Taking Yasmin: Tablet must be taken in the order directed on the package everyday at about the same time with some liquid as needed. One tablet is to be taken daily for 21 consecutive days. Each subsequent pack is started after a 7-day tablet-free interval, during which time, a withdrawal bleed usually occurs. This usually starts on days 2-3 after the last tablet and may not have finished before the next pack is started.
Starting on Yasmin: No Preceding Hormonal Contraceptive Use (In the Past Month): Tablet-taking has to start on day 1 of the woman's natural cycle (ie, the 1st day of menstrual bleeding). Starting on days 2-5 is allowed, but during the 1st cycle, a barrier method is recommended in addition for the first 7 days of tablet-taking.
Changing from Another Combined Oral Contraceptive (COC), Vaginal Ring or Transdermal Patch: The user should start with Yasmin preferably on the day after the last hormone-containing tablet of her previous COC, but at the latest on the day following the usual tablet-free or placebo tablet interval of her previous COC. In case a vaginal ring or transdermal patch has been used, the woman should start using Yasmin preferably on the day of removal, but at the latest when the next application would have been due.
Changing from a Progestogen-Only Method (Minipill, Injection, Implant) or from a Progestogen-Releasing Intrauterine System (IUS): The user may switch any day from the minipill (from an implant or the IUS on the day of its removal, from an injectable when the next injection would be due), but should in all of these cases be advised to additionally use a barrier method for the first 7 days of tablet-taking.
Following 1st Trimester Abortion: The woman may start immediately. When doing so, additional contraceptive measures are not necessary.
Following Delivery or 2nd Trimester Abortion: For breastfeeding women, see Use in pregnancy & lactation under Precautions.
Women should be advised to start at day 21-28 after delivery or 2nd-trimester abortion. When starting later, the woman should be advised to additionally use a barrier method for the first 7 days of tablet-taking. However, if intercourse has already occurred, pregnancy should be excluded before the actual start of COC use or the woman has to wait for her 1st menstrual period.
Management of Missed Tablets: If the user is <12 hrs late in taking any tablet, contraceptive protection is not reduced. The woman should take the tablet as soon as she remembers and should take further tablets at the usual time.
If the user is >12 hrs late in taking any tablet, contraceptive protection may be reduced. The management of missed tablets can be guided by the following 2 basic rules: Tablet-taking must never be discontinued for >7 days and 7 days of uninterrupted tablet-taking are required to attain adequate suppression of the hypothalamic-pituitary-ovarian axis.
Accordingly, the following advice can be given in daily practice: Week 1: The user should take the last missed tablet as soon as she remembers, even if this means taking 2 tablets at the same time. Then continue taking the tablets at the usual time. In addition, a barrier method eg, a condom, should be used for the next 7 days. If intercourse took place in the preceding 7 days, the possibility of a pregnancy should be considered. The more tablets are missed and the closer they are to the regular tablet-free interval, the higher the risk of a pregnancy.
Week 2: The user should take the last missed tablet as soon as she remembers, even if this means taking 2 tablets at the same time. The user then continues taking the tablets at the usual time. Provided that the user has taken her tablets correctly in the 7 days preceding the 1st missed tablet, there is no need to use extra contraceptive precautions. However, if this is not the case, or if she missed >1 tablet, the user should be advised to use extra precautions for 7 days.
Week 3: The risk of reduced reliability is imminent because of the forthcoming tablet-free interval. However, by adjusting the tablet-intake schedule, reduced contraceptive protection can still be prevented. By adhering to either of the following 2 options, there is therefore no need to use extra contraceptive precautions, provided that in the 7 days preceding the 1st missed tablet, the user has taken all tablets correctly. If this is not the case, the user should be advised to follow the 1st of these 2 options and to use extra precautions for the next 7 days as well: 1. The user should take the last missed tablet as soon as she remembers, even if this means taking 2 tablets at the same time. Then continue taking the tablets at the usual time. The next pack must be started as soon as the current pack is finished ie, no gap should be left between packs. The user is unlikely to have a withdrawal bleed until the end of the 2nd pack, but may experience spotting or breakthrough bleeding on tablet-taking days.
2. The user may also be advised to discontinue tablet-taking from the current pack. She should then have a tablet-free interval of up to 7 days, including the days she missed tablets, and subsequently continue with the next pack.
If the woman missed tablets and subsequently has no withdrawal bleed in the first normal tablet-free interval, the possibility of a pregnancy should be considered.
Advice in Case of GI Disturbances: In case of GI disturbances, absorption may not be complete and additional contraceptive measures should be taken.
If vomiting occurs within 3-4 hrs after tablet-taking, the advice concerning missed tablets, as given under Management of Missed Tablets, is applicable. If the woman does not want to change her normal tablet-taking schedule, she has to take the extra tablet(s) needed from another pack.
Shifting Periods or Delaying a Period: To delay a period, the woman should continue with another pack of Yasmin without a tablet-free interval. The extension can be carried on for as long as wished until the end of the 2nd pack. During the extension, the woman may experience breakthrough bleeding or spotting. Regular intake of Yasmin is then resumed after the usual 7-day tablet-free interval.
To shift periods to another day of the week than the user is used to with her current scheme, she can be advised to shorten forthcoming tablet-free interval by as many days as desired. The shorter the interval, the higher the risk that she does not have a withdrawal bleed, and will experience breakthrough bleeding and spotting during the 2nd pack (just as when delaying a period).
