The New York Times reported September 25 on the controversy surrounding Yaz and Yasmin, two popular birth control pills (BCPs). Part of the controversy stems from problematic marketing and manufacturing processes identified by the Food and Drug Administration. However, the principal concern is whether these medications increase the risk of blood clots.
To understand the safety issues, here’s a little background. Common estimates are that at baseline about 1 women in 10,000 will have a blood clot this year; that number increases to about 3 women in 10,000 if they’re taking BCPs. (Compare this to the fact that more than 50 women in 10,000 will get a blood clot due to pregnancy.) Since this is true for many BCPs, what’s so special about Yaz and Yasmin?
Like many BCPs, Yaz and Yasmin use both estrogens and progestins to prevent ovulation. However, unlike other BCPs, Yaz and Yasmin use a new progestin called drospirenone. The research on drospirenone is contradictory: one study sponsored by the manufacturer found no increased risk in blood clots, while two studies by independent researchers found a slight increase in blood clots from drospirenone.
Let’s take a closer look at these studies that show an increased risk. A Danish study by Lidegaard, published in the British Medical Journal, examined women taking different types of oral contraceptives. As expected, they found that the pill increases the risk of blood clots, from an annual rate of 3 per 10,000 women to 6 per 10,000 women. What did they find specifically about drospirenone? Comparing drospirenone to levonorgestrel (a progestin found in other BCPs such as Alesse and Nordette), they found that annually, 5.5 women out of 10,000 on levonorgestrel BCPs had blood clots, while about 8 women out of 10,000 on drospirenone had blood clots. A similar increase was also found when other progestins (desogestrel and gestodene, found in OrthoCept, Mircette, and others) were compared to levonorgestrel.
The second study, done in the Netherlands by van Hylckama Vlieg, found similar results. Patients taking BCPs had higher rates of blood clots: in patients aged 30-40 years old, the annual rate of blood clots was 2 per 10,000 women in patients who didn’t use BCPs, and 10 per 10,000 women who did use BCPs. It was lower in women younger than 30 and slightly higher in women older than 40. While the authors don’t report their results in the same manner as the previous study, extrapolation from their data shows that drospirenone has an annual rate of 12 blood clots per 10,000 women aged 30-40. Desogestrel BCPs also had similar increased rates compared to baseline.
The bottom line from these studies: Yaz and Yasmin, which use drospirenone, have a slightly higher risk of blood clots than BCPs using levonorgestrel. This risk is not dramatically higher. Furthermore, other BCPs containing desogestrel and gestodene also have a slightly increased risk of blood clots compared to levonorgestrel.
If you’re weighing the risks and benefits of birth control, remember that BCPs decrease the risk of getting ovarian and endometrial cancer. Also they definitely decrease the medical risks associated with pregnancy! To counter those benefits, there are some risks in smokers–people who smoke face increased risks of breast cancer and heart attacks if they use BCPs. There is debate whether non-smokers have an increased risk of breast cancer and heart attacks while using BCPs, currently there is no consensus on these issues.
So what should you do if you’re on Yaz or Yasmin? There’s no immediate cause for serious worry, but please use the information in this post to have an informed conversation with your health care provider about the best option for your individual situation. There might be a levonorgestrel-based BCP that’s better for you.
Gregg A. Miller
Gregg Miller, MD is a board-certified emergency room physician. Not nearly as good-looking as the doctors on the TV show ER, lacking the charisma of Dr. House, and much less scandalous than anyone on Grey’s Anatomy, he still managed to carve out a niche ...
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Holly Grigg-Spall says:
Please do take a look at my blog for more information on Yasmin, particularly the less publicised negative emotional side effects suffered by many women.
http://www.sweeteningthepill.blogspot.com/
Holly Grigg-Spall
Wayne O'Bryan says:
Why should women take a new birth control pill that apparently increases their risk of blood clots when there are many other alternatives that have been tested for decades that are less risky?
Adam Dawson says:
I am more than a little sick of three per 10,000 being an "acceptable" level of risk. A blood clot is not the same thing as tender nipples or weight gain. And why is it that Bayer has been downplaying these risks? Im sorry, but if I put out a candy bar or soft drink that caused blood clotting in 3 out of 10,000 of the people who used it, I'd get the crap sued out of me.
They probably deserve all these lawsuit sites that are getting set up...
http://www.mdinjurydisabilitylaw.com/2009/09/articles/prod-liab/yaz-and-yasmin-should-be-recalled/
Gregg A. Miller says:
Thanks for the comment. I'm not defending the drug company, but let me play devil's advocate -- the birth control pill is not like a candy bar or soft drink, it's a medicine and people expect medicines to have risks, as long as the benefits outweight the risk. BCPs might slightly increase your rate of blood clots, but they decrease your risk of pregnancy, which has a dramatically higher rate of blood clots.
Adam, maybe you should sue the candy bar and soft drink makers; daily doses of those increase your risk of obesity, which also is a risk factor for blood clots.
--Gregg
Adam Dawson says:
I understand where you are coming from, Greg, but isnt it profoundly irresponsible for a company to talk up the peripheral benefits (No more acne! No more PMS! No more crying jags!) without mentioning the additional risks that this variation on progestin brings with it? This strikes me as especially reckless behavior on Bayers part.
cyn says:
The birth control pill. Yaz, has been linked to life-threatening side effects such as strokes, blood clots, and heart attacks. Since 2004, at least 50 deaths have been reported in women taking Yaz and contraceptives made with similar ingredients. There is more information on this disturbing problem at http://www.yaz-may-cause-strokes.com/.
tina says:
"the birth control pill is not like a candy bar or soft drink"
Doctors hand out the pill EXACTLY like it's candy. They think all of our problems can be solved with a little birth control "therapy".
Women are treated like they are innately damaged and in need of regulation to make them "normal". You're even promoting the pill as if it will save us from cancer. Well, studies may show that it might reduce the risk of some cancers but they also show that they increase the risks of other cancers & health problems.
How many girls/women have to die or be injured before it's considered unsafe?
Alena says:
I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.
Alena
http://ovarianpain.net
andrea says:
thank dr. miller for putting me at easy with my decision. your article was very clear and you didn't come across as protecting the manufacturers, it was just plain facts - i appreciate that, as with facts i can make up my own mind! i am very happy taking yaz, my skin did clear (after years and lots of $$$ trying to get that done). i understand that i am taking a small risk and your explanation of the studies done about yaz have really helped me be ok with continuing taking this pill. aloha from hawaii.
Christy says:
Yaz and Yasmin are the only BCPs recommended from women with PCOS and they actually reduce the elevated androgens that many of us suffer with. My DHEA number has gone from 1522 to 250 in the 3 months I've been on Yasmin. I have suffered with severe depression as a side effect, but I hope to not be on the medicine long-term.