Yasmin

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Yasmin on Prescriptsy

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Yasmin is a combined oral contraceptive pill (COCP) containing drospirenone 3 mg and ethinylestradiol 0.03 mg, manufactured by Bayer.

It provides highly effective contraception when taken correctly and offers additional benefits from the unique pharmacological profile of drospirenone, which has anti-mineralocorticoid activity (reducing fluid retention and bloating) and anti-androgenic activity (reducing acne and excess hair growth).

Yasmin is a prescription-only medicine (POM) in the United Kingdom and is available free on NHS contraceptive prescription.

Combined oral contraceptives remain one of the most popular reversible contraceptive methods in the UK, used by approximately 28% of women aged 16 to 49 who use contraception.

The choice of COCP depends on individual factors including cardiovascular risk profile, preference for non-androgenic or anti-androgenic progestogens, and tolerance of side effects.

Drospirenone-containing COCPs such as Yasmin are particularly popular among women who experience fluid retention, bloating, or acne with other formulations.

This page provides a comprehensive clinical guide to Yasmin, covering its mechanism of action, how to take it, side effects, safety warnings including thrombotic risk, and how to obtain it in the United Kingdom.

Important safety information about Yasmin

Before reading further, note these essential safety points about Yasmin.

• All combined hormonal contraceptives carry a small increased risk of blood clots (venous and arterial thromboembolism). Know the warning signs: leg swelling and pain (DVT), sudden breathlessness or chest pain (PE), sudden severe headache or visual disturbance (stroke).
• Do not take Yasmin if you have a history of blood clots, stroke, heart attack, migraine with aura, or severe liver disease.
• Smoking while taking Yasmin significantly increases the risk of heart attack and stroke. Do not smoke while using combined hormonal contraception, especially if aged 35 or over.
• Yasmin contains drospirenone, which has anti-mineralocorticoid activity. Discuss with your prescriber if you take medications that affect potassium levels.
• Seek immediate medical attention if you develop signs of a blood clot (see side effects section).

Understanding combined oral contraception

Combined oral contraceptives contain a synthetic oestrogen (almost always ethinylestradiol or, in newer formulations, estradiol valerate or estetrol) and a synthetic progestogen.

The combination provides highly effective contraception through multiple mechanisms. The primary mechanism is suppression of ovulation.

Ethinylestradiol suppresses FSH, preventing follicular development, while the progestogen suppresses the LH surge required for ovulation.

Secondary mechanisms include alteration of cervical mucus (becoming thick and impenetrable to sperm), changes to the endometrial lining (reducing receptivity to implantation), and reduced tubal motility.

Progestogens used in COCPs are classified by their parent compound and generation. First-generation progestogens include norethisterone. Second-generation include levonorgestrel and norgestrel. Third-generation include desogestrel, gestodene, and norgestimate.

Drospirenone is sometimes classified separately because it is derived from spironolactone (a synthetic 17-alpha-spirolactone) rather than from testosterone or nortestosterone, giving it a distinct pharmacological profile with anti-mineralocorticoid and anti-androgenic activity and no androgenic, oestrogenic, or glucocorticoid activity.

How Yasmin works

Drospirenone 3 mg suppresses ovulation by inhibiting the mid-cycle LH surge through negative feedback on the hypothalamic-pituitary-gonadal axis.

It has a progestogenic potency approximately equivalent to 0.25 mg levonorgestrel. The anti-mineralocorticoid activity of drospirenone is pharmacologically equivalent to approximately 25 mg spironolactone.

This blocks the action of aldosterone at the mineralocorticoid receptor in the distal renal tubule, promoting mild sodium and water excretion and counteracting the fluid-retaining effect of ethinylestradiol.

In clinical studies, women taking Yasmin showed a mean body weight reduction of 0.2 to 0.8 kg compared with a mean increase of 0.5 to 1.0 kg with levonorgestrel-containing COCPs, attributable to reduced fluid retention.

The anti-androgenic activity of drospirenone results from direct competitive antagonism at the androgen receptor.

This reduces the effect of circulating androgens on target tissues including the pilosebaceous unit (hair follicle and sebaceous gland), leading to decreased sebum production and improved acne.

Ethinylestradiol further contributes to the anti-androgenic effect by increasing sex hormone-binding globulin (SHBG) production in the liver, which binds circulating free testosterone and reduces its bioavailability.

The combined anti-androgenic effect of Yasmin is clinically significant, with studies showing improvement in acne lesion counts comparable to co-cyprindiol (Dianette).

Ethinylestradiol 0.03 mg contributes to contraceptive efficacy by suppressing FSH and preventing follicular development. It also stabilises the endometrium, reducing the likelihood of breakthrough bleeding, and maintains the contraceptive effectiveness of the progestogen component.

Clinical evidence for Yasmin

Yasmin's contraceptive efficacy has been demonstrated in multiple clinical trials with a Pearl Index (number of pregnancies per 100 woman-years of use) of 0.72 with perfect use and approximately 1.0 with typical use in controlled studies.

Real-world effectiveness is lower (approximately 91% with typical use) due to missed pills and inconsistent timing.

The anti-mineralocorticoid effect of drospirenone has been confirmed in randomised controlled trials comparing Yasmin with levonorgestrel/ethinylestradiol 0.15/0.03 mg.

Women taking Yasmin reported significantly less bloating, fluid retention, and negative mood symptoms associated with the pill-free interval.

The DRSP/EE formulation was also associated with improved health-related quality of life scores on the Menstrual Distress Questionnaire.

Regarding the anti-androgenic effect, a 9-cycle randomised trial comparing Yasmin with a desogestrel/ethinylestradiol COCP demonstrated significant reductions in acne lesion counts, sebum production, and subjective skin greasiness with Yasmin.

The European Active Surveillance Study (EURAS) and subsequent pharmacoepidemiological studies have provided long-term safety data, including VTE risk estimates for drospirenone-containing COCPs (discussed in the warnings section).

How to take Yasmin

Take 1 tablet daily at approximately the same time each day for 21 consecutive days, followed by a 7-day tablet-free interval.

During the 7-day break, a withdrawal bleed usually occurs, starting 2 to 3 days after the last active tablet.

Start the next pack after exactly 7 tablet-free days, regardless of whether bleeding has stopped.

Contraceptive protection is maintained during the 7-day break provided the previous pack was taken correctly and the next pack is started on time.

Starting Yasmin for the first time: start on day 1 of your menstrual period for immediate protection.

If starting on days 2 to 5, use additional barrier contraception for the first 7 days.

Switching from another COCP: start the day after taking the last active tablet from the previous pack (no break needed).

Switching from a progestogen-only pill: start any day and use additional contraception for the first 7 days. After first-trimester abortion or miscarriage: start immediately.

After second-trimester abortion or childbirth (non-breastfeeding): start on day 21 to 28 postpartum.

Missed pills: follow the Faculty of Sexual and Reproductive Healthcare (FSRH) guidelines. One missed pill (less than 24 hours late): take immediately, continue the pack, no additional contraception.

Two or more missed pills (more than 48 hours since last pill): take the last missed pill immediately, discard earlier missed pills, use barrier contraception for 7 days.

If in week 1 and unprotected sex occurred, consider emergency contraception. If in week 3, skip the break and start the next pack immediately.

Continuous or extended use (tailored regimens)

The FSRH guideline on combined hormonal contraception (updated 2019) supports the use of flexible extended regimens (sometimes called tricycling or continuous use).

Instead of the standard 21/7 pattern, women may take active pills continuously for 9 weeks (3 packs) followed by a 4 to 7 day break, or continuously with a break only when breakthrough bleeding persists for 3 to 4 days.

This approach reduces the frequency of withdrawal bleeds, decreases hormone withdrawal symptoms (headache, mood changes, pain), and may improve contraceptive efficacy by eliminating the risk of extending the pill-free interval.

This is an off-label but widely recommended use pattern.

Side effects of Yasmin

Common side effects

Headache, breast tenderness, mood changes (depressed mood, mood swings, irritability), nausea, and irregular bleeding or spotting are reported in 1 to 10% of women, most commonly during the first 1 to 3 cycles.

These usually settle without intervention. If bleeding irregularities persist beyond 3 cycles, alternative diagnoses (cervical pathology, sexually transmitted infections, pregnancy) should be excluded.

Thromboembolism risk

All combined hormonal contraceptives increase the risk of venous thromboembolism (VTE) and arterial thromboembolism (ATE) compared with non-use.

The MHRA issued updated guidance on VTE risk with combined hormonal contraceptives in 2014.

For drospirenone-containing COCPs including Yasmin, the estimated VTE risk is 9 to 12 per 10,000 women per year, compared with 5 to 7 per 10,000 for levonorgestrel-containing COCPs and 2 per 10,000 for non-users.

This risk is highest during the first year of use and when restarting after a break of 4 weeks or more.

The absolute VTE risk remains small, and for most women the benefits of reliable contraception outweigh this risk.

The VTE risk in pregnancy is substantially higher at approximately 29 per 10,000.

Warning signs of VTE and ATE that require immediate medical attention: unusual leg swelling, pain, or warmth (DVT); sudden breathlessness, sharp chest pain, or coughing up blood (PE); sudden severe headache, visual disturbance, slurred speech, or weakness on one side (stroke); chest pain radiating to the arm or jaw, sweating, and nausea (myocardial infarction).

Call 999 immediately if any of these occur.

Other risks

A very small increase in breast cancer risk has been observed with current COCP use (relative risk approximately 1.24), which diminishes after stopping and returns to baseline within 10 years.

The absolute increase in risk is small and must be balanced against the protective effect of COCPs against ovarian cancer (30 to 50% risk reduction with 5 or more years of use, persisting for at least 20 years after stopping) and endometrial cancer (50% risk reduction with long-term use).

Cervical cancer risk is slightly increased with long-term use (5 or more years), likely related to persistence of HPV infection.

Cholestatic jaundice, gallstone formation, and very rarely hepatic adenoma have been reported. Report suspected adverse reactions to the MHRA at yellowcard.mhra.gov.uk .

Warnings and precautions

Risk factor assessment

Before prescribing Yasmin, healthcare providers must assess VTE and ATE risk factors using the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC).

UKMEC Category 4 (absolute contraindications) for combined hormonal contraceptives includes: current or past VTE, known thrombophilia, major surgery with prolonged immobilisation, migraine with aura at any age, current breast cancer, severe hypertension (systolic 160 or above, diastolic 95 or above), ischaemic heart disease, stroke, complicated valvular heart disease, and smoking 15 or more cigarettes per day in women aged 35 or above.

The prescription should be reviewed annually with reassessment of risk factors, blood pressure, and BMI.

Potassium considerations

Drospirenone's anti-mineralocorticoid effect can theoretically increase serum potassium. In clinical studies of women with normal renal function, no clinically significant hyperkalaemia occurred.

However, potassium should be monitored in the first cycle in women concurrently taking ACE inhibitors, angiotensin II receptor antagonists, potassium-sparing diuretics, aldosterone antagonists, NSAIDs, or heparin, and in women with renal impairment.

Surgery and immobilisation

Stop Yasmin at least 4 weeks before planned major surgery or any procedure involving prolonged lower limb immobilisation. Restart no earlier than 2 weeks after full remobilisation.

Consider thromboprophylaxis if stopping is not possible. For unplanned emergency surgery, consider pharmacological thromboprophylaxis (low-molecular-weight heparin).

How to get Yasmin in the UK

Yasmin is available on NHS prescription from your GP, sexual health clinic, or an authorised online prescriber registered with the General Pharmaceutical Council (GPhC).

All contraceptive prescriptions are free of charge on the NHS, regardless of age or exemption status. You do not pay the standard prescription charge for contraceptive medications.

Generic drospirenone/ethinylestradiol 3 mg/0.03 mg tablets are also available and are bioequivalent to branded Yasmin. A prescription is required; Yasmin is not available over the counter.

Sources

• Yasmin, Summary of Product Characteristics (EMC)
• Drospirenone with ethinylestradiol, British National Formulary (BNF)
• FSRH Guideline: Combined Hormonal Contraception
• UK Medical Eligibility Criteria for Contraceptive Use (UKMEC)
• Combined oral contraceptive pill, NHS
• MHRA Yellow Card Scheme