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Contraceptives (YASMIN and YAZ). Rethink Twice About Third-Generation Oral Contraceptives and YASMIN.
Two new large new studies have identified increased risk of blood thrombi in women treated with...
oral contraceptives containing drospirenone, or ethinylestradiol plus drospirenone (YASMIN).
Use, dosage, and storage
Both studies, one conducted in the Netherlands and one in Denmark, confirmed that oral contraceptive pills containing desogestrel (see Table 1) may increase the risk of life-threatening blood thrombi compared with second-generation contraceptive pills.
These studies found a significantly increased risk of venous blood thrombi in women treated with drospirenone-containing pills; YASMIN was the most frequently used drug of this type in these studies. The increased risk of blood thrombi when taking drospirenone-containing pills compared with older second-generation pills was 1.64 (Danish study) and 1.7 (Dutch study) times higher.
Both drugs are available at most pharmacies. The main difference between Ocella and Yasmin may be the cost.
Ocella is a generic birth control pill, so it may be covered by more insurance plans than Yasmin, the brand name version. This is because generics cost less. Because of this, many insurance plans will not cover brand-name drugs if a generic version is available.
The out-of-pocket price (what you would pay without insurance) may also be lower for generics than for brand-name drugs. With or without insurance, Ocella would probably be cheaper than Yasmin.
Cost, insurance coverage, and availability
Table 1. Third-generation oral contraceptives containing desogestrel currently available in the United States.
Generic name: Ethinyl estradiol plus desogestrel.
Trade names: Apri-28, Cyclessa, Desogen, Kariva, Mircette, Ortho-CEPT, Reclipsen, Velivet.
Table 2. Oral contraceptives containing drospirenone currently available in the United States.
Generic Name: Ethinyl estradiol plus drospirenone
Brand names: Yasmin, Yaz
Blood thrombi typically form in the veins of women's legs, but they can move elsewhere in the body and block blood flow. Blood thrombi that travel to the lungs and block blood flow are known as pulmonary embolisms, a condition that can lead to death.
Since 1999, we have advised our Worst Pills, Best Pills News readers against using oral contraceptives with desogestrel because they double the risk of life-threatening blood thrombi (compared to women taking a second-generation oral contraceptive) but do not protect against pregnancy more effectively than safer alternatives. The use of oral contraceptives with desogestrel also does not help to avoid side effects typical of second-generation contraceptives, such as unwanted hair growth or the appearance of acne.
The new studies from the Netherlands and Denmark confirmed earlier findings of a significantly increased risk of blood thrombi in women treated with oral contraceptives containing desogestrel or gestodene (the latter not available in the United States). The increased risk of blood thrombi was twice as high in the Dutch study and 1.8 times higher in the Danish study compared with women treated with pills containing older, safer second-generation progestins (see Table 3).
Table 3. Second generation oral contraceptives Generic name Trade name
Ethinyl estradiol plus levonorgestrel ALESSE 28; AVIANE; NORDETTE; SEASONALE;
TRIPHASIL; TRIVORA-28
Ethinylestradiol plus norethindrone COMBI PATCH; LOESTRIN FE 1/20; NEOCON 1/35;
ORTHO-NOVUM 7/7/7; OVCON 35
Ethinylestradiol plus norgestimate ORTHO-CYCLEN; ORTHOTRI-CYCLEN; TRINESSA
Ethinylestradiol plus norgestrel LO/OVRAL 28; LOW-OGESTREL
Ethinylestradiol plus norelgestromin ORTHO EVRA
We fully agree with the authors of the Dutch study who state that: "our results clearly show that the safest option in relation to the risk of venous thrombosis is an oral contraceptive containing levonorgestrel in combination with low-dose estrogens".
What is the difference between a second- and third-generation contraceptive and drospirenone? Most oral contraceptives contain a combination of hormones (estrogens and progestins). The most commonly used estrogen in combined oral contraceptives is ethinyl estradiol. Second- and third-generation contraceptives differ only in the progestin they contain.
Second-generation oral contraceptives have been on the market longer than third-generation oral contraceptives. They contain norgestrel, levonorgestrel, norethindrone or norgestimate. Studies showing increased risk with third-generation contraceptives are almost exclusively limited to desogestrel.
The newest third-generation oral contraceptives marketed in the United States contain the progestin desogestrel. An even newer progestin is drospirenone, which is present in the drugs YASMIN
We have continually discouraged the use of these newer contraceptives because they pose additional and unnecessary risks to women.
In early 2007, due to the publication of studies confirming the additional risk posed by desogestrel, we petitioned the FDA to ban third-generation oral contraceptives containing desogestrel.
At the time of our lawsuit, we explained these risks in a YouTube video embedded on the NotMyPill.org website. On this page, readers could join our petition to the FDA to ban these dangerous oral contraceptives. By the time we sent the petition, more than 20,000 people had signed the petition and 22,000 people had viewed the YouTube video. However, we have received no response from the FDA in the two and a half years since we sent it.
What you can do
If you take an oral contraceptive containing drospirenone or desogestrel, talk to your doctor about available contraceptive options. The safest alternatives are second-generation pills containing low-dose estrogen and levonorgestrel, norgestrel or norethindrone such as the combination levonorgestrel and ethinyl estradiol, or the brand names LEVORA and TRIVORA.
Do not stop contraceptive treatment immediately. Follow your doctor's instructions for changing your contraceptive treatment to avoid errors in contraceptive efficacy.
More information about Yasmin in Boletín Fármacos:
2002, Volume 5 (3); 2003, Volume 6 (3); 2004, Volume 7 (5); 2005, Volume 8 (4); 2006, Volume 9 (2);
2009, Volume 12 (5).
More information on Yaz in Boletín Fármacos:
2009, Volume 12 (4); 2009, Volume 12 (5).
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