Drospirenone: What it is and what to expect

Drospirenone is a synthetic progestin used in several combined oral contraceptives (COCs) like Yaz and Yasmin. It acts like the body’s progesterone but also has anti-androgen and mild antimineralocorticoid effects. That means it can help with acne and reduce water retention for some people — but it also can raise potassium levels in certain situations.

How drospirenone works

Combined pills with drospirenone contain both an estrogen and drospirenone. Together they prevent ovulation, thicken cervical mucus, and thin the uterine lining so pregnancy is unlikely. The anti-androgen effect can lower oil production in the skin, which is why some people see clearer skin while using it. The antimineralocorticoid action counteracts fluid buildup, so bloating and puffiness may improve for some users.

If you want birth control that may help acne or bloating, drospirenone options are worth discussing with your clinician. They're not a one-size-fits-all choice — effectiveness for acne varies and not everyone will notice these benefits.

Safety, side effects, and interactions

Common side effects include nausea, headache, breast tenderness, and irregular bleeding at first. A key difference with drospirenone is its potential to raise potassium. That’s usually not a problem for healthy people, but it can be risky if you take ACE inhibitors, ARBs, potassium-sparing diuretics, certain supplements, or have kidney disease.

There has also been research showing a slightly higher risk of blood clots (venous thromboembolism) with drospirenone-containing pills compared with some older progestins. The absolute risk for most people remains low, but it’s higher if you smoke (especially over 35), have a personal or family history of clots, uncontrolled high blood pressure, or certain clotting disorders. Talk openly with your provider about these risks before starting.

Other important points: avoid starting combined hormonal pills if you are pregnant. If you’re breastfeeding, timing and pill choice matter — discuss alternatives with your prescriber. If you notice sudden leg pain/swelling, shortness of breath, or chest pain, seek urgent medical care — these can signal a clot.

Missed-pill rules differ by brand, so check your pill leaflet. As a simple rule: if you miss one active pill, take it as soon as you remember; if you miss two or more, follow the instructions on the pack and consider backup contraception until you’ve taken active pills for seven days.

Before starting drospirenone, mention all meds and supplements you use. Your provider may check blood pressure and, when relevant, a baseline potassium level. If you take drugs that raise potassium or have kidney problems, your clinician may choose a different pill.

Want help deciding? Bring a list of your health issues and meds to your appointment. A short conversation with your provider can match the best birth control choice to your needs and keep you safe while getting the benefits you want.