Estrogen and Progestin (Oral Contraceptives)
Important Warning - Cigarette smoking increases the risk of serious side effects from oral contraceptives, including heart attacks, blood clots, and strokes. This risk is higher for women over 35 years old and heavy smokers (15 or more cigarettes per day). If you take oral contraceptives, you should not smoke.

Estrogen and Progestin (Oral Contraceptives)

(ess’ troe jen) (proe jes tin)

Other Names:Alesse^®, Apri^®, Aviane^®, Brevicon^®, Demulen^®, Desogen^®, Estrostep^®, Genora^®, Jenest^®, Levlen^®, Levlite^®, Levora^®, Lo/Ovral^®, Loestrin^®, Low-Ogestrel^®, Microgestin^®, Mircette^®, Modicon^®, Necon^®, Norinyl^®, Nordette^®, Nortrel^®, Ogestrel^®, Ortho-Cept^®, Ortho-Cyclen^®, Ortho-Novum^®, Ortho Tri-Cyclen^®, Ovcon^®, Ovral^®, Tri-Levlen^®, Tri-Norinyl^®, Triphasil^®, Trivora^®, Yasmin^®, Zovia^®, others, Birth-control pills, ethinyl estradiol and desogestrel, ethinyl estradiol and drospirenone, ethinyl estradiol and ethynodiol, ethinyl estradiol and levonorgestrel, ethinyl estradiol and norethindrone, ethinyl estradiol and norgestimate, ethinyl estradiol and norgestrel, mestranol and norethindrone

Why is this medication prescribed?

Oral contraceptives (birth-control pills) are used to prevent pregnancy. Estrogen and progestin are two female sex hormones. Combinations of estrogen and progestin work by preventing the release of eggs from the ovaries (ovulation) and changing the cervical mucus and the lining of the uterus. Oral contraceptives are a very effective method of birth control, but they do not prevent the spread of AIDS and other sexually transmitted diseases.

How should this medicine be used?

Oral contraceptives come in packets of 21 or 28 tablets to take by mouth once a day. To avoid upset stomach, take oral contraceptives with food or milk. Take the tablet routinely at the same time every day (e.g., after dinner or at bedtime) to help you remember to take the tablet regularly. Missing doses increases your risk of becoming pregnant.

When first starting on this medicine, use an additional method of birth control until you have correctly taken 7 days’ worth of medicine.

If you have a 21-tablet packet, take one tablet daily for 21 days and then none for seven days. Then start a new packet.

If you have a 28-tablet packet, take one tablet daily for 28 days. The last seven tablets are a different color. These tablets are not birth-control pills; they contain iron (ferrous fumarate) or an inactive ingredient. You should take one tablet daily continuously for 28 days in the order specified in your packet, starting a new packet the day after taking your 28th tablet.

Follow the directions on your prescription label carefully concerning when to take your first tablet (on the first or fifth day of your menstrual period or on the first Sunday after or on which bleeding begins). Take the oral contraceptive exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking this medicine without talking to your doctor.

If you have recently given birth, wait until 4 weeks after giving birth to begin taking oral contraceptives.

Before taking oral contraceptives, ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient and read it carefully.

What special precautions should I follow?

Before taking oral contraceptives,

• tell your doctor and pharmacist if you are allergic to estrogen, progestin, or any other medications. 

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: acetaminophen (APAP, Tylenol); antibiotics; anticoagulants (‘blood thinners’) such as warfarin (Coumadin); atorvastatin (Lipitor); clofibrate (Atromid-S); cyclosporine (Neoral, Sandimmune); griseofulvin (Fulvicin, Grifulvin, Grisactin); HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir); medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), phenytoin (Dilantin), and topiramate (Topamax); morphine (Kadian, MS Contin, MSIR, others); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisone (Deltasone), and prednisolone (Prelone); phenylbutazone; rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); temazepam (Restoril); theophylline (Theobid, Theo-Dur); and thyroid medication such as levothyroxine (Levothroid, Levoxyl, Synthroid). Before taking Yasmin, tell your doctor and pharmacist if you are taking angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), enalapril (Vasotec), and lisinopril (Prinivil, Zestril); angiotensin II antagonists such as irbesartan (Avapro), losartan (Cozaar), and valsartan (Diovan); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); diuretics (‘water pills’) such as amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium); or heparin. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. 

• tell your doctor what herbal products you are taking, especially St. John’s wort. 

• tell your doctor if you have or have ever had breast lumps or cancer; endometrial cancer; high blood pressure; high blood cholesterol and fats; diabetes (high blood sugar); asthma; stroke; blood clots; toxemia (high blood pressure during pregnancy); heart attack; epilepsy (seizures); migraine headaches; depression; liver, heart, gallbladder, or kidney disease; adrenal insufficiency (for Yasmin); jaundice (yellowing of the skin or eyes); vaginal bleeding between menstrual periods; and excessive weight gain and fluid retention (bloating) during the menstrual cycle. 

• do not take oral contraceptives if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking oral contraceptives, call your doctor immediately. 

• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking oral contraceptives. 

• tell your doctor and pharmacist if you wear contact lenses. If you notice changes in vision or ability to wear your lenses while taking hormone replacement therapy, see an eye doctor. 

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If you miss doses of your oral contraceptive, you may be at risk for becoming pregnant. Instructions about missed doses are different for different products. Carefully read the instructions in the manufacturer’s information for the patient. If you have any questions, call your doctor or pharmacist. If you miss pills, you may need to use a backup method of birth control for 7 days or until the end of the cycle.

What side effects can this medication cause?

Oral contraceptives may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• upset stomach
• vomiting
• stomach cramps or bloating
• diarrhea
• constipation
• gingivitis (swelling of the gum tissue)
• weight gain or weight loss
• brown or black skin patches
• acne
• swelling of the hands, feet, or lower legs (fluid retention)
• hair growth in unusual places
• bleeding or spotting between menstrual periods
• changes in menstrual flow
• painful or missed periods
• breast tenderness, enlargement, or discharge
• difficulty wearing contact lenses

Some side effects can be seious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• severe headache
• shortness of breath
• severe vomiting
• partial or complete loss of vision
• double vision
• speech problems
• dizziness or faintness
• weakness or numbness of an arm or leg
• crushing chest pain or chest heaviness
• coughing up blood
• calf pain
• severe stomach pain
• yellowing of the skin or eyes
• severe depression
• unusual bleeding
• loss of appetite
• extreme tiredness, weakness, or lack of energy
• fever
• dark-colored urine
• light-colored stool
• rash

Oral contraceptives may increase the risk of developing endometrial and breast cancer, gallbladder disease, liver tumors, heart attack, stroke, and blood clots. Talk to your doctor about the risks of taking this medication.

Oral contraceptives may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What storage conditions are needed for this medication?

Keep this medication in the packet it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

What other information should I know?

Keep all appointments with your doctor and the laboratory. You should have a complete physical examination every year, including blood pressure measurements, breast and pelvic exams, and a Pap test. Follow your doctor’s directions for examining your breasts; report any lumps immediately.

Before you have any laboratory tests, tell the laboratory personnel that you take oral contraceptives, as this medication may interfere with some laboratory tests.

If you miss one menstrual period and have taken your tablets as directed, continue taking them. However, if you miss one period and have not taken your tablets as directed or if you miss two menstrual periods and have taken the tablets as directed, call your doctor and use another method of birth control until you have a pregnancy test.

If you wish to stop taking oral contraceptives and become pregnant, use another method of birth control for at least 3 months after you stop taking the tablets to be sure that the medication will not harm the fetus. It may take a long time for you to become pregnant after you stop taking oral contraceptives, especially if you have never had a baby or if you had irregular, infrequent, or complete absence of menstrual periods before taking oral contraceptives. Questions should be discussed with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.