pharmachologic effect
Yarina is a combined oral contraceptive with ethinyl estradiol and the progestogen drospirenone. Contraception occurs primarily by preventing the release of an egg (ovulation) during the menstrual cycle.
Yarina thickens the vaginal fluid to prevent sperm from entering the egg (fertilization) and changes the lining of the uterus to prevent the implantation of a fertilized egg. If the fertilized egg does not attach to the uterus, it passes out of the body.
The drug does not have estrogenic, glucocorticoid or antiglucocorticoid effects. This gives drospirenone a pharmacological profile very similar to the natural hormone progesterone.
Clinical studies indicate that the mild antimineralocorticoid properties of Yarina result in a weak antimineralocorticoid effect.
Main characteristics
The contraceptive is available in the form of light yellow tablets, each of which has a special film coating and an engraved image in the form of a hexagon with the letters “DO” in the center.
The drug is supplied to pharmacies in special cardboard packages containing 1 or 3 blisters. Each such plate contains 21 tablets (this is how many days you need to take the product before taking a break).
Compound
The active ingredients of the drug Yarina are:
- drospirenone (3 mg);
- ethinyl estradiol (30 mcg).
But there are also additional components:
- macrogol 6000;
- pregelatinized starch;
- titanium dioxide;
- magnesium stearate;
- lactose monohydrate;
- hypromellose;
- povidone K25;
- iron oxide;
- corn starch.
This contraceptive is low-dose, containing a small amount of hormones, and monophasic (the medicine has the same composition).
Admission rules
Yarina begins to act from the first tablet, which can be taken on the day of the start of menstruation or a day after stopping the use of other contraceptives. The full course is designed for three calendar weeks, during which you should drink the dose prescribed by your doctor at the same time. After this, the woman needs a break of 7 days . During a week-long rest, the body independently provokes the onset of menstruation. After the break is completed, you can begin the next course of taking the drug.
Since the tablets begin to act in full force only on the seventh day, during the initial period of using Yarina it is recommended to use barrier means of protection against unwanted pregnancy.
Action
The contraceptive has a suppressive effect on the ovulation process and stimulates abundant secretion of cervical fluid, which prevents sperm from penetrating into the uterine cavity. In addition, the menstrual cycle is regulated: bleeding becomes less profuse and painful.
Features of drug interactions
If Yarina is taken together with drugs that activate the production of liver microsomal enzymes, this can lead to intensive removal of sex hormones from the body.
As a result, the woman experiences breakthrough bleeding and oral contraception becomes less effective. Therefore, it is necessary to resort to barrier-type contraceptives. The same should be done when using Tetracycline or Penicillin.
Side effects
Women taking Yarina may experience the following side effects:
- thromboembolism;
- scanty brown vaginal discharge;
- attacks of nausea and vomiting;
- abdominal pain, diarrhea;
- mood swings;
- migraine;
- thrombosis;
- increase or decrease in libido levels;
- rash, urticaria;
- weight gain;
- swelling;
- discharge from the mammary glands (in some cases, the girl’s breasts hurt and become enlarged);
- allergy.
Contraindications
Yarina tablets should not be used by women who have the following symptoms and diseases:
- renal and hepatic dysfunction;
- thrombophlebitis or thromboembolic disorders;
- cerebrovascular disease or coronary heart disease;
- valvular heart disease with thrombogenic complications;
- severe hypertension;
- diabetic angiopathy;
- migraine with a history of local neurological centers;
- known or suspected malignant breast tumors;
- endometrial carcinoma or other known or suspected estrogen-dependent neoplasia;
- undiagnosed abnormal sexual bleeding;
- benign or malignant tumors in the liver;
- known or suspected pregnancy.
Also, the medication is contraindicated in women who smoke.
Side effects
Instructions for use of Yarina tablets indicate that the most common side effects are irregular uterine bleeding, nausea, pain in the mammary glands and pain in the head.
From the reproductive system the following may occur:
chest pain or discomfort, menstrual irregularities, bleeding of the female genital tract, premenstrual syndrome.
Gastrointestinal side effects may include:
nausea, vomiting, digestive disorders.
CVS disorders:
hypertension, hypotension, varicose veins.
From the side of the central nervous system the following may occur:
headache, migraine, imbalance, drowsiness, paresthesia, asthenia.
Psychiatric disorders:
depression/depressive mood, nervousness, emotional lability, decreased and loss of libido, increased libido.
Dermatological reactions:
acne, dry skin, itching, rash, increased sweating, eczema, alopecia.
Respiratory disorders:
nosebleeds, asthma attacks, pharyngitis, sinusitis.
Musculoskeletal disorders:
back pain, limb pain, muscle spasms.
Metabolic disorders:
fluid retention, increased appetite, anorexia, hyperkalemia, hyponatremia.
Drug interactions
Combined oral contraceptives, such as Yarina, containing ethinyl estradiol, may inhibit the metabolism of other compounds.
Increased plasma concentrations of cyclosporine, prednisolone and theophylline have been reported when taking Yarina together. In addition, oral contraceptives may cause conjugation of other compounds. Decreased acetaminophen plasma concentrations and increased clearance of temazepam, salicylic acid, morphine, and clofibric acid were observed when these medications were administered with oral contraceptives.
Decreased contraceptive effectiveness and increased menstrual irregularities have been associated with concomitant use of Rifampicin.
Anticonvulsants, such as phenobarbital, phenytoin, and carbamazepine, increase the metabolism of ethinyl estradiol and/or some progestins, which may lead to decreased contraceptive effectiveness.
Pregnancy has been reported while taking Yarina and antimicrobial agents such as ampicillin, tetracycline and griseofulvin.
Herbal medications that cause certain enzymes, including cytochrome P450 3A4 (CYP3A4), may decrease the effectiveness of the medication or increase breakthrough bleeding.
Ascorbic acid and acetaminophen may increase plasma concentrations of some synthetic estrogens, possibly by inhibition of conjugation.
Indications for use
The drug Yarina Plus is prescribed as contraception for women with:
- Fluid retention in the body, which is associated with hormonal disorders;
- Lack of folate;
- Moderate acne.
In addition, birth control pills are very effective for endometriosis.
They can also be recommended by gynecologists for resolving ovarian cysts.
Photo gallery of testimony:
Folate deficiency
Fluid retention
Endometriosis
Ovarian cyst
Acne
Directions for use and doses
You need to drink Yarina every day for 21 days. You can take the tablets with or without food, but be sure to take them at the same time every day. The strip contains 21 tablets. Next to each tablet is printed the day of the week when you need to take it. If, for example, your appointment starts on Wednesday, you need to take a tablet with “WED” written next to it. Next, follow the direction of the arrow on the strip until all 21 tablets have been taken. Then you need to take a break for 7 days. During these 7 pill-free days (otherwise known as the stop or break week), menstrual bleeding should begin. This so-called “withdrawal bleed” usually begins on the 2nd or 3rd day of the off week.
On the 8th day after the last Yarina tablet (that is, after a 7-day break week), you should start taking it with the next strip, regardless of whether the bleeding has stopped or not. This means you need to start each strip, regardless of whether you are menstruating or not. If the medicine is used in this way, the woman is protected from pregnancy for 7 days when she does not take the pills.
Taking Yarin tablets should begin on the first day of the onset of menstruation; it is possible to reschedule the intake to the second day, but no later than the fifth day from the beginning of menstruation. However, in this case it is necessary to use additional methods of contraception for a week.
After an abortion in the first trimester of pregnancy, you can start taking Yarina immediately. In this case, barrier methods of contraception are not required.
If childbirth or abortion was performed in the second trimester, then taking the pills should be started no earlier than 21-28 days later.
If the delay in taking Yarina is less than 12 hours, then the contraceptive effect remains and in this case the missed pill should be taken immediately. The following is accepted according to the standard mode.
In the first seven days, the contraceptive effect is not guaranteed, so it is recommended to take barrier methods of contraception in parallel.
It is allowed to skip a dose with a break of no more than a week.
If vomiting or diarrhea occurs after taking the tablets, absorption may be incomplete and additional contraceptive measures should be used. If vomiting occurs within 3-4 hours after taking a tablet, it can be considered a missed tablet.
You can stop taking Yarina at any time. If a woman plans to become pregnant, she should stop taking the pills and wait until her menstruation.
If a woman wants to delay the onset of menstruation, she should reduce the next week's break by as many days as necessary.
Instructions for use of Yarina Plus tablets
The medication is taken orally, 1 piece at a time, with a small amount of clean water. Reception begins on the 1st day of the menstrual cycle. The instructions for Yarina Plus indicate the contents of 28 tablets. One pack is enough for a month. The next one begins after the previous one is completed. The instructions for use indicate that when using inactive pills, menstrual-like bleeding begins.
If vomiting or diarrhea occurs within 5 hours after taking the pill, the effectiveness of the contraceptive is reduced. In this case, the woman needs to do as described in the instructions for use. If a woman takes the next pill within the next 12 hours, there is no need to use additional methods of contraception.
How to switch from Yarina to Yarina Plus
The drugs are considered identical in concentration of active substances and the principle of effect on the body. When switching from "Yarina" to "Yarina Plus", tablets from the new pack are taken immediately after a week's break. The duration of the menstrual cycle and the degree of contraceptive effect remain the same. There should be no side effects as a result of the transition.
How to take Yarina Plus
Each tablet in a blister containing a contraceptive is marked. The numbers indicate the day of the cycle on which one or another pill should be taken. Violation of the application regimen leads to inhibition of the contraceptive effect. The next pack must be started even if menstruation has not occurred. In the instructions for use in this case, it is recommended to take a pregnancy test.
Attention! Menstruation while taking a contraceptive will always occur on the same day of the week.
Skipping the Yarina Plus tablet
If you miss a pill, take the next one as soon as possible. If less than 12 hours have passed since taking the previous pill, the contraceptive effect is completely preserved. An interval between doses of more than 12 hours indicates the need to use additional contraceptives.
Skipping a pill in the first week of use increases the likelihood of pregnancy. In this case, unprotected sexual intercourse is allowed only from next week. If your period does not come while using inactive pills, you should take a pregnancy test. If the result is negative, the next pack is accepted according to the previous scheme, even if the critical days have not arrived.
When you can not use protection with Yarina Plus
The contraceptive effect of the drug begins from the moment you take the first pill. When used correctly, it lasts throughout the entire cycle. The need to use barrier contraception appears in the following cases:
- skipping a pill;
- vomit;
- stool disorder;
- taking antibiotics or medications containing St. John's wort.
Is it possible to drink Yarina without a break?
There is no need to take a break between packs. But the previous version of the drug is used only with 7-day breaks. The exception is in cases of urgent need. These include situations in which the onset of menstruation is undesirable. A woman should first consult a gynecologist. It is highly not recommended to abuse this method of using the medication.
How long can you drink Yarina
The pills are taken for as long as the woman needs the contraceptive effect, but in accordance with the instructions. The period of continuous use can be several years. For medicinal purposes, the drug is prescribed for 3-6 months. In this case, it is possible to regulate the menstrual cycle and prepare the body for the upcoming conception.
How to stop drinking Yarina without consequences
Before stopping the drug, it is recommended to visit a gynecologist. Stopping treatment without finishing the packaging is strictly prohibited. This will lead to severe hormonal imbalance and related problems. But even correct refusal of the drug can provoke undesirable consequences. Instructions for use describe the following complications:
- relapses of gynecological diseases;
- multiple ovulation;
- decreased quality of skin and hair;
- development of unplanned pregnancy.
Some women claim that after taking it they got better. This happens due to hormonal changes. While taking the contraceptive, the ovaries were in a dormant state. After its cancellation, they began to work with redoubled force, which provoked weight gain.
To prevent withdrawal syndrome, withdrawal from the drug must be carried out under the supervision of specialists. It is advisable to undergo a comprehensive examination of all life support systems.
Overdose
To date, there have been no reports of overdose with Yarina. However, excessive use of pills may cause nausea, vomiting, and in some cases withdrawal bleeding.
There are no antidotes, and further treatment should be symptomatic, based on knowledge of the pharmacological action of the components. In case of overdose, patients should be monitored for signs of metabolic acidosis. Liver function tests, especially transaminase levels, should be performed 2-3 weeks after consumption.
Composition and release form
The medicine Yarina Plus is manufactured in the form of contraceptive pills with the concentration of active ingredients:
- Drospirenone - 3 mg;
- Ethinyl estradiol - 30 mcg;
- Calcium lefomefolate - 451 mcg.
The package contains 28 tablets: 21 are active contraceptives, and 7 are vitamin tablets.
The former are orange in color, and the latter are light orange. The role of the excipients belongs to :
- Single crystal cellulose;
- Lactose monohydrate;
- Hyprollose;
- Croscarmellose sodium;
- Magnesium stearate;
- To the dye.
special instructions
This medication should be used with extreme caution in patients with a history of liver disease due to an increased risk of serious side effects.
Yarina should be used with caution in patients with heart disease or patients who are susceptible to risk factors.
The tablets should be used with caution in patients with a history of breast cancer due to the increased risk of serious side effects.
Using this contraceptive may cause yellowing of the eyes and skin due to its effects on the liver and gallbladder. If this happens, you need to stop taking the medication and consult a doctor.
Yarina is not recommended for use in patients with a tumor caused by abnormal levels of estrogen in the body. The tumor may be endometrial or breast. Suitable diagnostic tests should be performed before starting treatment with this medication. Substitution with a suitable alternative may be necessary depending on the clinical condition.
Women with high blood pressure should take the pills with extreme caution. In such cases, the risk of adverse effects on the heart and blood vessels is extremely high. Depending on the clinical condition, close monitoring of cardiac function and vital signs and/or replacement with a suitable alternative may be required.
Yarina should be prescribed with extreme caution to patients with high levels of potassium in the blood. The risk of side effects in such cases is extremely high. Regular monitoring of potassium levels in the body is necessary while receiving this medication.
Yarina Plus
Use during pregnancy and breastfeeding
The drug is contraindicated during pregnancy.
If pregnancy is detected while taking Yarina® Plus, the drug should be discontinued immediately. Data on the results of using the drug Yarina® Plus during pregnancy are limited and do not allow us to draw any conclusions about the negative impact of the drug on pregnancy, the health of the fetus and newborn child. At the same time, extensive epidemiological studies have not revealed an increased risk of developmental defects in children born to women who took COCs before pregnancy or teratogenic effects in cases of inadvertent use of COCs in early pregnancy. Specific epidemiological studies have not been conducted on the drug Yarina® Plus. The drug is contraindicated during breastfeeding. Taking COCs can reduce the amount of breast milk and change its composition, so their use is not recommended until you stop breastfeeding. Small amounts of sex hormones and/or their metabolites can be excreted in breast milk, but there is no evidence of their negative effects on the health of the child.
Use for liver dysfunction
The drug is contraindicated for use in women with severe liver dysfunction.
Use for renal impairment
The drug is contraindicated for use in women with severe renal impairment and acute renal failure.
Use in children
It is assumed that the effectiveness and safety of the drug in post-pubertal age up to 18 years are similar to those in women after 18 years. The use of the drug is contraindicated until regular menstrual cycles have been established.
Use in elderly patients
The drug Yarina® Plus is not used after menopause.
special instructions
If any of the conditions, diseases and risk factors listed below currently exist, the potential risks and expected benefits of using Yarina® Plus should be carefully weighed in each individual case and discussed with the woman before she decides to start taking of this drug.
Diseases of the cardiovascular system
The results of epidemiological studies indicate a relationship between the use of COCs and an increased incidence of venous and arterial thrombosis and thromboembolism (such as deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular disorders) when using COCs. These diseases are rare.
The risk of developing venous thromboembolism (VTE) is greatest in the first year of using such drugs. An increased risk is present after initial use of a COC or resumption of use of the same or different COCs (after a dosing interval of 4 weeks or more). Data from a large prospective study involving 3 groups of patients suggest that this increased risk is predominantly present during the first 3 months.
The overall risk of VTE in patients taking low-dose COCs (<50 mcg ethinyl estradiol) is 2-3 times higher than in non-pregnant patients not taking COCs, although this risk remains lower than the risk of VTE during pregnancy and childbirth. .
VTE can be fatal (in 1-2% of cases).
VTE, manifested as deep vein thrombosis or pulmonary embolism, can occur with the use of any COC.
It is extremely rare when using COCs that thrombosis of other blood vessels occurs, for example, hepatic, mesenteric, renal, cerebral veins and arteries or retinal vessels. There is no consensus regarding the relationship between the occurrence of these events and the use of CCPs.
Symptoms of deep vein thrombosis (DVT): unilateral swelling of the lower extremity or along a vein of the lower extremity, pain or discomfort in the lower extremity only in an upright position or when walking, local increase in temperature in the affected lower extremity, redness or discoloration of the skin on the lower extremity.
Symptoms of pulmonary embolism (PE): difficulty or rapid breathing; sudden cough, incl. with hemoptysis; sharp pain in the chest, which may intensify with deep inspiration; sense of anxiety; severe dizziness; fast or irregular heartbeat. Some of these symptoms (eg, shortness of breath, cough) are nonspecific and may be misinterpreted as signs of other more or less severe events (eg, respiratory tract infection).
Arterial thromboembolism can lead to stroke, vascular occlusion, or myocardial infarction. Symptoms of a stroke: sudden weakness or loss of sensation in the face, upper or lower extremities, especially on one side of the body; sudden confusion, problems with speech and understanding; sudden unilateral or bilateral vision loss; sudden disturbance in gait, dizziness, loss of balance or coordination; sudden, severe or prolonged headache for no apparent reason; loss of consciousness or fainting with or without an epileptic seizure. Other signs of vascular occlusion: sudden pain, swelling and slight blue discoloration of the extremities, acute abdomen.
Symptoms of myocardial infarction: pain, discomfort, pressure, heaviness, a feeling of squeezing or fullness in the chest, arm or chest; discomfort radiating to the back, cheekbone, larynx, arm, stomach; cold sweat, nausea, vomiting or dizziness, severe weakness, anxiety or shortness of breath; fast or irregular heartbeat.
Arterial thromboembolism can be life-threatening or fatal.
In women with a combination of several risk factors or high severity of one of them (for example, complicated heart valve diseases, uncontrolled arterial hypertension, extensive surgical interventions with prolonged immobilization), the possibility of their mutual strengthening should be considered. In such cases, the total value of the existing risk factors increases. In this case, the use of Yarina® Plus is contraindicated.
The risk of developing thrombosis (venous and/or arterial) and thromboembolism increases:
- with age;
- in smokers (with increasing number of cigarettes or increasing age, the risk increases, especially in women over 35 years of age);
in the presence of:
- obesity (BMI more than 30 kg/m2);
- family history (for example, venous or arterial thromboembolism ever in close relatives or parents at a relatively young age). In the case of a hereditary or acquired predisposition, the woman should be referred to a specialist to decide on the possibility of using the drug Yarina® Plus;
- prolonged immobilization, major surgery, any operation on the lower extremities or major trauma. In these situations, it is advisable to stop using the drug Yarina® Plus (in the case of a planned operation, at least 4 weeks before it) and not to resume taking it for 2 weeks after the end of immobilization;
- dyslipoproteinemia;
- arterial hypertension;
- migraine;
- heart valve diseases;
- atrial fibrillation.
The possible role of varicose veins and superficial thrombophlebitis in the development of venous thromboembolism remains controversial.
The increased risk of thromboembolism in the postpartum period should be taken into account.
Peripheral circulatory disorders may also occur in diabetes mellitus, systemic lupus erythematosus, hemolytic uremic syndrome, chronic inflammatory bowel disease (Crohn's disease or UC), and sickle cell anemia.
An increase in the frequency and severity of migraine during use of Yarina® Plus (which may precede cerebrovascular events) may be grounds for immediate discontinuation of this drug.
Biochemical indicators indicating a hereditary or acquired predisposition to venous or arterial thrombosis include the following: resistance to activated protein C, hyperhomocysteinemia, antithrombin III deficiency, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant).
When assessing the risk-benefit ratio, it should be taken into account that adequate treatment of the relevant condition can reduce the associated risk of thrombosis. It should also be taken into account that the risk of thrombosis and thromboembolism during pregnancy is higher than when taking low-dose oral contraceptives (<50 mcg ethinyl estradiol).
Tumors
The most significant risk factor for developing cervical cancer is persistent human papillomavirus infection. There are reports of a slight increase in the risk of developing cervical cancer with long-term use of COCs. However, the connection with taking COCs has not been proven. The possibility of the relationship of these data with screening for cervical diseases and with characteristics of sexual behavior (less frequent use of barrier methods of contraception) is discussed.
A meta-analysis of 54 epidemiological studies showed that there is a slightly increased relative risk of developing breast cancer diagnosed in women currently taking COCs (relative risk 1.24). The increased risk gradually disappears within 10 years of stopping these drugs. Because breast cancer is rare in women under 40 years of age, the increase in breast cancer diagnoses in women who are currently or recently taking COCs is small relative to the overall risk of breast cancer. Its connection with the use of CCP has not been proven. The observed increased risk may be a consequence of careful monitoring and earlier diagnosis of breast cancer in women using COCs. Women who have ever used COCs are diagnosed with earlier stages of breast cancer than women who have never used them.
In rare cases, during the use of COCs, the development of benign, and in extremely rare cases, malignant liver tumors was observed, which in some patients led to life-threatening intra-abdominal bleeding.
If severe abdominal pain, liver enlargement, or signs of intra-abdominal bleeding occur, this should be taken into account when making a differential diagnosis.
Other states
Clinical studies have shown no effect of drospirenone on plasma potassium concentrations in patients with mild to moderate renal failure. However, in patients with impaired renal function and an initial potassium concentration at the upper limit of normal, the risk of developing hyperkalemia cannot be excluded while taking medications that lead to potassium retention in the body.
Women with hypertriglyceridemia (or a family history of this condition) may have an increased risk of developing pancreatitis while taking COCs.
Although slight increases in blood pressure have been described in many women taking COCs, clinically significant increases have rarely been observed. However, if a persistent, clinically significant increase in blood pressure develops while using Yarina® Plus, this drug should be discontinued and treatment of arterial hypertension should be started. The drug can be continued if normal blood pressure values are achieved with antihypertensive therapy.
The following conditions have been reported to develop or worsen during both pregnancy and COC use, but their association with COC use has not been proven: jaundice and/or pruritus associated with cholestasis; formation of gallstones; porphyria; systemic lupus erythematosus: hemolytic-uremic syndrome; Sydenham's chorea; herpes during pregnancy; hearing loss associated with otosclerosis. Cases of Crohn's disease and ulcerative colitis have also been described with the use of COCs.
In women with hereditary forms of angioedema, exogenous estrogens may cause or worsen symptoms of angioedema.
Acute or chronic liver dysfunction may require discontinuation of Yarina® Plus until liver function tests return to normal. Recurrent cholestatic jaundice, which develops for the first time during pregnancy or during a previous intake of sex hormones, requires discontinuation of the drug Yarina® Plus.
Although COCs may have an effect on insulin resistance and glucose tolerance, there is no need to change the therapeutic regimen in diabetic patients using Yarina® Plus. However, women with diabetes should be closely monitored while using this drug.
Chloasma can sometimes develop, especially in women with a history of chloasma during pregnancy. Women with a tendency to chloasma while taking Yarina® Plus should avoid prolonged exposure to the sun and exposure to ultraviolet radiation.
Folates may mask vitamin B12 deficiency.
Preclinical safety data
Preclinical data from routine repeated-dose toxicity, genotoxicity, carcinogenicity and reproductive toxicity studies do not indicate a particular risk to humans. However, it should be remembered that sex hormones can promote the growth of certain hormone-dependent tissues and tumors.
Laboratory tests
Taking Yarina® Plus may affect the results of some laboratory tests, including indicators of liver, kidney, thyroid, adrenal function, the concentration of transport proteins in plasma, indicators of carbohydrate metabolism, parameters of blood coagulation and fibrinolysis. Changes usually do not go beyond normal values. Drospirenone increases plasma renin activity and aldosterone concentrations, which is associated with its antimineralocorticoid effect.
There is a theoretical possibility of increasing the concentration of potassium in the blood plasma in women receiving Yarina® Plus simultaneously with other drugs that can increase the content of potassium in the blood plasma. These drugs include angiotensin II receptor antagonists, potassium-sparing diuretics, and aldosterone antagonists. However, in studies evaluating the interaction of drospirenone with ACE inhibitors or indomethacin, there was no significant difference in plasma potassium concentrations compared with placebo.
Reduced efficiency
The effectiveness of Yarina® Plus may be reduced in the following cases: if you miss pills, with gastrointestinal disorders or as a result of drug interactions.
Frequency and severity of menstrual-like bleeding
While using the drug Yarina® Plus, irregular (acyclic) spotting and bleeding from the vagina (spotting or breakthrough uterine bleeding) may occur, especially during the first months of use. Therefore, any irregular bleeding should be assessed after an adaptation period of approximately 3 cycles.
If irregular bleeding recurs or develops after previous regular cycles, careful evaluation should be performed to rule out malignancy or pregnancy.
Some women may not develop withdrawal bleeding during a pill-free break. If Yarina® Plus was taken as recommended, it is unlikely that the woman is pregnant. However, if the drug Yarina® Plus is not used regularly and there are no two withdrawal bleedings in a row, the drug cannot be continued until pregnancy has been ruled out.
Medical examinations
Before starting or resuming use of the drug, it is necessary to familiarize yourself with the woman’s life history, family history, conduct a thorough physical examination (including measuring blood pressure, heart rate, determining BMI, examining the mammary glands), gynecological examination, cytological examination of the cervix (Papanicolaou test), and exclude pregnancy. . When resuming taking the drug Yarina® Plus, the volume of additional studies and the frequency of control examinations are determined individually, but at least once every 6 months.
The woman should be warned that Yarina® Plus does not protect against HIV infection and other sexually transmitted diseases.
Impact on the ability to drive vehicles and operate machinery
There have been no reported cases of adverse effects of the drug Yarina® Plus on the speed of psychomotor reactions; No studies have been conducted to study the effect of the drug on the speed of psychomotor reactions.
