I didn’t finish Yarina, my period began. Yarina (Yarina plus) and menstruation

Modern oral contraceptives are one of the most reliable ways to prevent pregnancy. Like any medicine, pharmacists constantly refine and improve them. Each new generation of contraceptives is becoming more effective and safer for health. Today, such a tool is Yarina. The drug not only excludes the possibility of conception, but at the same time has a beneficial effect on the nature of menstruation. But despite the popularity of the contraceptive and active use, it may not be clear to all women how Yarina and menstruation are related, what the features may be during and after the course of administration.

How does it affect menstruation

The drug to prevent pregnancy is recommended for women with a regular cycle who do not have gynecological problems. Its main task, like another similar remedy, is to ensure that the female reproductive system functions as if ovulation has already happened. Thanks to the mechanisms that trigger the active substances of Yarina, the maturation of the egg is blocked, it does not separate, and, accordingly, conception does not occur.

Many women note that Yarina has a positive effect on menstruation: the associated pain disappears, the abundance of bleeding decreases, their duration is reduced, which prevents the occurrence of iron deficiency anemia and further complications. Therefore, for women with severe manifestations of MC, gynecologists can prescribe a Yarina course for therapeutic purposes to change its quality.

In addition, the drug has a beneficial effect on well-being and appearance: it reduces the fluid content in the body, which relieves swelling, counteracts weight gain. Plus, the contraceptive is that it has an antiandrogenic property: it regulates the work of the sebaceous glands, which has a positive effect on the condition of the skin and hair - acne is eliminated, the manifestation of seborrhea is reduced.

In patients who have not previously taken pills, there are mild intermenstrual discharge. This usually happens in the first months of taking, and then disappear. But just in case, you should still see your gynecologist in order to prevent undesirable consequences.

While taking the contraceptive, irregular spotting or breakthrough bleeding may occur. This usually happens at the beginning of the course, and after a while they disappear as the body gets used to Yarina. Therefore, it is advisable to evaluate their character only after the end of the adaptation period - usually this happens three months after the start of the course.

If menstrual-like bleeding continues or they occur after previously regular cycles, then it will be necessary to be examined to exclude pregnancy (which is hardly possible under the conditions of admission) or oncological pathologies.

• Why there is no menstruation after Yarina

If OK was taken according to all the rules: without gaps, with taking an additional pill after vomiting or diarrhea, then conception is hardly possible. But if the bleeding lasts for two cycles, then it is better to protect yourself - visit a gynecologist and find out the cause. In this case, Yarina is not taken until there is reliable evidence of the absence of pregnancy.

It also happens that the problem lies in the reaction of the reproductive system to the constituent components of the contraceptive. In this case, you will need to interrupt the reception in order to induce menstruation after the cancellation of Yarina. The irritant will be eliminated and the cycle will be restored.

How to drink the drug

To achieve a guaranteed effect of the pill, you need to drink one tablet every day, without skipping, for 21 days and always at the same time. After the tablets in the blister run out, you will need to take a seven-day break from taking. During such a respite, menstrual-like bleeding should occur. This usually happens on the 2nd or 3rd day of the break. A week later, they resume taking the pills from the next blister.

A woman who was first prescribed Yarina, and before that no oral contraceptives were used, can start the course on the first day of monthly bleeding. A delay of up to 2-5 days of menstruation is allowed, but then, if a woman is sexually active, she is recommended to insure herself with other means of protection in the first week of taking Yarina.

If, before the appointment, the woman used any OK, then it is allowed to start the course with Yarina's tablets on the next day after the completion (or cancellation) of the previous one.

If protective equipment such as an intrauterine ring, a spiral and other similar medical devices were used, then they go to Yarina on the day they are removed.

What to do in case of skipping Yarina

It happens that a woman forgot or could not, for some reason, take a pill on time. If less than 12 hours have passed since the last procedure, then she should make up for the omission as soon as possible. Moreover, if the forgotten pill coincides with the next pill (according to the established schedule), she will have to drink two at once.

If a woman realizes herself much later, and more than 12 hours have passed, then the contraceptive protection weakens, and she will have to use other means of protection within a week after the resumption of the course.

If less than 4 hours have passed since the ingestion, and the woman has developed vomiting or diarrhea, then the active substances will not have time to be absorbed, their concentration will decrease, which will negatively affect the contraceptive effect. To make up for the lack, you need to drink another pill of Yarina.

If the trouble happened towards the end of the course, and the contents of the blister are over, the pill is taken from a new plate. And after a 21-day course, a weekly interval is observed.

How to drink pills after an abortion or miscarriage

It all depends on the period at which the abortion happened. If this happened for a short period (in the first three months of gestation), then the pills begin to be drunk immediately - on the day of the abortion. In this case, the need for additional barrier means is eliminated.

If a woman decides to use protection after childbirth or an interruption occurs in the second term of pregnancy, then the pills begin to be drunk after 3-4 weeks. If you take it later, you will need to use condoms for a week after the first pill you take. But if during these 3-4 weeks there were unprotected sex, you will either have to wait for your period, or get checked by a doctor to make sure that you are not pregnant.

How to change the beginning of the MC with pills

With the help of Yarin, a woman can change the day of the onset of menstruation. To delay them, they do not observe a week break, but continue to take the drug from the next package immediately after the end of the previous one. Moreover, it is allowed to drink the remedy until the second pack is over, and if necessary, interrupt the course when necessary. Then the bleeding will start. If a woman continuously takes Yarina, then during the second cycle of administration, spotting or scanty bleeding may occur.

When interrupting the course, you will need to observe a weekly interval and then continue to drink Yarina as usual.

When a woman needs to shift the usual schedule of the MC, she can independently postpone it for as many days as she wishes. To do this, you need to reduce the weekly break by this number of days. Moreover, the more the interval is reduced, the less likely the onset of menstruation during this period. That is, if the break is less than three days, then bleeding may not occur, but appear during the next cycle.

• Delay after the cancellation of Yarina

Refusal of a contraceptive can provoke a failure in the MC in the form of a lack of menstruation on time. You should not panic right away, since the delay can be caused by a restructuring of the body after the cancellation of an external source of hormones. It will take him some time to return to their independent development. How many days or weeks this will take depends only on the individual characteristics of the female body. But if the period of absence is delayed, you will need to visit your gynecologist to understand the reason for what is happening.

Possible side effects during the course of Yarina

The drug is not in vain considered one of the most effective: in addition to a strong effect, it is very well tolerated. However, the possibility of side effects cannot be ruled out. Therefore, a woman needs to be prepared that the body will react negatively to the pills. The most common complaints include nausea and vomiting, discomfort in the chest - soreness and tension. Unwanted states are also in the form:

• Frequent mood swings, depression, loss of libido
• Headaches
• Migraines
• Thromboembolism of arteries or veins
• Bleeding of unknown origin
• Acne, skin rashes.

In addition to these side effects, other negative manifestations are possible. Thus, there is evidence that after OK, tumors of the mammary gland or liver are more often diagnosed. In addition, other undesirable actions of Yarina are not excluded:

• The occurrence of erythema nodosum
• Hypertension
• pancreatitis
• Angioedema
• Impaired glucose tolerance
• Liver or kidney disorders
• Pigmentation on the face.

If you feel unwell and have uncharacteristic symptoms, it is better to consult a doctor. It is possible that Yarina simply does not fit, and the drug will have to be replaced with a similar remedy. But it may turn out that the contraceptive has nothing to do with it, and the negative symptoms simply coincided with the time of the course. Then you need to find out what affected your health, and eliminate the cause of the malaise.

Who is not allowed to take contraceptives

You can take a contraceptive for women who do not have health problems. Therefore, before you start taking Yarina, you will need to undergo an examination. The reason for the prohibition of contraception may be:

• Current presence of thrombosis or conditions preceding it, predisposition to it (including mention in anamnesis)
• Migraines (at the time of appointment or in the past)
• Complications of blood vessels in diabetes mellitus
• pancreatitis
• Pathologies of the liver or violations of its work, tumors of the organ
• The presence of hormone-dependent neoplasms
• Pregnancy (confirmed or possible), GV
• Individual susceptibility of OK components.

When you need an ambulance

When taking Yarina, like any drug, unforeseen reactions of the body can occur. Therefore, you should not hesitate to get medical help if a woman has symptoms:

• Chest pain radiating to left arm
• Unexplained bout of severe coughing, dyspnea
• Unnaturally severe head pain
• Acute hearing/vision impairment, diplopia
• Speech dysfunction
• Disorder of smell, taste
• Fainting
• Numbness of body parts
• Pain and swelling in the legs.

With such symptoms, an ambulance should be called immediately to prevent tragic consequences.

Yarina's modern contraceptive is of higher quality than other predecessors. The drug not only protects women from unnecessary pregnancy, but also has a positive effect on the monthly cycle: it normalizes and eliminates painful syndromes. But in order for Yarina to help, all the conditions for admission must be observed.

Yarina is a monophasic oral contraceptive. This means that all tablets in a package contain the same dose of hormones. One tablet of Yarina contains 30 micrograms (0.03 mg) of Ethinylestradiol and 3 mg of Drospirenone.

One package contains one blister (plate) of Yarina to be taken within one month.

WARNING: The drug has contraindications. Do not start using this drug without first talking to your doctor.

Analogues

What reduces the contraceptive effect of Yarina?

The contraceptive effect of Yarina can be reduced by vomiting, diarrhea, taking large doses of alcohol, and taking certain medications. Read more about it here:

How to delay menstruation with Yarin?

If you need to delay your period, then after finishing one pack of Yarin the next day, start a new blister without taking a 7-day break. In this case, menstruation will be delayed by 2-4 weeks, but there may be slight bloody spotting around the middle of the next package.

Please note: you can postpone your period only if you took Yarin at least one month before unwanted menstruation.

Do I need to take long breaks while taking Yarina?

If you have been taking Yarina for more than 6-12 months, you may want to consider taking a break for a few months. You can read about how useful such breaks are by clicking on the link:

What to do if there is no menstruation during the 7-day break in taking Yarin?

Carefully remember whether you took all the pills correctly in the past month.

If last month you had errors in taking the pills (misses, delays), then stop taking Yarin's pills until you are sure that you are not pregnant.

What should I do if I become pregnant while taking Yarina?

Pregnancy in the case of proper administration of Yarin tablets is extremely rare. It is more likely that the pregnancy came as a result of the errors that you made in the previous month.

So, what to do if the test unexpectedly showed 2 strips? First of all, stop taking the pills and consult a gynecologist.

Taking Yarina in the early stages of pregnancy cannot harm the health of your unborn child, so you can safely leave the pregnancy. In this case, start taking as soon as possible.

Yarina's reception before surgery

If you have a planned operation, then taking Yarin tablets should be stopped a month (4 weeks) before surgery. This will reduce the risk of blood clots in the vessels. If the operation is required urgently, then be sure to tell the surgeon that you are taking birth control pills. In this case, the doctor will take additional measures to prevent the formation of blood clots (with the help of drugs).

You will be able to start taking Yarin 2 weeks after you can walk on your own after surgery.

How often do you need to visit a gynecologist while taking Yarin?

Even if nothing bothers you, then you need to visit a gynecologist prophylactically at least once a year.

Content

To prevent unwanted pregnancy, Yarina Plus can be an effective remedy - the instructions for use prescribe for women to take it for the purpose of contraception or the treatment of hormonal disorders. It is necessary to drink these tablets every day, adhering to the exact scheme. Otherwise, the effectiveness of the drug may be lost.

What is Yarina Plus

The drug Yarina Plus is a monophasic contraceptive drug intended for oral use. Taking the medication helps prevent unwanted pregnancy, improve the condition of a woman with various hormonal disorders. The active substances of the drug can cause significant harm to health, so its use should not be started without a doctor's recommendation.

Compound

Blister Yarina Plus contains active and auxiliary tablets. The main active ingredient of vitamin pills is micronized calcium levomefolate. In the instructions for use, the composition of the first type of pills is represented by the following substances:

• ethinylestradiol;
• drospirenone;
• calcium levomefolate;
• lactose monohydrate:
• microcrystalline cellulose;
• magnesium stearate;
• sodium croscarmellose;
• hyprolose.

Release form

The drug Yarina Plus is released in the form of tablets of two types. Active combination pills are round and orange in color. Each blister contains 21 pieces of such dragees. Vitamin pills have a light orange color, rounded shape. The blister contains 7 such dragees. Records are packaged inside cardboard boxes along with special stickers that help form the appointment calendar.

pharmachologic effect

According to its properties, Yarina is a combination drug that performs a contraceptive function. The mechanism of its action is to stop the process of ovulation, increase the viscosity of the secretion of the cervix. Taking oral contraceptives helps to establish the regularity of menstruation, prevents the occurrence of non-cyclic bleeding, and reduces the risk of ovarian and endometrial cancer.

Yarina Plus helps to reduce the profusion, soreness and duration of menstruation. This factor helps to reduce the risk of developing anemia. One of the components of the composition of the drug is drospirenone, which reduces the likelihood of peripheral edema, fights acne, regulates oily hair and skin, and eliminates seborrhea.

With the correct use of the substance, the Pearl index is very low, but it can increase if you miss a dose. Absorption of the substance occurs after 1-2 hours, food does not affect its bioavailability. Metabolism is intense, the concentration of drospirenone inside the blood plasma has two phases of decline. The decay products are excreted by the kidneys and organs of the gastrointestinal tract.

The presence of calcium levomefolate (a biologically active form of folic acid) helps to meet the need for folate, if the patient's history indicates their insufficient concentration in the blood plasma. If a woman becomes pregnant immediately after stopping taking the contraceptive, this substance will help reduce the risk of neural tube defects in the unborn child. The excretion of the component occurs through the kidneys and intestines.

Indications for use

The contraceptive drug Yarina is prescribed by a doctor based on the results of the necessary studies. The tool has the following indications:

• contraception, treatment of moderate acne;
• contraception for women who have signs of hormone-dependent fluid retention;
• contraception intended for the fair sex with a deficiency of folates (folic acid derivatives).

Instructions for use

The correct use of Yarin Plus helps to achieve the desired effect - the attached instructions for use prescribe to take the tablets orally inside with water. Every day at the same time, you need to swallow one pill in the order indicated on the package. The pack contains active and auxiliary tablets. On the 2-3 day of taking inactive pills, bleeding may occur. An important rule on how to take Yarina Plus is the condition that the tablets from the next pack should be started immediately after the completion of the previous one.

When to start drinking Yarina

An important aspect of how to drink Yarina Plus is the correct time to start using. If the patient has not used contraceptives containing hormones in the past month, the first tablet of the drug should be taken on the 1st day of the menstrual cycle. When Yarina Plus begins to act, there is no need to supplement protection with barrier methods of contraception. The effect comes immediately. It is permissible to start taking the medicine on the 2-5th day of the onset of menstruation. In this case, you will need to use barrier contraceptives for a period of 7 days.

drug interaction

Combining the Yarina contraceptive with hypnotics, St. John's wort, Rifampicin, Carbamazepine, Griseofulvin, it is necessary to additionally use barrier methods of protection. These drugs increase the clearance of hormones by accelerating the induction of liver enzymes. HIV and hepatitis C protease inhibitors can have a clinically significant effect on the concentration of estrogen and progesterone, so these drugs are not recommended to be used simultaneously with Yarina Plus.

Most antibiotics are able to reduce the level of ethinyl estradiol. If antibacterial drugs are used together with a contraceptive, additional external methods to prevent unwanted pregnancy should be used. Such measures are required during the course of antibiotics and for a week after the completion of treatment. Yarina can affect the metabolism of antiepileptic drugs, so their combined use is not recommended.

Side effects

If contraindications are ignored or the drug is used incorrectly, side effects may occur that affect the body systems. Such consequences are manifested by the following symptoms:

• The immune system reacts with an allergy.
• On the part of the nervous system and mental health, migraines, headaches, changes in the strength of sexual desire, and frequent mood swings can be detected.
• The effect on the heart and blood vessels is manifested in the form of a decrease or increase in blood pressure, in rare cases - thromboembolism.
• On the part of the digestive tract, fluid retention in the body, a sharp change in body weight, nausea, diarrhea, vomiting, and abdominal pain can be observed.
• On the mammary glands and genitals of a woman, taking the medicine may be affected by the appearance of vaginal discharge (leucorrhoea), pain in the chest area, its enlargement, absence or pain of menstrual-like bleeding, and bleeding outside the cycle.
• From the side of the skin, the following consequences appear: urticaria, erythema multiforme and nodosum, acne, itching, eczema.
• A side effect for the respiratory system is the development of bronchial asthma.
• The defeat of the sensory organs is expressed in hypoacusia, allergy to contact lenses.

Severe side effects have been observed in women taking these combined contraceptives. The use of the drug can provoke such consequences:

• arterial and venous thromboembolic disorders;
• hyperkalemia;
• change in the process of glucose uptake;
• impaired liver function, cholestasis, jaundice;
• angioedema;
• hypertriglyceridemia.

Overdose

When taking a large amount of COC Yarin, an overdose may occur. In this regard, the patient has several symptoms: vomiting, nausea, metrorrhagia, spotting from the vagina. However, the levomefolate contained in the calcium preparation, according to the instructions for use, is in most cases well tolerated by the female body. There is no single antidote that can help with an overdose. Patients are shown symptomatic therapy.

Contraindications

The use of contraceptives can have a strong effect on the body. Therefore, some categories of women should not use Yarina Plus - the instructions for use establish the following contraindications:

• hypersensitivity to the components of the drug;
• pre-thrombotic conditions (ischemia, angina pectoris);
• migraines accompanied by neurological symptoms;
• hereditary or acquired predisposition to the formation of venous or arterial thrombi (deficiency of protein C, S, antithrombin), cerebrovasculitis, damage to the walls of blood vessels with a violation of their integrity, thromboembolism;
• hepatitis, liver failure;
• tumors of undiagnosed etiology, hormone-dependent neoplasms;
• pregnancy and lactation;
• severe or acute failure of kidney function;
• pancreatitis;
• diabetes mellitus with vascular complications;
• neoplasms of the liver;
• bleeding from the vagina of unknown origin.

special instructions

The instruction indicates that the use of Yarina increases the risk of deep vein thrombosis of the lower extremities. Arterial thromboembolism can lead to stroke, myocardial infarction. If the patient has prolonged, intense and frequent migraines, the use of the drug should be stopped immediately. Against the background of the use of the drug, hyperkalemia may occur. This reaction is typical for women with impaired kidney function and high levels of potassium inside the body.

If a persistent increase in blood pressure is noted during the use of the drug, the use of the drug should be discontinued. You can resume use if the indicators return to normal under the influence of hypertension therapy. Pancreatitis may occur in patients suffering from hypertriglyceridemia. A decrease in the effectiveness of the drug can occur if the instructions for use are violated, against the background of drug interactions, the appearance of vomiting and diarrhea.

During the period of use of the contraceptive, non-cyclic vaginal bleeding is possible. The doctors will evaluate the discharge after the completion of the adaptation period, which is 3 cycles. Before prescribing the remedy, specialists collect the patient's history, conduct a gynecological examination, a cytological examination of the cervix, and exclude pregnancy.

Pregnancy and lactation

According to the instructions, Yarina Plus tablets should not be used during pregnancy and breastfeeding. If conception occurred during the use of the drug, its urgent cancellation is necessary. Specific studies that reveal the negative effect of the drug on the process of bearing the fetus and its health have not been conducted. During lactation, contraceptives cannot be used. Its use can lead to a decrease in the amount of milk in the mother, a change in its composition. In the process of lactation, sex hormones can penetrate the child's body and affect his health.

Use in the elderly

According to the instructions for use, the drug is not used in the elderly after menopause. This is explained by the fact that during this period of life, women do not have the indications necessary for prescribing the medicine. In addition, in old age, the risk of developing side effects of the drug from the cardiovascular system of patients increases.

Application in childhood

The instruction prescribes that it is possible to start using Yarin's drug from the moment a regular menstrual cycle is established. If menstruation has not yet come or the duration of the breaks between them varies, the use of tablets is contraindicated. The combined contraceptive demonstrates the same effectiveness when taken by women over 18 years of age and girls who are in the post-pubertal period until adulthood.

Analogues

The drug Yarina Plus has several medications that are similar in composition and action. Medicines of the COC group are prescribed to prevent unwanted pregnancy. You can buy them only with a doctor's prescription. Yarina's analogues include the following drugs:

• Jess Plus;
• Midian;
• Vidora Micro;
• Modell Pro;
• Diecyclene;
• Gestarella;
• Bonade.

Yarina or Yarina Plus

The drug Yarina and its modified version Plus belong to the group of oral contraceptives. Medicines have a similar composition - their active ingredients are ethinylestradiol and drospirenone at a concentration of 30 μg and 3 μg. However, there are differences between the means. Yarina Plus additionally contains calcium levomefolate. The modified version is preferred for folic acid deficient women.

Price

You can buy Yarina Plus at a pharmacy or buy it in an online store by ordering from a catalog. In the second case, the medicine will cost less, but the cost of delivery should be taken into account. You can compare drug prices using the table:

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.

One of the most common side effects while taking contraceptives is the appearance of bleeding at the wrong phase of the cycle. They can be released in different volumes and have a different consistency, ranging from liquid and translucent to dark blood clots.

pharmachologic effect
Contraceptive and estrogen-gestagenic action.

Yarina tablets are no exception: every third woman taking this low-dose drug has experienced unusual bleeding in the middle or end of the cycle. In what situations is this symptom normal, and when should you sound the alarm?

Why does spotting occur?

Spotting discharge with blood impurities, which in everyday life is often called "daub", occurs in about half of women taking oral contraceptives. Most of them forget about this problem after one or two months, but in some cases, these discharges can remain for six months or more. The appearance of spotting bleeding is associated with the amount of hormones in a woman's body, and it is quite natural during the period of adaptation.

Throughout the menstrual cycle, estrogen levels are constantly in motion, rising in the initial phase and falling in the middle. Unlike the natural level of estrogen in the blood, its amount in modern oral contraceptives is constant and low throughout the entire cycle. Since the body believes that there is not enough estrogen, it begins the process of rejection of the endometrium ahead of time - hence the pink, bloody or brown discharge.

Allocations of this type can not only “smear”: sometimes they resemble ordinary menstruation, scanty and quickly ending. Regardless of the consistency, bleeding during adaptation to the drug cannot be too profuse, and also does not last longer than two or three days.

Most often, spotting bleeding occurs while taking microdosed drugs, such as Jess, Novinet, Mercilon and others. These contraceptives contain the lowest dose of estrogen, and sometimes the body may consider their amount insufficient even after the adaptation period is over. Low-dose drugs with a higher dose of estrogen are less likely to show this effect, so many women while taking Yarina may not notice spotting in themselves.

When else is spotting normal?

Uncharacteristic bleeding while taking oral contraceptives can speak not only about the adaptation of the body to a new level of estrogen. There are a number of other normal causes for spotting bleeding that don't require you to see a doctor!

At the start of a new package

When the break or placebo pill ends and the cycle starts again, the body can get rid of unnecessary endometrium for a few more days. After menstrual bleeding, part of the discharge may remain in the uterus, and leave it a little later: this phenomenon explains the bleeding two to three days after the end of menstruation.

During ovulation

Toward the middle of a pack of birth control pills, when ovulation should begin in the body, various types of bleeding may appear. In this phase of the cycle, the body requires the highest level of estrogen, and its lack can lead to premature rejection of the endometrium. It can be spotting or regular bleeding that resembles menstruation, but regardless of consistency, it never lasts longer than three days and is never too heavy.

With no break between packs

Birth control pills can be taken continuously to avoid menstruation at an inconvenient moment. Many women adjust their cycles in this way, removing periods from their schedule during vacations or important holidays. However, often with this administration of the drug, spotting, bloody or brown, occurs.

Such an effect can manifest itself both when taking Yarina, and while taking any other oral contraceptive: the specific drug is not important, this reaction depends on the body of a particular woman who is not ready to continue the cycle. This symptom can ruin a woman's plans, but it is not dangerous.

When is spotting dangerous?

In addition to natural, there are also pathological causes of bleeding while taking Yarina and other contraceptives. Some of them may not be dangerous to health, but they create the risk of unwanted pregnancy and even hormonal failure.

What could be the cause of pathological bleeding when taking OK?

Inappropriate drug

The most common cause of abnormal spotting is the wrong drug. If a woman has been taking pills for more than six months, but the unpleasant symptom has not disappeared, most likely, the dosage of the hormone in this remedy is not suitable for her, and a new contraceptive must be selected. Depending on the phase in which the spotting appears, the cause may lie in different hormones: discharge at the beginning of the cycle indicates a lack of estrogen, and at the end - a lack of progestogen in the body.

Decreased contraceptive effect

Bloody discharge when taking Yarina, which occurs at the wrong phase of the cycle, may indicate an insufficient level of contraception. Most often, it decreases due to missing pills: if a day or more has passed since the required moment of administration, and the pill has not been drunk, brown spotting bleeding may begin. If this symptom occurs, it is necessary to take care of additional contraception before starting a new cycle.

Also, the intake of alcohol and certain drugs can reduce the contraceptive effect, a complete list of which can be found in the instructions for oral contraceptives.

Disease

The appearance of bleeding while taking oral contraceptives may not be related to the drug in any way: often spotting occurs for completely different reasons associated with various diseases. The case may be in endometriosis, uterine fibroids, inflammatory and infectious diseases of various origins. Any of these diseases are accompanied by additional symptoms: pain in the lower abdomen, burning, itching, or an unpleasant odor.

Pregnancy

If you start spotting in the middle of your cycle, but you don't have menstrual-like bleeding at the right time, the cause may be early in your pregnancy. In addition to the absence of menstruation, this condition is characterized by swelling and pain in the chest, increased drowsiness, nausea, and general weakness. Taking oral contraceptives during pregnancy is very dangerous, so if you suspect that it could still come, you should do a test as soon as possible.

Most often, spotting while taking Yarina and other OKs is a completely natural phenomenon for the female body. But, if you suspect a pathological cause, immediately consult a gynecologist: you can’t joke with the health of the reproductive system.

Film-coated tablets in a blister pack, two types:

• Active tablets are orange, round, biconvex, on one side embossed with "Y +" in a regular hexagon (21 pcs. in a blister). Active ingredient: 1 tablet contains ethinylestradiol (micronized, in the form of betadex clathrate) - 30 mcg, drospirenone (micronized) - 3 mg, calcium levomefolate (micronized) - 451 mcg. Excipients: lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hyprolose, magnesium stearate.
• Auxiliary (vitamin) tablets are light orange in color, round, biconvex, on one side with "M +" embossed in a regular hexagon (7 pieces in a blister). Active ingredient: 1 tablet contains calcium levomefolate (micronized) - 451 mg. Excipients: lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hyprolose, magnesium stearate.

Pharmacological action

Yarina Plus is a low-dose monophasic oral combined estrogen-progestogen contraceptive product, including active tablets and supplementary vitamin tablets containing calcium levomefolate. The contraceptive effect of the drug Yarina Plus is mainly carried out by suppressing ovulation and increasing the viscosity of cervical mucus.

In women taking combined oral contraceptives (COCs), the cycle becomes more regular, the pain, intensity and duration of menstrual bleeding decrease, resulting in a reduced risk of iron deficiency anemia. There is also evidence of a reduced risk of endometrial and ovarian cancer.

Drospirenone, contained in Yarina Plus, has an antimineralocorticoid effect and helps prevent hormone-dependent fluid retention, which can manifest itself in weight loss and a decrease in the likelihood of peripheral edema. Drospirenone also has antiandrogenic activity and helps reduce acne (blackheads), oily skin and hair. This effect of drospirenone is similar to the action of natural progesterone produced in the female body. This should be taken into account when choosing a contraceptive, especially for women with hormone-dependent fluid retention, as well as women with acne and seborrhea. When used correctly, the Pearl Index (an indicator that reflects the number of pregnancies in 100 women using a contraceptive during the year) is less than 1. If pills are missed or used incorrectly, the Pearl Index may increase.

The acidic form of calcium levomefolate is structurally identical to natural L-5-methyltetrahydrofolate (L-5-methyl-THF), the main folate form found in food. The average plasma concentration in people who do not use food enriched with folic acid is about 15 nmol / l. Levomefolate, unlike folic acid, is a biologically active form of folate. Because of this, it is absorbed better than folic acid. Levomefolate is indicated to meet the increased need and ensure the necessary folate content in the body of a woman during pregnancy and lactation. The introduction of calcium levomefolate in the composition of an oral contraceptive drug reduces the risk of developing a neural tube defect of the fetus if a woman becomes pregnant unexpectedly, immediately after stopping the use of contraception (or, in very rare cases, when using oral contraception).

Indications for use

• contraception (primarily for women with symptoms of hormone-dependent fluid retention in the body);
• contraception and treatment of moderate acne (acne vulgaris);
• contraception in women with folate deficiency.

Dosage and administration

Take the tablets at about the same time every day, with water if necessary. Follow the direction of the arrows until you have taken all 28 pills. As a rule, menstruation begins 2-3 days after taking the last active tablet of Yarin Plus (that is, during the period when you will take the last 7 tablets from the last row of the package). Do not take a break between packs, i.e. Start taking a new pack of pills the day after you finish your current pack, even if your menstrual bleeding ("withdrawal" bleeding) has not yet ended. This means that you will always start a new pack on the same day of the week, and that the "withdrawal" bleeding will occur around the same dates each month.

Starting the drug

• When no hormonal birth control has been used in the previous month
  Start taking Yarin Plus on the first day of the cycle, that is, on the first day of menstrual bleeding. Take the pill labeled with the corresponding day of the week. Then take the tablets in order. Yarina Plus begins to act immediately, so there is no need to use additional barrier methods of contraception. Talk to your doctor if you are not sure when exactly to start taking the drug.
• When switching from other combined oral contraceptives
  You can start taking Yarin Plus the next day after you take the last pill from your current pack of hormonal contraceptives (this means that there will be no break in taking the pills). If your previous contraceptive also contains pills without active substances, you can start taking Yarin Plus the next day after taking the last active pill (if you have any doubts, ask your doctor about it). You can start taking later, but no later than the day following the planned 7-day break in taking the contraceptives you are currently using (or no later than the next day after taking the last inactive tablet from the package of contraceptives you are using).
• When switching from a vaginal ring or contraceptive patch
  If you have previously used a vaginal ring or transdermal patch, it is preferable to start on the day the ring/patch is removed, but no later than the day the ring/patch was scheduled to be replaced. If you follow these rules, there is no need for additional contraceptive measures.
• When switching from oral contraceptives containing only progestogen (mini-pill)
  You can stop taking the mini-pill any day and start taking Yarin Plus the next day, at the same time. During the first 7 days of taking the tablets, you must also use an additional barrier method of contraception (for example, a condom).
• When switching from an injectable contraceptive, an implant, or a progestogen-releasing intrauterine contraceptive (Mirena)
  Start taking Yarin Plus on the day when the next injection is due or on the day of removal of the implant or intrauterine contraceptive. During the first 7 days of taking the tablets, you must also use an additional barrier method of contraception.
• After childbirth
  If you have just had a baby, your doctor may recommend that you wait until the end of your first normal menstrual cycle before starting Yarin Plus. Sometimes, on the recommendation of a doctor, it is possible to start taking the drug earlier.
• After a spontaneous miscarriage or abortion in the first trimester of pregnancy
  Check with your doctor. It is usually recommended to start taking immediately.

Discontinuation of Yarin Plus

You can stop taking Yarina Plus at any time. If you are not planning a pregnancy, ask your doctor about other methods of contraception. If you want to get pregnant, stop taking Yarin Plus and wait for natural menstrual bleeding before trying to get pregnant. This will help you calculate your baby's expected date of birth.

Taking missed pills

If the delay in taking the next pill is less than 12 hours, the contraceptive effect of Yarina Plus is preserved. Take the pill as soon as you remember. Take the next tablet at the usual time. If the delay in taking the tablets was more than 12 hours, contraceptive protection may be reduced. The more pills missed in a row, and the closer this gap is to the start of the intake or to the end of the intake, the higher the risk of pregnancy. In this case, you can follow the following rules:

Forgotten more than one tablet from the package
Consult your doctor.

One tablet missed in the first week of taking the drug
Take the missed pill as soon as you remember (even if it means taking two pills at the same time). Take the next tablet at the usual time. Additionally, use a barrier method of contraception for the next 7 days. If sexual intercourse took place during the week before the pill was missed, the possibility of pregnancy should be considered. Talk to your doctor right away (see also Missed Pill Schedule).

One tablet missed in the second week of taking the drug
Take the missed pill as soon as you remember (even if it means taking two pills at the same time). Take the next tablet at the usual time. If you have taken your pills correctly in the 7 days preceding the first missed pill, the contraceptive effect of Yarina Plus is preserved and you do not need to use additional contraceptive measures. Otherwise, as well as if you miss two or more tablets, you must additionally use barrier methods of contraception for 7 days.

One tablet missed in the third week of taking the drug
If during the 7 days preceding the first missed tablet, all tablets were taken correctly, there is no need to use additional contraceptive methods. You can take either of the following two options without the need for additional contraceptive measures.

1. Take the missed pill as soon as you remember (even if it means taking two pills at the same time). Take the next tablet at the usual time. Start the next pack as soon as you finish taking the pills from the current pack, so there is no break between packs. Withdrawal bleeding is unlikely until the pills in the second pack are finished, but spotting or breakthrough bleeding may occur on the days of taking the drug.
2. Stop taking the pills in the current pack, take a break of 7 days or less (including the day you skip pills), and then start taking a new pack. Using this schedule, you can always start your next pack on the day of the week you normally would. If there is no expected menstrual bleeding after a break in taking the pills, you may be pregnant. Check with your doctor before starting a new pack.

In severe gastrointestinal disorders, absorption may be incomplete, so additional contraceptive measures should be taken. If vomiting or diarrhea occurs within 4 hours of taking the active pill, the recommendations for missed pills, which are listed in the section Taking missed pills, apply. If you do not want to change your usual dosage, you will need to take additional tablet(s) from a different pack.

Delaying the onset of menstrual bleeding

You can delay the onset of menstrual bleeding if you start taking the next pack of Yarin Plus immediately after the end of the current pack. You can continue taking the tablets in this package for as long as you wish or until the package runs out. If you want menstrual-like bleeding to start, stop taking the pills. While taking Yarina from the second package, spotting or bleeding may occur on the days of taking the tablets. Start the next pack after the usual 7-day break.

Changing the day of onset of menstrual bleeding

If you take the pills as recommended, you will have menstrual-like bleeding on about the same day every 4 weeks. If you want to change it, shorten (but don't lengthen) the amount of time you don't take pills. For example, if your cycle usually starts on Friday and in the future you want it to start on Tuesday (3 days earlier), the next pack should start 3 days earlier than usual. If the pill-free break is very short (for example, 3 days or less), menstrual bleeding may not occur during the break. In this case, bleeding or spotting may occur while taking the tablets from the next package.

Side effect

When taking the drug Yarina Plus, like any other medicines, adverse reactions may occur, although their appearance is not necessary in all patients. See sections "With caution" and "Special instructions". Please read these sections carefully and, in case of adverse reactions, including serious ones, consult your doctor.

The following is the frequency of adverse reactions reported in clinical trials with Yarina. These adverse reactions can also be attributed to the drug Yarina Plus.

Frequent adverse reactions (more than 1/100 and less than 1/10):

• depressed mood
• headache
• migraine
• nausea
• pain in the mammary glands
• vaginal candidiasis
• cycle disruption
• acyclic bleeding

Infrequent adverse reactions (more than 1/1000 and less than 1/100):

• change in body weight
• fluid retention
• change in libido
• increased blood pressure (BP)
• decrease in blood pressure
• vomit
• eczema
• vaginitis

Rare adverse reactions (more than 1/10000 and less than 1/1000):

• hypoacusia
• thromboembolism
• bronchial asthma
• secretions from the mammary glands

Adverse reactions that were reported during the use of Yarin Plus, but which frequency of occurrence could not be estimated: hypersensitivity reaction, mood swings, contact lens intolerance, abdominal pain, diarrhea, rash, urticaria, erythema nodosum, erythema multiforme, milk enlargement glands.

In women with hereditary forms of angioedema, exogenous estrogens may cause or worsen the symptoms of angioedema. If any of the side effects becomes serious or if you notice any side effects not listed in the instructions, please tell your doctor.

Contraindications for use

Yarina Plus is contraindicated in the presence of any of the conditions/diseases listed below. If any of these conditions / diseases develop for the first time while taking the drug, the drug should be immediately discontinued.

• Thrombosis (venous and arterial) and thromboembolism at present or in history (including deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), cerebrovascular disorders.
• Conditions preceding thrombosis (including transient ischemic attacks, angina pectoris) at present or in history.
• The presence of multiple or pronounced risk factors for venous or arterial thrombosis.
• Migraine with focal neurological symptoms at present or in history.
• Diabetes mellitus with vascular complications.
• Liver failure and severe liver disease (before normalization of liver tests).
• Severe and / or acute renal failure.
• Liver tumors (benign or malignant) at present or in history.
• Identified hormone-dependent malignant neoplasms (including the genital organs or mammary glands) or suspicion of them.
• Bleeding from the vagina of unknown origin.
• Pregnancy or suspicion of it.
• breastfeeding period.
• Hypersensitivity or intolerance to any of the components of the drug Yarina Plus.
• Yarina Plus contains lactose and is therefore contraindicated in patients with rare hereditary problems of lactose intolerance, lactase deficiency or glucose-galactose malabsorption.

Carefully

The potential risk and expected benefit of using Yarina Plus should be assessed in each individual case in the presence of the following diseases / conditions and risk factors:

• Risk factors for the development of thrombosis and thromboembolism: smoking, obesity, dyslipoproteinemia, controlled arterial hypertension, migraine without focal neurological symptoms, uncomplicated valvular heart disease, hereditary predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident at a young age in one of the immediate relatives);
• Other diseases in which peripheral circulatory disorders may occur: diabetes mellitus without vascular complications, systemic lupus erythematosus, hemolytic uremic syndrome, Crohn's disease and ulcerative colitis, sickle cell anemia, phlebitis of superficial veins;
• Hereditary angioedema;
• Hypertriglyceridemia;
• Liver diseases not related to contraindications (see "Contraindications");
• Diseases that first arose or worsened during pregnancy or against the background of a previous intake of sex hormones (for example, jaundice and / or itching associated with cholestasis, cholelithiasis, otosclerosis with hearing loss, porphyria, herpes pregnant, Sydenham's chorea);
• postpartum period.

The use of the drug Yarina during pregnancy and lactation

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 taking Yarina Plus during pregnancy are limited, and do not allow any conclusions to be drawn about the negative effect of the drug on pregnancy, the health of the fetus and newborn. 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 a teratogenic effect in cases of COC use by negligence in early pregnancy. No specific epidemiological studies have been conducted with Yarina Plus.

The drug is contraindicated during lactation. Taking COCs can reduce the amount of breast milk and change its composition, so their use is not recommended until breastfeeding is stopped. A small amount of sex hormones and / or their metabolites can be excreted in milk, but there is no evidence of their negative impact on the health of the child.

Use for violations of the liver and kidneys

• The use of the drug is contraindicated in the presence or history of severe forms of liver disease (until the indicators of liver tests are normal), the presence or history of benign or malignant liver tumors;
• The drug is contraindicated for use in women with severe renal impairment and in acute renal failure.

special instructions

If any of the conditions, diseases and risk factors listed below are currently present, the potential risk and expected benefit of using Yarina Plus should be carefully weighed in each individual case and discussed with the woman before she decides to start taking this drug.

For disorders of the cardiovascular system

There are epidemiological data on an increased incidence of venous and arterial thrombosis and thromboembolism (such as deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke) when taking COCs. These diseases are rare. The risk of developing venous thromboembolism (VTE) is highest in the first year of taking these drugs. An increased risk is present after the initial use of combined oral contraceptives or the resumption of use of the same or different combined oral contraceptives (after a break between doses of 4 weeks or more). Data from a large prospective study in 3 groups of patients show that this increased risk is predominantly present during the first 3 months.

The overall risk of VTE in patients taking low-dose combined oral contraceptives (Data from a large prospective study involving 3 groups of patients show that in women with or without risk factors for VTE, using ethinylestradiol / drospirenone containing contraceptives at a dosage of 0.03 mg / 3 mg, respectively , the incidence of VTE is the same as with the use of levonorgestrel-containing oral contraceptives.VTE can be fatal (in 1-2% of cases).

VTE manifesting as deep vein thrombosis or pulmonary embolism can occur with any combined oral contraceptive.

Very rarely, when using combined oral contraceptives, thrombosis of other blood vessels occurs, for example, hepatic, mesenteric, renal, cerebral veins and arteries or vessels of the retina. There is no consensus regarding the relationship between the occurrence of these events and the use of combined oral contraceptives.

Symptoms of deep vein thrombosis (DVT) include the following: unilateral swelling of the lower extremity or along a vein in the leg, pain or discomfort in the leg only when standing or walking, localized fever in the affected leg, and redness or discoloration of the skin on the leg.

Symptoms of pulmonary embolism (PE) are as follows: difficulty or rapid breathing; sudden cough, including hemoptysis; sharp pain in the chest, which may worsen with a deep breath; 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. The symptoms of a stroke are as follows: sudden weakness or loss of sensation in the face, arm or leg, especially on one side of the body, sudden confusion, problems with speech and understanding; sudden unilateral or bilateral loss of vision; sudden disturbance of gait, dizziness, loss of balance or coordination of movements; sudden, severe or prolonged headache with no apparent cause; loss of consciousness or fainting with or without an epileptic seizure. Other signs of vascular occlusion: sudden pain, swelling and slight blueness of the extremities, acute abdomen.

Symptoms of a myocardial infarction include: pain, discomfort, pressure, heaviness, a feeling of tightness or fullness in the chest, arm, or chest; discomfort with irradiation 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 fatal.

The risk of developing thrombosis (venous and / or arterial) and thromboembolism increases in the presence of:

• obesity (body mass index 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 examined by an appropriate specialist to decide on the possibility of taking Yarina Plus;
• prolonged immobilization, major surgery, any operation on the legs, or major trauma. In these situations, it is advisable to stop using Yarina Plus (in the case of a planned operation, at least four weeks before it) and not resume taking it within two weeks after the end of immobilization;
• dyslipoproteinemia;
• arterial hypertension;
• migraine;
• heart valve disease;
• atrial fibrillation;
• with age;
• in smokers (with an increase in the number of cigarettes or an increase in age, the risk increases, especially in women over 35 years old);

The question of the possible role of varicose veins and superficial thrombophlebitis in the development of venous thromboembolism remains controversial.

An increased risk of thromboembolism in the postpartum period should be taken into account.

Peripheral circulatory disorders can also occur in diabetes mellitus, systemic lupus erythematosus, hemolytic uremic syndrome, chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis), and sickle cell anemia.

An increase in the frequency and severity of migraine during the use of Yarina Plus (which may precede cerebrovascular disorders) 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, lack of antithrombin-III, lack of protein C, lack of protein S, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant).

In assessing the risk-benefit ratio, it should be taken into account that adequate treatment of the respective condition may reduce the associated risk of thrombosis. It should also be borne in mind that the risk of thrombosis and thromboembolism during pregnancy is higher than when taking low-dose oral contraceptives ( 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 the use of COCs has not been proven. The possibility of the relationship of these data with the screening of diseases of the cervix and with the peculiarities of sexual behavior (more rare 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 after stopping these drugs. Due to the fact that breast cancer is rare in women under 40 years of age, the increase in the number of breast cancer diagnoses in women who are currently taking COCs or have recently taken them is insignificant in relation to the overall risk of this disease. Its association with COC use has not been proven. The observed increase in risk may be due to careful monitoring and earlier diagnosis of breast cancer in women using COCs. In women who have ever used COCs, earlier stages of breast cancer are detected than in women who have never used them.

In rare cases, against the background of the use of COCs, the development of benign, and in extremely rare cases, malignant neoplasms of the liver, which in some patients led to life-threatening intra-abdominal bleeding, was observed. If there is severe pain in the abdomen, an enlarged liver, or signs of intra-abdominal bleeding, this should be taken into account when making a differential diagnosis.

Other states

Clinical studies have shown no effect of drospirenone on plasma potassium concentration in patients with mild to moderate renal insufficiency. However, in patients with impaired renal function and an initial concentration of potassium at the upper limit of normal, the risk of developing hyperkalemia while taking drugs that lead to potassium retention in the body cannot be excluded.

In women with hypertriglyceridemia (or a family history of this condition), there may be an increased risk of developing pancreatitis while taking COCs. Although a slight increase in blood pressure has been described in many women taking COCs, clinically significant increases have been rare. However, if a persistent, clinically significant increase in blood pressure develops while taking 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 the help of antihypertensive therapy.

The following conditions have been reported to develop or worsen both during pregnancy and while taking COCs, but their relationship with COC use has not been proven: jaundice and / or itching associated with cholestasis; the formation of stones in the gallbladder; porphyria; systemic lupus erythematosus; hemolytic-uremic syndrome; chorea; herpes of pregnant women; 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 the 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 previous use of sex hormones, requires discontinuation of Yarina Plus.

Although COCs may affect insulin resistance and glucose tolerance, there is no need to change the therapeutic regimen in diabetic patients using Yarina Plus. However, diabetic women should be closely monitored while taking this drug.

Occasionally, chloasma may develop, especially in women with a history of chloasma of pregnancy. Women with a tendency to chloasma while taking Yarina Plus should avoid prolonged exposure to the sun and exposure to ultraviolet radiation.

Folates can mask a lack of vitamin B12.

Laboratory tests

Taking Yarina Plus may affect the results of some laboratory tests, including liver, kidney, thyroid, adrenal function, plasma transport protein concentrations, carbohydrate metabolism, blood coagulation and fibrinolysis parameters. Changes usually do not go beyond the boundaries of normal values. Drospirenone increases plasma renin activity and aldosterone concentration, 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 the drug 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 angiotensin-converting enzyme (ACE) inhibitors or indomethacin, no significant difference was found between plasma potassium concentrations compared with placebo.

Reduced efficiency

The effectiveness of the drug Yarina Plus may be reduced in the following cases: when skipping tablets, with vomiting and diarrhea, or as a result of drug interactions.

Frequency and severity of menstrual bleeding

While taking the drug Yarina Plus during the first few months, irregular (acyclic) bleeding from the vagina (spotting spotting or "breakthrough" uterine bleeding) may be observed. Apply hygiene products and continue taking the tablets as usual. Irregular bleeding usually stops as your body adapts to the drug (usually after 3 pill cycles). If they continue, increase in intensity, or resume after stopping, contact your doctor.

Absence of regular menstrual bleeding

If you have taken all the pills correctly and you have not vomited while taking the pills or taking other medications at the same time, then the chance of pregnancy is low. Continue taking Yarina Plus as usual. If there are no 2 menstrual-like bleeding in a row, consult a doctor immediately. Do not start the next pack until the doctor has ruled out pregnancy.

When to consult a doctor

Regular checkups

If you are taking Yarina Plus, your doctor will inform you about the need for regular check-ups, at least at least once every 6 months.

Consult your doctor as soon as possible

• With any changes in health, especially any of the conditions listed in this leaflet (see also "Contraindications" and "Use with caution");
• With local compaction in the mammary gland;
• If you are going to use other drugs (see also "Interaction with other drugs");
• If prolonged immobility is expected (for example, a cast is applied to the leg), hospitalization or surgery is planned (consult your doctor at least 3-4 weeks before the proposed operation);
• If you experience unusually heavy bleeding from the vagina;
• If you forgot to take a tablet in the first week of taking the pack and had sexual intercourse seven days or less before;
• You have not had another menstrual bleeding twice in a row or you suspect that you are pregnant (do not start taking the next pack until you have consulted with your doctor).

Stop taking the tablets and tell your doctor immediately if you notice possible signs of thrombosis, myocardial infarction or stroke: unusual cough; unusually severe pain behind the sternum, radiating to the left arm; sudden onset of shortness of breath, unusual, severe and prolonged headache or migraine attack; partial or complete loss of vision or double vision; inarticulate speech; sudden changes in hearing, smell, or taste; dizziness or fainting; weakness or loss of sensation in any part of the body; severe pain in the abdomen; severe pain in the leg or sudden swelling of any of the legs.

Yarina Plus does not protect against contracting HIV infection (AIDS) or any other sexually transmitted disease.

Influence on the ability to drive vehicles and mechanisms

There were no cases of adverse effects of the drug Yarina Plus on the speed of psychomotor reactions; studies to study the effect of the drug on the speed of psychomotor reactions have not been conducted.

Overdose

No cases of Yarina Plus overdose have been reported. Symptoms that may occur in overdose: nausea, vomiting, spotting vaginal discharge or metrorrhagia (more often in young women). There is no specific antidote, symptomatic treatment should be carried out.

Calcium levomefolate and its metabolites are identical to folates, which are part of food products, the daily consumption of which does not harm the body. Taking calcium levomefolate at a dose of 17 mg/day (a dose 37 times higher than that contained in 1 tablet of Yarina Plus) for 12 weeks was well tolerated.

drug interaction

Interactions of oral contraceptives with other drugs may lead to "breakthrough" uterine bleeding and / or reduce the reliability of contraception.

Interactions leading to a decrease in the effectiveness of the drug Yarina Plus

Influence on hepatic metabolism: the use of drugs that induce microsomal liver enzymes may lead to an increase in the clearance of sex hormones. These drugs include: phenytoin, barbiturates, primidone, carbamazepine, rifampicin, possibly also oxcarbazepine, topiramate, felbamate, griseofulvin and preparations containing St. John's wort. HIV protease inhibitors (eg ritonavir) and non-nucleoside reverse transcriptase inhibitors (eg nevirapine) and combinations thereof also have the potential to affect hepatic metabolism.

Effects on enterohepatic recirculation: According to separate studies, some antibiotics (eg penicillins and tetracyclines) can reduce the enterohepatic recirculation of estrogens, thereby reducing the concentration of ethinyl estradiol.

While taking drugs that affect microsomal liver enzymes, and within 28 days after their withdrawal, an additional barrier method of contraception should be used.

While taking antibiotics (with the exception of rifampicin and griseofulvin) and within 7 days after their withdrawal, an additional barrier method of contraception should be used. If the period of use of the barrier method of contraception ends later than the hormone-containing orange tablets in the package, you should skip taking the remaining auxiliary light orange tablets and start taking Yarina Plus from a new package without interruption in taking the tablets.

Interactions that reduce the effectiveness of calcium levomefolate

Effects on folate metabolism: Some drugs reduce blood folate concentrations or reduce the effectiveness of levomefolate calcium by inhibiting the enzyme dihydrofolate reductase (eg, methotrexate, trimethoprim, sulfasalazine, and triamterene) or by decreasing folate absorption (eg, cholestyramine) or through unknown mechanisms ( e.g. antiepileptic drugs: carbamazepine, phenytoin, phenobarbital, primidone and valproic acid).

Effects on the metabolism of COCs (enzyme inhibitors)

The main metabolites of drospirenone are formed in plasma without the participation of the cytochrome P450 system. Therefore, the effect of inhibitors of the cytochrome P450 system on the metabolism of drospirenone is unlikely.

The effect of COCs or calcium levomefolate on the activity of other drugs

COCs can interfere with the metabolism of other drugs, leading to an increase (eg, cyclosporine) or a decrease (eg, lamotrigine) in plasma and tissue concentrations.

Based on interaction studies, as well as studies involving female volunteers taking omeprazole, simvastatin and midazolam as test substrates, it can be concluded that the effect of drospirenone at a dose of 3 mg on the metabolism of other drugs is unlikely.

Folates may alter the pharmacokinetics or pharmacodynamics of some drugs that affect folate metabolism, such as antiepileptic drugs (phenytoin), methotrexate or pyrimethamine, which may be accompanied by a decrease (generally reversible, provided the dose of the drug affecting folate metabolism) decreases in their therapeutic effect. The use of folate during treatment with such drugs is recommended mainly to reduce the toxicity of the latter.