Beyond Birth Control: Yaz and Beyaz

Yaz and Beyaz
Yaz and Beyaz. Photo © 2015 Dawn Stacey

When it comes to choosing a combination birth control pill, there are many options available. Though most birth control pills come in 28 or 21 day packs, there are two unique formulations of combination birth pills because they are available in 24-day packs. These birth control pills are Yaz and Beyaz.

  • Yaz actually contains 24 days of hormone pills, followed by 4 days of placebo tablets. For women who choose the pill for contraception, Yaz is also FDA approved to treat the emotional and physical symptoms of PMDD -- symptoms that are severe enough to impact the lives of many women. Yaz is also FDA-approved to treat moderate acne (if you already have had your menstrual period and are least 14 years old).
  • Beyaz is one of the newer pills on the market. Just like Yaz, it is FDA-approved to help provide PMDD symptom relief as well as treat moderate acne. What makes Beyaz different is it has 24 hormone pills that also include levomefolate calcium (B vitamin/folic acid). There are also 4 placebo pills that don't contain any hormones but do have folate as well. Folate lowers the risk of having rare neural tube defects in a pregnancy. This may be helpful if you become pregnant while use Beyaz use or shortly after stopping its use. Beyaz provides you with the 0.4 mg of folic acid recommended daily for women of reproductive age.

A possible advantage of a 24-day dosing schedule is that it may offer you fewer hormone fluctuations than the 21 days of active pills in a typical 21/28 day pack. Both Yaz and Beyaz work like any other combination pill. Yet, in addition to having 24-day active pill schedule, these pills are also different because of the type of progestin they contain.

Yaz and Beyaz both consist of an estrogen/drospirenone formulation. 

There has been some concern that drospirenone-containing pills may increase your chance of developing blood clots. The reality is that all birth control pills pose a risk of developing blood clots. With that being said, based on an FDA self-funded study that examined data from over 800,000 women, the agency suggests that the use of pills containing drospirenone (like Yaz and Beyaz) are linked to an approximate 1.5-fold overall increase in VTE/blood clots risk when compared to low-dose oral contraceptive.

Yet, when you put this into perspective, overall blood clot risk is still considered to be relatively low, and even the FDA admits that that the available research does not yield consistent results or account for significant patient characteristics that could also be contributing to blood clot risk. However, because of this review, the FDA called for new labeling requirements on drospirenone-containing pills. 

Another issue that surrounds Yaz and Beyaz use has to do with the potential higher potassium levels. Drospirenone can subdue hormones that regulate your body's water and electrolyte-levels. Because of this, it is very important that you are completely honest when talking to your doctor about your medical history. Because pills with drospirenone may interact with other medications that increase potassium -- such as certain medications for high blood pressure or heart conditions, anti-inflammatory drugs (like Ibuprofen), and some water pills (diuretics), your doctor needs to know if you are already using these types of medications before prescribing you Yaz or Beyaz.

In fact, the product labels for both Yaz and Beyaz include a warning that advises doctors who prescribe these pills to monitor serum potassium levels in the first month if you are also being treated with any drug associated with potassium retention. Because these two brands of birth control pills have received so much attention about blood clot risk, it seems that doctors may not be paying enough attention to these potassium warnings. Research suggests that that roughly 17.6% of women use both drospirenone-containing pills and a potassium interacting drug, and 29% of this overlap in use typically takes place within a month of beginning the birth control pill.

Doctors may be overlooking the possibility of this interaction because of who is prescribing what. It appears that that 18% of women have their potassium-increasing medication prescribed by family practice or internal medicine doctors and their Yaz/Beyaz being prescribed by their OB/GYNs.

Research also reveals:

  • 9.5% of women are prescribed both medications (Yaz/Beyaz and a potassium-raising medication) by their OB/GYNs
  • 8.4% were prescribed both medications by their family practice or internal medicine doctor.
  • 17% of women are using a potassium-increasing medication before starting Yaz/Beyaz.
  • 83% of women are using Yaz/Beyaz before initiating a potassium-raising medication.

Take Home Message: Yaz and Beyaz can be great alternative pill brands for many women. Because of their 24-day dosing schedule, you may experience less hormonal fluctuation (and be relieved of symptoms that may be associated with this). Plus, these birth control pills offer non-contraceptive benefits that are attractive to many women. If you are going to use Yaz or Beyaz, you should weigh these benefits against your blood clot risk. Finally, you need to be aware of how these pills could potentially increase potassium levels. Because there is evidence to suggest that not all doctors are aware of the possible interaction between Yaz/Beyaz and potassium-raising medications (or the need to test and/or monitor serum potassium levels), it is crucial that you tell your doctor if you are using one of these medications before beginning the other.

Sources:

American College of Obstetricians and Gynecologists. "Risk of venous thromboembolism among users of drospirenone-containing oral contraceptive pills." Committee Opinion No. 540. Obstet Gynecol 2012 (Reaffirmed 2014);120:1239–42. Accessed via private subscription.

McAdams, M, Staffa, JA, & Dal Pan, GJ. "The concomitant prescribing of ethinyl estradiol/drospirenone and potentially interacting drugs." Contraception, 2007 76(4), 278-281. Accessed via private subscription.

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