Norethindrone Acetate; Ethinyl Estradiol; Ferrous Fumarate Capsules or Tablets

What is this medication?

NORETHINDRONE ACETATE; ETHINYL ESTRADIOL; FERROUS FUMARATE (nor eth IN drone AS e tate; ETH in il es tra DYE ole; FER us FUE ma rate) prevents ovulation and pregnancy. It may also be used to treat acne. It belongs to a group of medications called oral contraceptives. It is a combination of the hormones estrogen and progestin.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Aurovela 24 Fe 1/20, Aurovela Fe, Blisovi 24 Fe, Blisovi Fe, Estrostep Fe, Gemmily, Gildess 24 Fe, Gildess Fe 1.5/30, Gildess Fe 1/20, Hailey 24 Fe, Hailey Fe 1.5/30, Junel Fe 1.5/30, Junel Fe 1/20, Junel Fe 24, Larin Fe, Lo Loestrin Fe, Loestrin 24 Fe, Loestrin FE 1.5/30, Loestrin FE 1/20, Lomedia 24 Fe, Merzee, Microgestin 24 Fe, Microgestin Fe 1.5/30, Microgestin Fe 1/20, Tarina 24 Fe, Tarina Fe 1/20, Taysofy, Taytulla, Tilia Fe, Tri-Legest Fe

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Abnormal vaginal bleeding
• Blood vessel disease or blood clots
• Breast, cervical, endometrial, ovarian, liver, or uterine cancer
• Diabetes
• Gallbladder disease
• Having surgery
• Heart disease or recent heart attack
• High blood pressure
• High cholesterol or triglycerides
• History of irregular heartbeat or heart valve problems
• Kidney disease
• Liver disease
• Migraine headaches
• Protein C deficiency
• Protein S deficiency
• Recently had a baby, miscarriage, or abortion
• Stroke
• Systemic lupus erythematosus (SLE)
• Tobacco smoker
• An unusual or allergic reaction to estrogens, progestins, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

How should I use this medication?

Take this medication by mouth. To reduce nausea, this medication may be taken with food. Follow the directions on the prescription label. Take this medication at the same time each day and in the order directed on the package. Do not take your medication more often than directed.

A patient package insert for the product will be given with each prescription and refill. Read this sheet carefully each time. The sheet may change frequently.

Contact your care team regarding the use of this medication in children. Special care may be needed. This medication has been used in female children who have started having menstrual periods.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, refer to the patient information sheet you received with your medication for direction. If you miss more than one pill, this medication may not be as effective, and you may need to use another form of birth control.

What may interact with this medication?

Do not take this medication with the following:

• Dasabuvir; ombitasvir; paritaprevir; ritonavir
• Ombitasvir; paritaprevir; ritonavir

This medication may also interact with the following:

• Acetaminophen
• Antibiotics or medications for infections, especially rifampin, rifabutin, rifapentine, and griseofulvin, and possibly penicillins or tetracyclines
• Aprepitant
• Ascorbic acid (vitamin C)
• Atorvastatin
• Barbiturate medications, such as phenobarbital
• Bosentan
• Carbamazepine
• Caffeine
• Clofibrate
• Cyclosporine
• Dantrolene
• Doxercalciferol
• Felbamate
• Grapefruit juice
• Hydrocortisone
• Medications for anxiety or sleeping problems, such as diazepam or temazepam
• Medications for diabetes, including pioglitazone
• Mineral oil
• Modafinil
• Mycophenolate
• Nefazodone
• Oxcarbazepine
• Phenytoin
• Prednisolone
• Ritonavir or other medications for HIV infection or AIDS
• Rosuvastatin
• Selegiline
• Soy isoflavones supplements
• St. John's wort
• Tamoxifen or raloxifene
• Theophylline
• Thyroid hormones
• Topiramate
• Warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. You will need a regular breast and pelvic exam and Pap smear while on this medication.

Use an additional method of contraception during the first cycle that you take these tablets.

If you have any reason to think you are pregnant, stop taking this medication right away and contact your care team.

If you are taking this medication for hormone related problems, it may take several cycles of use to see improvement in your condition.

Smoking increases the risk of getting a blood clot or having a stroke while you are taking birth control pills, especially if you are more than 35 years old. You are strongly advised not to smoke.

This medication can make your body retain fluid, making your fingers, hands, or ankles swell. Your blood pressure can go up. Contact your care team if you feel you are retaining fluid.

This medication can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

If you wear contact lenses and notice visual changes, or if the lenses begin to feel uncomfortable, consult your eye care specialist.

In some women, tenderness, swelling, or minor bleeding of the gums may occur. Notify your dentist if this happens. Brushing and flossing your teeth regularly may help limit this. See your dentist regularly and inform your dentist of the medications you are taking.

If you are going to have elective surgery, you may need to stop taking this medication before the surgery. Consult your care team for advice.

This medication does not protect you against HIV infection (AIDS) or any other sexually transmitted diseases.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
• Gallbladder problems—severe stomach pain, nausea, vomiting, fever
• Increase in blood pressure
• Liver injury—right upper belly pain, loss of appetite, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
• New or worsening migraines or headaches
• Stroke—sudden numbness or weakness of the face, arm or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
• Unusual vaginal discharge, itching, or odor
• Worsening mood, feelings of depression

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

• Breast pain or tenderness
• Dark patches of skin on the face or other sun-exposed areas
• Irregular menstrual cycles or spotting
• Nausea
• Weight gain

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children and pets.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medication after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

How do you take Lo Loestrin Fe?

You’ll take two types of “active” pills containing hormones that prevent pregnancy (a blue pill and a white pill). You’ll also take a “non-active” placebo pill (a brown pill). Start taking Lo Loestrin Fe on the first day of your period. If you’re switching from a different type of birth control pill, start Lo Loestrin Fe the first day you would’ve begun a new packet of your old birth control pills.

• Take the blue pill containing estrogen and progestin for 24 days straight.
• Take the white pill that contains estrogen only on days 25 and 26.
• Take the brown placebo pill on days 27 and 28.

You won’t need to use a backup form of birth control if you start taking the pills on the first day of your period. If you start Lo Loestrin Fe on a day other than Day 1 of your period, you’ll need to take a backup form of birth control, like condoms and spermicide, for seven straight days.

When do you get your period on Lo Loestrin Fe?

You don’t get periods when you’re on birth control. This is because you don’t ovulate (your ovaries don’t release an egg). As a result, you don’t need to shed the egg and uterine lining like you do during a typical menstrual cycle.

But you do have vaginal bleeding on birth control. It’s called withdrawal bleeding. The bleeding is your body’s response to the hormone levels in your pills dropping as you progress through the pack. Expect to bleed the last week of the 28-day pill cycle.

Does Lo Loestrin Fe stop periods?

It can stop you from bleeding, especially when you first start taking it. Some people taking Lo Loestrin Fe have reported not bleeding at all or having lighter bleeding than before taking birth control. Many people taking Lo Loestrin Fe bleed for about two days.

Still, not having a period could mean you’re pregnant. It’s a good idea to contact your healthcare provider if you suspect you may be pregnant. For example, if you’re sexually active and miss two periods in a row, or if you miss a period after forgetting to take a pill, you may need to contact your provider.

How do you skip your period on Lo Loestrin Fe?

You can prevent bleeding on Lo Loestrin Fe and several other combination pills (birth control pill regimens containing progestin/estrogen) by skipping the inactive pills and only taking active pills.

This has potential downsides, though, like “breakthrough bleeding.” With breakthrough bleeding, you have unexpected bleeding or spotting (light bleeding). Also, not bleeding can make it harder to tell if you’re pregnant.

Contact your healthcare provider to discuss the benefits and risks of skipping the inactive pills so you don’t bleed before changing your treatment regimen with Lo Loestrin Fe or any birth control pill.

A note from Cleveland Clinic

It’s a good idea to set reminders to ensure you’re taking the right birth control pills at the right time to prevent pregnancy. Missing even a single dose can increase your chances of becoming pregnant. If you have any questions about your birth control pills — including when to take them or potential benefits in addition to pregnancy prevention — ask your healthcare provider. They can advise you on the best birth control pill for you and make sure you’re confident that you’re using it correctly.

Note: Intro and FAQ sections written and reviewed by Cleveland Clinic professionals.