advice. It is not a treatment for acne, PCOS, irregular periods or any infection, and it must not be used during pregnancy.

How well it works. Taken correctly, fewer than 1 woman in 100 becomes pregnant in a year of use - that is the figure from the clinical studies of this medicine, and it means the pill was taken on time every day. With typical use, including late or missed tablets, the chance of pregnancy is higher; a missed tablet, a late start or vomiting soon after a tablet all lower the protection.

What Yasmin is not for:

• Not for sexually transmitted infections. No hormonal pill protects against HIV, chlamydia, gonorrhoea or any other STI. Only condoms do.
• Not an emergency contraceptive. Emergency contraception is a different medicine, used after unprotected sex, and it works best the sooner it is taken. Ask a doctor or pharmacist - do not try to use your regular pack as a substitute.
• Not a treatment for acne on its own. Some women who take pills containing drospirenone notice their skin improves, and one 24+4 drospirenone pill was studied for acne. In 2012 the European medicines regulator decided against approving that acne indication, because women who were not seeking contraception would be exposed to the clot risks of these pills when other acne treatments are available. Take Yasmin for your skin only if your doctor has specifically prescribed it for that reason.

Other uses your doctor may discuss. Combined pills are also used in practice to help with heavy or painful periods, premenstrual symptoms, ovarian cysts and endometriosis-related pain. Evidence supports several of these uses, but they are not part of the approved labelling for these products, so they count as off-label use - acceptable only when your own doctor has weighed it up for you.

Reliable pregnancy prevention. Taken correctly, this is one of the more dependable reversible contraceptive methods. It does not need to be fitted, inserted or timed around sex, and it is fully reversible - you simply stop when you want to.

Shorter, lighter and less painful periods. With a 21+7 pack, the withdrawal bleed usually starts within 3 days of the last yellow tablet and tends to be lighter and less crampy than a natural period. In the clinical studies, unscheduled spotting or bleeding fell from about 12% of women in the second cycle to about 6% by the thirteenth cycle, so early irregular bleeding usually settles. Some women have no bleed at all in a cycle - that happens in up to about 1 in 9 women per cycle and is not harmful if every tablet was taken on time.

Less fluid retention. Drospirenone's effect on salt and water balance is the reason some women notice less bloating in the last week of the pack. It is a modest effect, and not everyone notices it - bloating and fluid retention are still listed as possible side effects of this medicine.

Longer-term health effects. Combined pills in general are linked to a lower risk of ovarian and endometrial (womb lining) cancer with longer use - roughly a quarter lower risk of ovarian cancer with ever-use, and about a 30-40% lower risk of endometrial cancer that grows to roughly half with around 10-15 years of use. That protection seems to last for years after stopping. The picture is not one-sided: some studies find a small rise in breast cancer risk (from no increase up to about 20-30%) that is limited to current or recent users and fades after stopping, and cervical cancer risk rises in women who use combined pills for more than 5 years, mainly in those with HPV infection; that risk also falls back towards normal after stopping. Overall cancer risk does not appear to change. If you have a personal or family history of cancer, discuss it with your doctor before starting.

1. Fix a time you will not forget - the same time each day. Bedtime after your evening meal suits many women.
2. The pack says to take one tablet by mouth with a little water. You can take it with or without food, and the tablet should be swallowed whole.
3. Work through the pack in the order the arrows show. Take all 21 yellow hormone tablets first, then the 7 white tablets. Do not skip the white ones.
4. Start the next pack the day after your last white tablet. Do not leave a gap to wait for your period.
5. First pack: start on day 1 of your period - protection begins straight away. If you start on the first Sunday after your period begins, or on any day later than day 1, use condoms as a back-up for the first 7 days.
6. Switching from another method: your doctor will tell you which day to start, depending on whether you were on another pill, a patch, a ring, an injection, an implant or an IUD. Follow that plan rather than guessing.

Severe vomiting or diarrhoea can stop the tablet being absorbed properly. If you vomit within 3 to 4 hours of taking a tablet, treat that day as a missed tablet. If the vomiting or diarrhoea continues, keep taking your tablets and use condoms until you have spoken to your doctor.

The dose is one tablet a day, at the same time every day, in the order printed on the pack - exactly as your doctor has prescribed. There is no dose to increase or reduce on your own, and taking two tablets to "catch up" outside the missed-pill instructions is not safe practice.

The pack for this product is built as a 28-day cycle: 21 yellow hormone tablets followed by 7 white tablets, with no break before the next pack. Always follow the schedule printed on your own pack. Pack designs differ between products and between countries, so if the pack in your hand looks different from what is described here, go by the pack and check with your pharmacist.

If you miss tablets:

• One yellow tablet missed: take it as soon as you remember and take the next one at your usual time - you may take two tablets in one day. No back-up method is needed.
• Two yellow tablets missed in a row, in week 1 or week 2: the pack instructions say to take two tablets as soon as you remember, two tablets the next day, then one a day until the pack is finished. Use condoms for 7 days after restarting.
• Two yellow tablets missed in a row, in week 3 or week 4: Day-1 start: throw away the rest of the pack and start a new pack the same day. Sunday start: keep taking one tablet a day until Sunday, then throw away the rest of the pack and start a new pack that day. Either way, use condoms for 7 days. You may not bleed this month, but if you miss two periods in a row, see your doctor. Week 4 of this pack is the white-tablet week, so this rule is really about mistakes at the end of the yellow tablets.
• Three or more yellow tablets missed in a row: the same rule as above - throw away the rest of the pack and start a new pack straight away, with condoms for 7 days.
• White tablets missed: throw away the tablets you missed and keep taking one tablet a day until the pack is empty. No back-up method is needed, provided you start your next pack on the right day.
• Not sure what to do? Use condoms every time you have sex and call your doctor. Keep taking one yellow tablet a day until you are told otherwise.

Taking more than prescribed. No serious harm has been reported from an accidental extra tablet, even when tablets were swallowed by children. An overdose may cause nausea and a bleeding episode. If a child has taken tablets, take the child and the pack to the nearest hospital. If you feel unwell after taking extra tablets, contact your doctor.

Stopping Yasmin. You can stop whenever you wish - speak to your doctor first for a pre-pregnancy check-up if you plan to conceive. Protection ends as soon as you stop, so use another method if you do not want to become pregnant.

Do not take Yasmin if any of these apply to you. These are absolute - your doctor will suggest a different contraceptive method.

• A blood clot in the legs, lungs or eye, now or in the past
• A stroke, a heart attack, or narrowing of the blood vessels to the heart or brain
• Certain heart valve or heart rhythm problems that can cause clots to form in the heart
• An inherited or acquired blood-clotting disorder
• High blood pressure that medicine cannot control, or high blood pressure with blood vessel disease
• Diabetes with damage to the eyes, nerves, kidneys or blood vessels
• Migraine with aura, numbness, weakness or vision changes; or migraine of any type if you are over 35
• Smoking, if you are over 35
• Breast cancer now, or at any time in the past
• Liver disease or liver tumours
• Kidney (renal) impairment
• Adrenal disease or adrenal insufficiency
• Unexplained abnormal vaginal bleeding that has not been investigated
• Certain hepatitis C combination medicines containing ombitasvir, paritaprevir and ritonavir, with or without dasabuvir
• Pregnancy, or if you think you may be pregnant

Tell your doctor if any of the following apply, so they can weigh the risks and benefits for you:

• You are overweight, or you have a family history of a blood clot at a young age (below 50)
• You are going to have major surgery, or you will be off your feet for a long time (for example after an accident or illness)
• You have given birth within the last 4 weeks, or you are breastfeeding - combined pills can reduce milk supply, and the risk of a clot is higher in the weeks after delivery
• You have well-controlled high blood pressure, diabetes or pre-diabetes, high cholesterol, gallbladder disease, or a history of jaundice in pregnancy
• You have a history of depression, migraine, or a swelling condition called hereditary angioedema
• You have had dark patches on your face (chloasma) during pregnancy or on a previous pill
• You wear contact lenses - some women find their lenses less comfortable on combined pills
• You take any medicine that raises blood potassium, such as ACE inhibitors, angiotensin-II receptor antagonists, potassium-sparing diuretics, potassium supplements, heparin or long-term daily NSAIDs. Your doctor may check your blood potassium in the first cycle.
• You have thyroid disease - your thyroid medicine dose may need review

Age matters in both directions. Yasmin is not to be used before the first period, and it is not for women after menopause. It has not been studied in postmenopausal women.

Plan a yearly check-up while you are on it, including a blood pressure check.

Most side effects are mild and settle within the first few packs. In the clinical studies of this medicine, the most common were:

• Premenstrual symptoms; Reported by: 13.2%; What to expect: Mood and body symptoms in the days before the bleed

• Headache or migraine; Reported by: 10.7%; What to expect: The side effect most likely to make women stop the pill (1.5% stopped for this reason)

• Breast pain, tenderness or discomfort; Reported by: 8.3%; What to expect: Usually improves with time

• Nausea or vomiting; Reported by: 4.5%; What to expect: Common in the first packs; taking the tablet after food may help

• Stomach pain or tenderness; Reported by: 2.3%; What to expect: Usually mild

• Mood changes (low mood, irritability, mood swings); Reported by: 2.3%; What to expect: Tell your doctor if this becomes serious

Other effects reported include spotting or bleeding between periods (especially in the first 3 months), breast enlargement, weight change, acne, less interest in sex, dark patches on the face, and trouble wearing contact lenses.

Serious side effects are uncommon but need attention: blood clots in the veins or arteries, high blood pressure, gallbladder disease, liver problems, and a raised blood potassium level. The prescribing information for this medicine, last updated in May 2023, carries a boxed warning: women over 35 years old who smoke should not use it, because smoking multiplies the risk of a heart attack, stroke or clot.

Every combined pill raises the risk of a clot in the veins, and the risk differs depending on the progestin in the pill. European regulators reviewed all of these products and published these comparisons:

• Women not using a combined pill, patch or ring, and not pregnant - About 2 in 10,000
• Women using a combined pill with levonorgestrel, norethisterone or norgestimate - About 5 to 7 in 10,000
• Women using a combined pill with drospirenone (as in Yasmin), gestodene or desogestrel - About 9 to 12 in 10,000

Two things put those numbers in context. First, the clot risk of any combined pill is highest in the first year of use, and highest again if you restart after a break of 4 weeks or more. Second, pregnancy and the weeks after childbirth carry a higher clot risk than these pills do.

Talk to your doctor about your own risk before you start. The risks go up with age, smoking, being very overweight, migraine, a family history of clots at a young age, and being immobile for long periods. Stop Yasmin at least 4 weeks before major surgery and do not restart until at least 2 weeks afterwards, unless your surgeon says otherwise.

Do not wait for your next appointment if you notice any of these:

• Severe pain, swelling or tenderness in one leg
• Sudden unexplained breathlessness, fast breathing or a cough
• Chest pain, or pain spreading to the arm or jaw
• Weakness or numbness in the face, arm or leg, or difficulty speaking
• Sudden loss of vision or any sudden change in eyesight
• A severe headache unlike your usual headaches
• Yellowing of the skin or eyes, or severe pain in the upper stomach
• Thoughts of harming yourself

Some medicines make Yasmin work less well, and Yasmin can change how some medicines work. Always tell your doctor and pharmacist everything you take, including herbal products.

• Medicines that reduce protection: phenytoin, carbamazepine, phenobarbital, oxcarbazepine, topiramate, rifampicin, griseofulvin, bosentan, felbamate, and the herbal product St John's wort. Use condoms while you take them and for 28 days after you stop, because the pill may fail.
• Medicines that raise blood potassium: ACE inhibitors, angiotensin-II receptor antagonists, potassium-sparing diuretics such as spironolactone, potassium supplements, heparin, aldosterone antagonists, and long-term daily NSAIDs. Your doctor may check your potassium level during the first cycle.
• Medicines that raise the hormone levels in the pill: ketoconazole, itraconazole, voriconazole, fluconazole, clarithromycin, erythromycin, verapamil, diltiazem and grapefruit juice in large amounts.
• Lamotrigine (used for epilepsy): Yasmin can lower its blood levels and reduce seizure control, so the dose may need adjusting.
• Thyroid hormone replacement: your dose may need to increase, because the pill raises the protein that carries thyroid hormone in the blood.
• HIV and hepatitis C medicines: levels of the pill's hormones can rise or fall unpredictably. Certain hepatitis C combinations must never be taken with Yasmin.

Tell any doctor, dentist or laboratory that you are taking Yasmin, because it can change the results of some blood tests.

• Smoking is the most important avoidable risk with this medicine. If you smoke and you are over 35, Yasmin is not for you. If you smoke and you are under 35, stopping is strongly advised.
• Alcohol is not listed as an interaction with this medicine. Heavy drinking is a general health risk rather than a specific interaction here, and it matters more if you also smoke.
• Driving is not usually affected. If you develop a bad headache or a migraine — a common side effect — wait until you feel well before driving.
• Keep a spare pack and a back-up method such as condoms at home, so a missed refill does not turn into missed tablets.

Store the tablets at 25 °C, with short excursions allowed between 15 °C and 30 °C, as stated in the prescribing information - or as printed on your own pack. Keep them in the original pack, away from heat, light and moisture, and out of reach of children. Check the expiry date before starting a new pack, and never share your tablets with anyone else.