Estrogen And Progestin (Oral Contraceptives) 

Uses For estrogen and progestin oral contraceptives 

Oral contraceptives are known also as  the Pill, OCs, BCs, BC tablets, or birth control pills. estrogen and progestin oral contraceptives usually contains two types  of hormones, estrogens and progestins and, when taken properly, prevents pregnancy. It works by stopping a woman's egg  from fully developing each month. The egg can no longer accept a sperm and fertilization is prevented. Although  oral contraceptives have other effects that help prevent a pregnancy from occurring, this is the main action. 

Sometimes a woman's egg can still develop even though the medication is taken once each day, especially when more than 24 hours pass between two doses. In almost all cases when the medicine was taken properly  and an egg develops, fertilization can still be stopped by oral contraceptives.  This is because oral contraceptives also thicken cervical mucus at the opening of the uterus. This makes it hard  for the partner's sperm to reach the egg. In addition, oral contraceptives change the uterus lining just enough so that an egg will not stop in the uterus to develop. All of these effects make it difficult to become pregnant when properly taking an oral contraceptive. 

No contraceptive method is 100 percent effective. Studies show that fewer than one of each one hundred  women correctly using oral contraceptives becomes pregnant during the first year of use. Birth control methods such as having surgery to become sterile  or not having sex are  more effective. Using condoms, diaphragms, progestin-only  oral contraceptives, or spermicides is  not as effective as using oral contraceptives containing estrogens and progestins. Discuss with your health care professional your options for birth control. 

The triphasic cycle product of norgestimate and ethinyl estradiol (the brand name Ortho Tri-Cyclen) and norethindrone acetate and ethinyl estradiol (the brand name Estrostep) can be used for the treatment of moderate acne only if the patient is at least 15 years old, has acne that has not improved with topical anti-acne medicines, has gotten approval from her doctor, has begun to have menstrual periods, desires an oral contraceptive for birth control, and plans to stay on it for at least 6 months. 

Sometimes these preparations can be used for other conditions as determined by your doctor. 

Oral contraceptives are available only with your doctor's prescription. 

Once a medicine has been approved for marketing for a certain use, experience may show that it  is also useful for other medical problems. Although these uses are not included in product labeling, oral contraceptives are used in certain patients with the following medical conditions: 

• Amenorrhea (stopping of menses for several consecutive months) 
• Dysfunctional uterine bleeding (abnormal uterine bleeding) 
• Dysmenorrhea (painful menstrual bleeding) 
• Hypermenorrhea (excessive menstrual bleeding) 
• Emergency contraception within 72 hours of unprotected intercourse 
• Endometriosis (painful bleeding from uterine-like tissue that can grow in different parts of the  female body) 
• Hirsutism in females (male-like hair growth) 
• Hyperandrogenism, ovarian (excessive production  of male hormones) 
• Polycystic ovary syndrome (many problems that include amenorrhea, hirsutism, infertility, and many tiny cysts or sacs usually in both ovaries) 

• Must be taken with food within 72 hours  of unprotected sexual intercourse. One single course (2 doses 12 hours apart) is a one-time emergency protection. Using more than one course in a month will reduce  the effectiveness. 
• Because  the hormones are strong, watch for danger signs. Call your doctor if you experience any severe pains in your leg, stomach, or chest; any vision or breathing changes; yellowing  of skin; headaches; numbness; or trouble in speaking. 
• You may experience nausea so take it with food and call your doctor if you vomit  the medicine. 
• Your menstrual period may start earlier than usual. If it doesn't start, call your doctor. 

• You may need  to use oral contraceptives for 6 to 12 months before you see less new hair growth. 

• Sometimes instead of following  the directions on the oral contraceptive's package, your doctor may ask you to follow different directions, such as taking  the active tablets in the package each day without stopping for 6  to 9 months. This means that after 21 days you will start  a new package  of pills. If you are  not sure about how to take estrogen and progestin oral contraceptives, discuss any questions with your health care professional. 
• Also, your symptoms of endometriosis may worsen at first but with continued use  of the oral contraceptives your symptoms should lessen  and your condition improve. 

Importance  of Diet 

Make certain your health care professional knows if you are on any special diet, such as a low-sodium or low-sugar diet. 

Before Using estrogen and progestin  oral contraceptives

Allergies 
Tell your doctor if you have ever had any unusual or allergic reaction  to medicines  in this group or any other medicines. Also tell your health care professional if you have any other types  of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. 

Pediatric
estrogen and progestin oral contraceptives is frequently used for birth control in teenage females and has not been shown  to cause different side effects or problems than it does in adults. Some teenagers may need extra information on  the importance of taking this medication exactly as prescribed. 

Pregnancy 
Oral contraceptives are not recommended for use during pregnancy  and should be discontinued if you become pregnant or think you are pregnant. When oral contraceptives were accidently taken early  in pregnancy, problems in the fetus did not occur. Women  who are not breast-feeding may begin  to take oral contraceptives two weeks after having a baby. 

Breast Feeding 
Oral contraceptives pass into the breast milk and can change the content or lower the amount of breast milk. Also, they may shorten a woman's ability to breast-feed by about 1 month, especially when the mother is only partially breast-feeding. Because the amount of hormones is so small in low-dose contraceptives, your doctor may allow you to begin using  an oral contraceptive after you have been breast-feeding for a while. However, it may be necessary for you  to use another method of birth control or to stop breast-feeding while taking oral contraceptives. 

Interactions with Medicines 
Although certain medicines  should not  be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter OTC) medicine. 

Interactions with Food/Tobacco/Alcohol 

Certain medicines should not be used at or around the time  of eating food or eating certain types  of food since interactions may occur. Using alcohol  or tobacco with certain medicines may also cause interactions to occur. Discuss with  your healthcare professional  the use of your medicine with food, alcohol, or tobacco. 

Other Medical Problems 

The presence of other medical problems may affect  the use of medicines in this class. Make sure you tell  your doctor if you have  any other medical problems, especially: 

• Abnormal changes in menstrual or uterine bleeding or 
• Endometriosis or 
• Fibroid tumors of the uterus—Oral contraceptives usually improve these female conditions but sometimes they can make them worse or make the diagnosis of these problems more difficult. 
• Blood clots (or history of) or 
• Heart or circulation disease or 
• Stroke (or history of)—If these conditions are already present, oral contraceptives may have a greater chance of causing blood clots or circulation problems, especially in women who smoke tobacco. Otherwise, oral contraceptives may help prevent circulation and heart disease if  you are healthy and  do not smoke. 
• Breast disease (not involving cancer)—Oral contraceptives usually protect against certain breast diseases, such  as breast cysts or breast lumps; however, your doctor may want to follow your condition  more closely. 
• Cancer, including breast cancer (or history of  or family history of)—Oral contraceptives may worsen some cancers, especially when breast, cervical, or uterine cancers already exist. Use  of oral contraceptives is not recommended if you have any of these conditions. If you have a family history of breast disease, oral contraceptives may still be a good choice but you may need to be tested  more often. 
• Chorea gravidarum  or
• Gallbladder disease or gallstones (or history of) or 
• High blood cholesterol or 
• Liver disease (or history of, including jaundice during pregnancy or oral contraceptive use) or 
• Mental depression (or history of)—Oral contraceptives may make these conditions worse or, rarely, cause them to occur again.  Oral contraceptives may still be a good choice but you may need to be tested more often. 
• Diabetes mellitus (sugar diabetes)—Use  of oral contraceptives may cause an increase, usually only a small increase,  in your blood sugar and usually does not affect the amount of diabetes medicine  that you take. You or your doctor will want to test for any changes in your blood sugar for 12 to 24 months after starting to take oral contraceptives in case the dose  of your diabetes medicine needs to be changed. 
• Epilepsy (seizures) (or history of) or 
• Heart or circulation problems or 
• High blood pressure (hypertension) or 
• Migraine headaches—Oral contraceptives may cause fluid build-up and may cause these conditions to become worse; however, some people have fewer migraine headaches when they use oral contraceptives. 

Proper Use of estrogen and progestin  oral contraceptives

To make  using oral contraceptives as safe  and reliable as possible,  you should understand how and when to take them and what effects may be expected. 

A paper with  information for the patient will be given to you with your filled prescription,  and will provide many details concerning the use of oral contraceptives. Read this paper carefully and ask your health care professional if you need additional information or explanation. 

Take estrogen and progestin oral contraceptives with food to help prevent nausea that might occur during the first few weeks. Nausea usually disappears with continued use or if the medicine is taken at bedtime. 

When  you begin to use oral contraceptives, your body will require at least 7 days to adjust before  a pregnancy will be prevented. You will need to use an additional birth control method  for at least  7 days. Some doctors recommend using an additional method of birth control for the first cycle (or 3 weeks) to ensure full protection. Follow the advice of your doctor or other health care professional. 

Try to  take the doses no more than 24 hours apart to reduce the possibility of side effects and to prevent pregnancy. Since  one of the most important factors in the proper use of oral contraceptives is taking every dose exactly on schedule, you should never let your  tablet supply run out. When possible, try to keep an extra month's supply of tablets on hand and replace it monthly. 

It is very important that you keep the tablets in their original container and take the tablets in the same order that they appear in the container.  The containers help you keep track  of which tablets to take next. Different colored  tablets in the same package contain  different amounts of hormones or  are placebos (tablets that do not contain hormones). The effectiveness  of the medicine is reduced if the  tablets are taken out  of order. 

• Monophasic (one-phase) cycle dosing schedule: Most available dosing schedules are monophasic. If you are taking  tablets of one strength (color) for 21 days, you  are using a monophasic schedule. For  the 28-day monophasic cycle you will also take an additional 7 inactive tablets, which are another  color. If you are taking  the brand name Mircette, the last seven  tablets of the 28-day cycle contains two inactive tablets (for Days 22 and 23) and five tablets (for Days 24 through 28) that  contain a low dose of estrogen. Taking the last 7  tablets is not required for full protection against pregnancy but they do help to replace estrogen. 
• Biphasic (two-phase) cycle dosing schedule: If  you are using a biphasic twenty-one–day schedule, you are taking tablets of  one strength (color)  for either seven or ten days, depending on  the medication prescribed (the first phase). You then take tablets of  a second strength (color) for  the next eleven or fourteen days, depending on the medication prescribed (the second phase). At this point,  you will have taken a total of twenty-one tablets. For the twenty-eight–day biphasic cycle you will also  take an additional seven inactive tablets, which are a third color. 
• Triphasic (three-phase) cycle dosing schedule:  If you are using  a triphasic twenty-one–day schedule, you are taking tablets of  one strength (color) for five, six or seven days, depending on  the medicine prescribed (the  first phase). You then take tablets of a second strength (color) for the next five, seven, or nine days, depending  on the medicine prescribed (the second phase). After that, you take tablets of a third strength (color) for  the next five, seven, nine, or ten days, depending  on the medicine prescribed (the third phase). At this point,  you will have taken a total  of twenty-one tablets. For  the twenty-eight–day triphasic cycle you will also take an additional seven inactive tablets, which are a fourth color. 

If you are taking one  of the brand name products, Estrostep Fe or Loestrin Fe, each of the  last seven tablets that you will take on Days 21 through 28  of your cycle contains iron. These  tablets are also a different color from the other  tablets in your package. They help to replace some  of the iron  you lose when you have a menstrual period. 

Dosing
The dose medicines in this class  will be different for different patients. Follow  your doctor's orders or the directions  on the label. The following information includes only the average doses  of these medicines. If  your dose is different, do not change it unless your  doctor tells  you to do so. 

The amount  of medicine  that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses,  and the length of time  you take the medicine depend on the medical problem for which you are using the medicine. 

• For oral dosage forms (monophasic, biphasic, or triphasic tablets): 

1. For contraception: 

                      Adults and teenagers— 

• For the twenty-one–day cycle—Take 1 tablet  a day for twenty-one days. Skip seven days. Then repeat  the cycle. 
• For the twenty-eight–day cycle—Take 1 tablet a day for twenty-eight days. Then repeat the cycle. 
• For oral dosage forms (norethindrone acetate and ethinyl estradiol triphasic  tablets and norgestimate and ethinyl estradiol triphasic tablets: 

        2.  To treat acne: 

                     Adults and teenagers— 

• For  the twenty-one–day cycle—Take 1 tablet a day for twenty-one days. Skip seven days. Then repeat the cycle. 
• For the twenty-eight–day cycle—Take 1 tablet a day for twenty-eight days. Then repeat the cycle. 
• Teenagers up to 15 years of age—Use and  dose must be determined by your doctor. 

Missed Dose 

Call your doctor  or pharmacist for instructions. 

Follow your doctor's orders or  the directions on the label if  you miss a dose of estrogen and progestin  oral contraceptives. The following information includes only some of the ways to handle missed doses. Your health care professional may want  you to stop  taking the medicine  and use other birth control methods for  the rest of the month until you have  your menstrual period. Then your health care professional can tell you how  to begin taking your medicine again. 

For monophasic, biphasic, or triphasic cycles: 

• If you miss the first tablet of a new cycle—Take the missed tablet as soon as you remember and take the next tablet at the usual time.  You may take 2 tablets in one day. Then continue your regular dosing schedule. Also,  use another  birth control method until  you have taken seven days of  your tablets after the last missed dose. 
• If  you miss 1 tablet during the cycle—Take the missed tablet as soon as you remember. Take the next tablet at the usual time. You may  take 2 tablets in one day. Then continue  your regular dosing schedule. 
• If you miss 2 tablets in a row in the first or second week—Take 2 tablets on the day  that you remember and 2 tablets the next day. Then continue taking 1 tablet  a day. Also use another  birth control method until you begin a new cycle. 
• If you miss 2 tablets in a row in the third week;  or
• If  you miss 3 or more tablets in a row at any time during  the cycle— 

1. Using a Day-1 start: Throw out your current cycle and  begin taking a new cycle. Also, use another birth control method until  you have taken seven days of  your tablets after the last missed dose. You may not have a menstrual period this month. But if  you miss two menstrual periods in a row, call your health care professional. 
2. Using a Sunday start: Keep taking one tablet a  day from your current pack until Sunday. Then, on Sunday, throw out your old pack and begin a new pack. Also use another birth control method until  you have taken seven days of your tablets after the last missed dose. You may  not have a menstrual period this month. But if  you miss two menstrual periods in a row, call  your health care professional. 

If you miss any of  the last seven (inactive) tablets  of a twenty-eight–day cycle, there is no danger of pregnancy. However,  the first tablet (active)  of the next month's cycle must be taken on  the regularly scheduled day, in spite  of any missed doses, if pregnancy is to  be avoided. The active and inactive tablets are colored differently  for your convenience. 

Storage

Keep out of the reach of children.

Store the medicine in a closed container  at room temperature,  away from heat, moisture, and direct light. Keep from freezing. 

Do not keep  outdated medicine or medicine no longer needed.

Precautions While Using estrogen and progestin oral contraceptives 

It is very important that  your doctor check your progress at regular visits to make sure estrogen and progestin oral contraceptives does not cause unwanted effects. These visits will usually be every 6 to 12 months, but some doctors require them more often. 

Tell  the medical doctor  or dentist in charge that you are taking estrogen and progestin oral contraceptives before any kind of surgery (including dental surgery) or  emergency treatment. Your doctor will decide whether you should continue taking estrogen and progestin oral contraceptives. 

The following medicines may reduce the effectiveness of oral contraceptives. You should use an additional method of birth control during each cycle in which any of the following medicines are used: 

• Ampicillin 
• Barbiturates
• Carbamazepine (e.g., Tegretol) 
• Griseofulvin (e.g., Fulvicin) 
• Penicillin V 
• Phenytoin (e.g., Dilantin) 
• Primidone (e.g., Mysoline) 
• Rifampin (e.g., Rifadin) 
• Ritonavir (e.g., Norvir) 
• Tetracyclines (medicine for infection) 
• Troglitazone (e.g., Rezulin) 

Check with your doctor if you have any questions about this. 

Vaginal bleeding of various amounts may occur between your regular menstrual periods during the first 3 months of use. This is sometimes called spotting when slight, or breakthrough bleeding when heavier. If this  should occur: 

• Continue on your regular dosing schedule. 
• The bleeding usually stops within 1 week. 
• Check  with your doctor if the bleeding continues for more than 1 week. 
• After you  have been taking oral contraceptives on schedule  and for more than 3 months  and bleeding continues, check with your doctor. 

Missed menstrual periods may occur: 

• If  you have not taken  the medicine exactly as scheduled. Pregnancy must be considered as a possibility. 
• If the medicine is not the right strength or type for your needs. 
• If you stop taking oral contraceptives, especially if you have taken oral  contraceptives for 2 or more years 

Check with  your doctor if  you miss any menstrual periods so that the cause may be determined. 

In some patients using estrogen-containing oral contraceptives, tenderness, swelling, or bleeding  of the gums may occur. Brushing and flossing your teeth carefully and  regularly and massaging your gums  may help prevent this. See your dentist regularly  to have your teeth cleaned. Check with your medical doctor or dentist  if you have any questions about how to take care of your teeth and gums,  or if you notice any tenderness, swelling,  or bleeding  of your gums. Also,  it has been shown that estrogen-containing  oral contraceptives may cause a healing problem called dry socket after a tooth has been removed.  If you are going  to have a tooth removed, tell your dentist or oral surgeon that you are  taking oral contraceptives. 

Some people who take oral  contraceptives may become more sensitive to sunlight than they are normally. When you begin taking estrogen and progestin oral contraceptives, avoid too much sun and  do not use a sunlamp until you see how you react  to the sun, especially if  you tend to burn easily. If  you have a severe reaction, check with your doctor. Some people may develop brown, blotchy spots on exposed areas. These spots usually disappear gradually when the medicine is stopped. 

If you suspect that you may have become pregnant,  stop taking estrogen and progestin  oral contraceptives immediately and check with your doctor 

If you are scheduled for  any laboratory tests, tell your doctor  that you are taking birth control pills 

Check with your doctor before refilling an old prescription, especially after a pregnancy. You will need another physical examination and your doctor  may change your prescription.
estrogen and progestin oral contraceptives Side Effects 

Healthy women who do not smoke cigarettes  have almost no chance of having a severe side effect from taking oral contraceptives. For most women, more problems occur because of pregnancy than will occur from taking oral contraceptives. But for some women who have special health problems, oral contraceptives can cause some unwanted effects. Some of these unwanted effects include benign (not cancerous) liver tumors, liver cancer, or blood clots or related problems, such as a stroke. Although these effects are very rare, they can be serious enough to cause death. You may want to discuss these effects  with your doctor.

Smoking cigarettes during the use of oral  contraceptives has been found to greatly increase  the chances of these serious side effects occurring. To reduce  the risk of serious side effects, do not smoke cigarettes while  you are  taking oral contraceptives. Cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive use. The risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age. 

Along with its needed effects, a medicine may cause some unwanted effects. Although  not all of these side effects may occur, if they do occur they may need medical attention. 

The following side effects may be caused by blood clots. Get emergency help immediately if  any of the following side effects occur: 

Rare

• Abdominal or stomach pain (sudden, severe, or continuing) 
• coughing up blood 
• headache (severe or sudden) 
• loss of coordination (sudden) 
• loss of vision or change in vision (sudden) 
• pains in chest, groin, or leg (especially in calf of leg) 
• shortness of breath (sudden or unexplained) 
• slurring of speech (sudden) 
• weakness, numbness, or pain in arm or leg (unexplained) 

Check with your doctor as soon as possible if any of the following side effects occur: 

More common  - usually less common after the first 3 months of oral contraceptive use 

• Changes in the uterine bleeding pattern at menses or between menses, such as decreased bleeding at menses, breakthrough bleeding or spotting between periods, prolonged bleeding at menses, complete stopping of menstrual bleeding that occurs over several months in a row, or stopping of menstrual bleeding that only occurs sometimes 

Less common 

• Headaches or migraines (although headaches may lessen in many users, in others, they may increase in number or become worse) 
• increased blood pressure 
• vaginal infection with vaginal itching or irritation, or thick, white, or curd-like discharge 

For women with diabetes mellitus 

• Mild increase of blood sugar—Faintness, nausea, pale skin, or sweating 

Rare

• Mental depression 
• swelling, pain, or tenderness in upper abdominal area 

For women who smoke tobacco 

• Pains in stomach, side, or abdomen 
• yellow eyes or skin 

For women with a history of breast disease 

• Lumps in breast 

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: 
More common 

• Abdominal cramping or bloating 
• acne (usually less common after first 3 months  and may improve if acne already exists) 
• breast pain, tenderness, or swelling 
• dizziness
• nausea
• swelling of ankles  and feet
• unusual tiredness or weakness 
• vomiting

Less common 

• Brown, blotchy spots on exposed skin 
• gain or loss of body or facial hair 
• increased or decreased interest in sexual intercourse 
• increased sensitivity of skin to sunlight 
• weight gain or loss 

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. 

Call your doctor for medical advice about side effects. You may report side effects to the FDA.