Yaz

Pregnancy Prevention

Yaz is primarily prescribed as an oral contraceptive to prevent pregnancy. It contains two hormones, drospirenone and ethinyl estradiol, which work together to inhibit ovulation and cause changes in the cervical mucus and uterine lining to make it harder for sperm to reach an egg or for a fertilized egg to attach.

Premenstrual Dysphoric Disorder (PMDD)

This medication is approved to treat the symptoms of PMDD. PMDD is a medical condition more severe than typical premenstrual syndrome (PMS), characterized by significant emotional and physical symptoms that interfere with daily life and relationships. Symptoms may include:

• Persistent irritability, anger, or anxiety
• Depressed mood or feelings of hopelessness
• Sleep disturbances or low energy
• Physical symptoms such as breast tenderness, headaches, or bloating

Acne Treatment

Yaz is used to treat moderate acne vulgaris in females who are at least 14 years old. It is typically prescribed for this purpose only if the individual has started their menstrual period and also desires an oral contraceptive for birth control.

Hormonal Action

Yaz contains two female hormones: a progestin called drospirenone and an estrogen called ethinyl estradiol. These hormones work together to prevent pregnancy through several different methods.

Preventing Ovulation

The main way this medication works is by stopping ovulation. By maintaining consistent hormone levels in the body, the pill signals the brain to suppress the hormones that normally trigger the ovaries to release an egg each month. If no egg is released, fertilization cannot occur.

Additional Safeguards

Even if an egg were to be released, Yaz provides other layers of protection:

• Cervical Mucus Changes: The hormones cause the mucus at the opening of the uterus to become thicker and stickier. This creates a physical barrier that makes it difficult for sperm to swim into the uterus to reach an egg.
• Uterine Lining Changes: The medication alters the lining of the uterus, making it thinner. This change makes it less likely for a fertilized egg to attach to the uterine wall and develop.

Other Uses

For conditions like acne or premenstrual dysphoric disorder (PMDD), the hormones in Yaz help by regulating the body's natural hormonal fluctuations. Drospirenone, the progestin in Yaz, also has properties that may help reduce water retention and bloating associated with the menstrual cycle.

Common Side Effects

Many people using Yaz experience mild side effects that often resolve after a few months of use. Common issues include:

• Nausea or vomiting
• Stomach cramps or bloating
• Headache or migraine
• Breast tenderness or swelling
• Changes in weight or appetite
• Mood changes or feeling tired
• Vaginal itching or discharge
• Changes in menstrual periods or breakthrough bleeding
• Decreased sex drive
• Darkening of facial skin (melasma)

Serious Side Effects

While less common, Yaz can cause serious and potentially life-threatening side effects. Seek medical help immediately if you experience signs of a blood clot, such as sudden shortness of breath, chest pain, or swelling and pain in one leg.

Other serious side effects include:

• High potassium levels: Drospirenone, one of the active ingredients in Yaz, can increase potassium in the blood, which may affect heart rhythm.
• Liver problems: Symptoms include yellowing of the skin or eyes (jaundice), dark urine, or upper stomach pain.
• Gallbladder disease: This may cause severe pain in the upper abdomen.
• High blood pressure: Blood pressure should be monitored regularly while taking this medication.
• Severe depression: Contact a healthcare provider if you experience significant mood changes or sleep problems.
• Allergic reactions: Signs include rash, hives, or swelling of the face, lips, or throat.

Boxed Warning: Smoking and Cardiovascular Risk

Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive use. This risk increases with age, particularly in women over 35 years old, and with the number of cigarettes smoked. For this reason, combination oral contraceptives are contraindicated in women who are older than 35 and smoke.

Thromboembolic Disorders

The use of Yaz increases the risk of serious blood clotting conditions, including venous thromboembolism (such as deep vein thrombosis and pulmonary embolism), stroke, and myocardial infarction. Some studies have indicated that the risk of blood clots may be higher with products containing drospirenone compared to those containing other progestins.

Hyperkalemia

Yaz contains drospirenone, a progestin with antimineralocorticoid activity that can lead to hyperkalemia (high potassium levels) in high-risk patients. It is contraindicated in patients with conditions that predispose them to hyperkalemia, such as:

• Renal impairment
• Hepatic impairment
• Adrenal insufficiency

For patients taking other medications that may increase potassium levels (such as ACE inhibitors, ARBs, potassium-sparing diuretics, or chronic NSAID use), a serum potassium level should be checked during the first treatment cycle.

Liver Disease

This medication should not be used by individuals with acute liver disease or liver tumors. Discontinuation is necessary if jaundice or significant liver enzyme elevations occur. There is also a slightly increased risk of developing gallbladder disease while taking combination oral contraceptives.

Other Contraindications and Precautions

Yaz should not be used by individuals with:

• A high risk of arterial or venous thrombotic diseases
• Undiagnosed abnormal uterine bleeding
• Current or past breast cancer or other hormone-sensitive cancers
• Pregnancy

Additionally, this medication may affect glucose tolerance and lipid levels. It may also cause an increase in blood pressure or changes in the frequency or severity of migraines.

Pregnancy

Yaz is a medication used to prevent pregnancy and is not intended for use during pregnancy. If you become pregnant while taking this medication, you should stop taking it immediately and contact a healthcare provider. While studies have not shown an increased risk of birth defects when oral contraceptives are taken accidentally during early pregnancy, the medication serves no purpose once a pregnancy has begun.

Breastfeeding

The use of Yaz while breastfeeding is generally not recommended, especially in the early stages of nursing. Considerations include:

• Milk Production: Combined oral contraceptives like Yaz can decrease the amount and quality of breast milk produced.
• Hormone Transfer: Small amounts of the active hormones in Yaz can pass into breast milk. The effects on the nursing infant are not fully understood.

Healthcare providers often suggest using other forms of birth control until a nursing infant is completely weaned.

Available Forms

Yaz is supplied as a blister card containing a sequence of tablets intended for oral use. Each pack is designed for a menstrual cycle and contains two different types of tablets:

• Active tablets: These film-coated tablets contain the active hormonal ingredients.
• Inert tablets: These film-coated tablets do not contain active medication and serve as placeholders to help maintain a daily routine.

FDA Approval and Indications

Yaz is approved by the U.S. Food and Drug Administration (FDA) for the prevention of pregnancy in women. It is also indicated for the treatment of symptoms associated with premenstrual dysphoric disorder (PMDD) for women who choose to use an oral contraceptive. Additionally, it is approved to treat moderate acne vulgaris in women at least 14 years of age who have started their menstrual periods and desire birth control.

Boxed Warning

The FDA-approved labeling for Yaz includes a boxed warning regarding cigarette smoking and serious cardiovascular events. Smoking increases the risk of serious cardiovascular side effects from combination oral contraceptive use, including heart attack, blood clots, and stroke. This risk increases with age, particularly in women over 35, and with the number of cigarettes smoked. Yaz is contraindicated in women who are over 35 years old and smoke.

Generic Availability

The FDA has approved multiple generic versions of Yaz. These generic products are considered therapeutically equivalent to the brand-name medication and contain the same active ingredients, drospirenone and ethinyl estradiol.

Increased Risk of Blood Clots

Yaz is a combination birth control pill that contains drospirenone and ethinyl estradiol. Like other hormonal contraceptives, it increases the risk of developing blood clots in the legs (deep vein thrombosis), lungs (pulmonary embolism), heart (heart attack), or brain (stroke). Some medical evidence suggests that birth control pills containing drospirenone may carry a higher risk of blood clots compared to pills containing other types of progestins, though the overall risk remains lower than the risk of blood clots during pregnancy or the postpartum period.

Factors That Increase Risk

Certain factors can significantly increase the likelihood of developing a blood clot while taking Yaz:

• Smoking: Smoking while using Yaz greatly increases the risk of serious cardiovascular events. This risk is highest for those over age 35 who smoke 15 or more cigarettes per day.
• Age: The risk of cardiovascular complications increases as you get older.
• Medical History: A history of high blood pressure, high cholesterol, diabetes, or being overweight increases the risk.
• Immobility: Major surgery or being unable to move for long periods, such as during recovery or long-distance travel, can raise the risk of clots.

Warning Signs to Watch For

Seek immediate medical attention if you experience any of the following symptoms:

• Sudden pain, swelling, or warmth in one leg.
• Chest pain, discomfort, or a feeling of heaviness.
• Sudden shortness of breath or coughing up blood.
• Severe or unusual headache.
• Sudden changes in vision or loss of vision.
• Weakness or numbness in an arm or leg, especially on one side of the body.