The other day, we saw a patient with polycystic ovarian syndrome.  She was at the clinic for a PAP smear.  She told us she had PCOS and was been managed by her primary care doctor.  We asked her what medications she was on. She said she used to be on Yasmin but was not currently taking it.  She did not volunteer any further info regarding why she was not compliant.  She mentioned that she does not get her periods.

On observation/physical exam, she is a heavy-set teenager (18) with facial hair.  She also had excess body hair in a male distribution pattern and some acne.   

So, I'm wondering what is Yasmin and why is she not taking it.  Here is what I found.

PCOS is a primary ovarian defect.  Women with PCOS have abnormalities in the metabolism of androgens and estrogen and in the control of androgen production.  There is decreased estrogen levels and consequent anovulation.  The syndrome is variable in its' presentation.  Associated signs include: menstrual dysfunction, hirsutism, infertility, obesity and impaired glucose tolerance.

Some of the mainstay treatments include diet modification and exercise to address obesity.   Metformin for impaired glucose intolerance and infertility (a high likelihood of having ovulatory cycles while on metformin.) Hirsutism: Weight loss (shown to decrease androgen production in women who are obese; therefore, losing weight can slow hair growth) and oral contraceptive (oral contraceptives slow hair growth in 60-100% of women with hyperandrogenemia) and spironolactone

So Yasmine (Drospirenone/EE) is an oral contraceptive (which is supposed to address irregular cycle and hirsutism).  However, according to this study which concludes that Yasmin provides good cycle control for women with PCOS, with an improvement in acne over 6 months but not in other symptoms of the syndrome. I wondered if our patient stopped taking Yasmine because she saw no improvement of her facial her (which seemed more of concern to her than her irregular periods).  I wondered if she was educated on why she was taking Yasmine and if she was given the option of other drugs (mentioned in this study) and spironolactone. Note: Because spironolactone is a class D in pregnancy, an effective form of contraception is required when using these compounds.

Faz: Spironolactone is an antiandrogenic med which improves hirsutism, however, it is also a teratogen so if you give spironolactone to a young women you should add birth control med.

Pamy:I believe she was nineteen and see below for Diane35, and metformin for pcos rx

ANS to yor questions 1. we saw the patient at an off site clinic. The doctor I shadowed is not her primary care physician. 2. Here is the conclusion from one of the studies I cited "CONCLUSION:: The combination of metformin with intermittent application of Diane35 is an appropriate alternative for the pathogenic influence and clinical improvement of the symptoms of androgen excess in cases with PCOS." Diane 35 Each tablet contains a small amount of two different hormones. These are cyproterone acetate (a progestogen with antiandrogenic properties) and ethinylestradiol (an estrogen).