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Introduction

The generic of this medication is: Norethindrone 0.35m. Other similar brand names are: Camila, Deblitane, Errin, Heather, Incassia, Jencycla, Jolivette, Lyza, Nor-QD, Nora-BE, Norlyda, Norlyroc, Ortho Micronor, Sharobel, Tulana

This birth control plan reviews the risks and benefits of the treatment we are recommending. Please make sure to read it and the manufacturer's pamphlet that comes with the medicine. The manufacturer's pamphlet contains the full information on interactions, side effects, and other important information you should know about the medicine before you start.

Active Ingredient

• Norethindrone (progestin analog)
  

Instructions

You have stated that you wish to take oral contraception pills to prevent pregnancy and in some instances improve menstrual symptoms. This medication is a progestin only form of hormonal oral contraceptive. It contains the hormone: Norethindrone (progestin). It works mainly by suppressing the release of an egg (ovulation) during your menstrual cycle, thickening your cervical mucus, and thinning your endometrium. This contraceptive should be taken at the same time daily and no later than 3 hours from the time administered from the previous day.

This contraceptive is great for those with a history of high blood pressure, migraines with aura, migraines without aura in patients over age 35, and other conditions that prevent estrogen contraceptive use.

When to Start

This treatment can be started on the day of pick up or delivery. You do not need to start this pill at any particular point within your menstrual cycle. You will need to use a backup method, like condoms, for the first 48 hours if you're having reproductive intercourse before pregnancy prevention will begin. Oftentimes packs start on a Sunday, if you'd like to wait until the Sunday of your next cycle you may, but you may still experience irregular bleeding for the first 3 packs as your body is adjusting to the hormones as expected.

Switching from a different contraceptive:

• Oral contraceptive: Start your oral birth control the day after your last contraceptive pill was taken. Use a backup method for 48 hours if any doses were missed between packs.

• Transdermal patch and vaginal ring- Start your oral birth control the day before your patch/ring is removed. Use a backup method for 48 hours if you had any hormone free days during your last patch/ring cycle.

• Injection- Start your oral birth control up to 15 weeks after your last injection. You should use a backup method for 48 hours if it's been 15 weeks or over since your last injection.

• IUD or implant: Start your oral contraceptive 7 days prior to removal. If you start your oral contraceptive after removal or 48 hours before removal ensure to use a backup method for the first 48 hours.
  
  

Refills

You will automatically be sent a refill every 90 days (subject to a refill visit to help screen for side effects). You may request a refill early by logging into your Account (Subscriptions > Next Refill) or placing a new one-time order. If you decide to stop treatment prior to using your complete subscription please contact us for further guidance.

Allergies

This medicine, like all medications, may cause an allergic reaction if you are allergic to similar medicines or components. If you are allergic to any of the following please do not take the medicine and call or message us or see your medical provider in person.

• Norethindrone
  
  

Conditions

We have evaluated your health history and the specific health information you provided us, however if anything changes and you develop one of these conditions, please stop taking this medicine and call or message us immediately. This list is not all inclusive.

• Adrenal insufficiency
• Current or history of estrogen or progesterone sensitive cancer
• Hepatic tumors
• Pregnancy
• Renal impairment
• Undiagnosed abnormal uterine bleeding
• Taking Hepatitis C drugs (Ombitasvir/paritaprevir/ritonavir with or without dasabuvir)
• Cerebrovascular disease or history of strokes
• Coronary artery disease or history of heart attack
• Lupus with unknown or positive antiphospholipid antibody status
• Porphyria
• Bariatric surgeries (Roux-en-y & biliopancreatic diversion)
• Advised by a healthcare provider to not take hormones
• Menopause

Pregnancy and Breastfeeding

This contraceptive is not recommended during pregnancy.

Fair quality evidence shows Norethindrone does not adversely affect milk supply or the growth and development of the infant. This formulary is safe while breastfeeding.

Medicines, Supplements, and Foods

We have evaluated the specific health information you provided us, however if you are taking any of the medicines, foods, or supplements listed below call or message us before you take the medicine. Some of these can cause your birth control to be less effective and cause more severe or dangerous side effects. Please ensure your chart is up to date with your current medications, allergies, and medical conditions so your provider can safely treat you as this list may not be all inclusive.

• Antibiotics: Rifampin, Rifabutin
• Anticonvulsants or anti-seizure medications such as: carbamazepine (Tegretol®), phenytoin (Dilantin®), oxcarbazepine (Trileptal®), primidone or topiramate (Topamax®), Lamictal (Lamotrigine), Rufinamide, Felbamate
• Antiretrovirals: Efavirenz, nevirapine, nelfinavir, and some ritonavir-containing drugs
• Herbal medications such as St. John’s wort and DIM
• HIV Medications
• Modafinil (Provigil®)
• Barbiturates like Phenobarbital
• Ella (Ulipristal Acetate)

Emergency Side Effects

True anaphylactic allergic reactions to oral contraception are extremely rare because the active ingredients in these medications mimic naturally occurring hormones in your body. If any of the emergency side effects listed in the manufacturer's pamphlet happen to you please stop taking the medicine and call 911 or seek immediate medical help in person. This list is not all inclusive

• Allergic reaction like: rash, hives, itching, red, swollen, blistered, or peeling skin with or without fever, wheezing, tightness or pain in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
• Liver problems like: dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.
• Signs of a blood clot like: chest pain or pressure, coughing up blood, shortness of breath, swelling, warmth, numbness, change of color, or pain in a leg or arm, trouble speaking, or swallowing
• Visual changes
• Sudden severe onset headaches
• One sided or persistent leg pain with or without swelling
• Weakness or numbness in your extremities
• Trouble speaking

Other Side Effects

This medicine can also cause other side effects including (this list is not all inclusive):

• Headaches
• Vaginal discharge
• Edema (swelling in legs)
• Worsening of varicose veins
• Mood changes
• Melasma (brownish skin, on the forehead, nose, upper lip, and cheeks)
• Amenorrhea (loss of period)
• Breast Changes: breast enlargement, discharge, tenderness, pain
• Increased or decreased Weight
• Changes in menstrual flow
• Abdominal cramps, bloating, nausea, vomiting
• Breakthrough bleeding, spotting, changes in secretions
• Yeast infection
• Change in sexual drive
• Acne
  
  

Accurate Information

We have evaluated the specific health information you provided and are making our recommendations based on it. If you forgot to provide or incorrectly provided that information we may misdiagnose or fail to diagnose conditions that you may have which could affect our recommendation for treatment. If you need to clarify or update any information about your health you can message or call us anytime.

Treatment Failure/Missed Doses

The effectiveness of hormonal oral contraception is very high when it is consistently taken and doses are not missed. The average treatment failure for progestin oral contraception is 9 pregnancies per 100 women. The biggest cause of pregnancy is missed doses.

Missed dose: Take as soon as remembered. A back up method of contraception should be used for 48 hours if dose is taken ≥3 hours late. If you miss two consecutive menstrual cycles, you should take a pregnancy test and consider emergency contraception.

Accepting or Declining Our Recommendation

We are recommending this treatment for you because the potential benefits of treatment outweigh the risks. You should evaluate this information as well as the manufacturer's pamphlet, and any input from your in-person healthcare team, or other relevant information to decide if this treatment plan is appropriate for you. You are free to decline our treatment recommendations.

Alternative Treatment

We have based our recommendation on your specific case and current medical guidelines, but there may be alternative treatments or strategies that may be helpful to you. Some may be more or less effective than what we provide. Some treatments may require an in-person exam or procedure which we can't provide. Message us or talk to your medical provider in-person to discuss alternative treatments. Here are some other treatments or strategies that you might consider:

• Implanon implant contraceptives
• Intrauterine device (IUD)
• Intermittent injections
• Transdermal patches
• Nuvaring
• Male or female condoms
• Diaphragm
• Spermicide
• Alternative oral contraceptive pill
• Sterilization
• Sponge
• Cap
  
  

Share with Your In-Person Healthcare Team

You can access your records anytime. We strongly recommend that you update your in-person primary care provider, pharmacist, and the rest of your healthcare team to let them know about any new medicines you are taking or other changes in your health.

You can also ask us questions anytime and we are happy to help you share any information about your health with your in-person healthcare team.