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Introduction

The generic version of this birth control is Ethinyl estradiol 0.02 mg and norethindrone acetate 1 mg [24 tablets] and ferrous fumarate 75 mg [4 tablets] . Similar brand names to this medication are: Junel FE 1/20, Microgestin® Fe 1/20, Aurovela FE 1/20, Blisovi 24 Fe, Blisovi FE 1/20, Gildess FE 1/20, Hailey FE 1/20, Larin Fe 1/20, Loestrin Fe 1/20, Tarina FE 1/20,

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.

Instructions

You have stated that you wish to take oral contraception pills to prevent pregnancy, ease painful periods, and in some instances to treat acne. This combination hormone medication is used to prevent pregnancy. It contains 2 hormones: norethindrone (a progestin) and ethinyl estradiol (an estrogen). It works mainly by preventing the release of an egg (ovulation) during your menstrual cycle. It also contains Iron (Fe) supplement to help replenish iron in your body that is lost during menstruation. Dose should be taken at the same time each day, preferably either after the evening meal or at bedtime.

When to Start

Schedule 1 (Sunday starter): Dose begins on first Sunday after onset of menstruation; if the menstrual period starts on Sunday, take the first tablet that very same day. With a Sunday start, an additional method of contraception should be used until after the first 7 days of consecutive administration.

Schedule 2 (Day 1 starter): Dose starts on the first day of menstrual cycle taking 1 tablet daily.

Switching from a different contraceptive:

• Oral contraceptive: Start on the same day that a new pack of the previous oral contraceptive would have been taken
• Transdermal patch, vaginal ring, injection: Start on the day the next dose would have been due
• IUD or implant: Start on the day of removal According to the manufacturer, if severe diarrhea or vomiting occur within 3 to 4 hours after taking an active tablet, back-up contraceptive measures may be needed.
  
  

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.

Active Ingredients

• Ethinyl estradiol (Estrogen analog)
• Norethindrone acetatel (progesterone analog)
• Ferrous Fumarate (Iron Supplement)
  
  

Allergies/Contraindications

True anaphylactic allergic reactions to oral contraception are extremely rare because the active ingredients in these medications mimic naturally occurring hormones in your body. However these medications do have other ingredients that may cause allergic reactions. If you experience any of the symptoms below, you should immediately go to the emergency room or call 911.

Allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness 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.

There are several contraindications to taking hormonal combined contraception. If you have any of the following conditions please let your medical provider know prior to starting medication:

• 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)
  
  

Use is also contraindicated in women at high risk of having a blood clot or arterial or venous thrombotic diseases including:

• Cerebrovascular disease or history of strokes
• Coronary artery disease or history of heart attack
• Diabetes mellitus with vascular disease
• Current or history of DVT (deep vein thrombosis) or PE (pulmonary Embolism)
• Hyper Coagulopathies (easy to make blood clots) (inherited or acquired),
• Hypertension or high blood pressure (uncontrolled)
• Headaches with focal neurological symptoms or migraine headaches (with or without aura) if >35 years old
• Thrombogenic valvular or rhythm diseases of the heart (eg, subacute bacterial endocarditis with valvular disease or atrial fibrillation)
• 35+ years old who smoke
• 45+ years old
  
  

Conditions

We have evaluated your health history and the specific health information you provided us, however if anything changes and you develop or discover that one of these conditions applies to you please stop taking this medicine and call or message us immediately.

Pregnancy and Breastfeeding

Use is contraindicated in pregnant women. Combination hormonal contraceptives are used to prevent pregnancy; treatment should be discontinued if pregnancy occurs. In general, the use of combination hormonal contraceptives, when inadvertently used early in pregnancy, have not been associated adverse fetal or maternal effects

Due to the increased risk of blood clots in legs postpartum, combination hormonal contraceptives should not be started in breastfeeding women <21 days following delivery. The risk of getting a blood clot decreases to population baseline by postpartum day 42. Use of combination hormonal contraceptives in women between 21 and 42 days after delivery should take into consideration the individual woman's risk factors for Getting a blood clot (eg, age ≥35 years, previous blood clot, thrombophilia, immobility, preeclampsia, transfusion at delivery, cesarean delivery, peripartum cardiomyopathy, BMI ≥30 kg/m2, postpartum hemorrhage, or smoking). The risks, benefits, and alternatives to combination hormonal contraception should be evaluated when initiating treatment in breastfeeding women. This should be discussed with your medical provider who delivered your child prior to starting treatment.

Emergency Side Effects

This medicine can cause dangerous and potentially life threatening side effects. If any of the emergency side effects listed in the manufacturer's pamphlet or those below happen to you please stop taking the medicine and call 911 or seek immediate medical help in-person:

• Anaphylaxis/anaphylactoid reaction (shortness of breath, difficulty breathing, facial swelling or edema, tongue swelling)
• Jaundice (yellowing of skin and eyes)
  
  

Other Side Effects

• Edema (swelling in legs)
• Worsening of varicose veins
• Depression
• Chloasma (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
  
  

Medicines, Supplements, and Foods

We have evaluated your health history and the specific health information you provided us, however if anything changes and you start or discover that 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. Alternative method of contraceptive (male condoms) Should be used if you are taking these medications:

• Antibiotics: Rifampin, cefixime, ciprofloxacin, fluconazole, metronidazole nitrofurantoin macrocrystal oral.
• Anticonvulsants or anti-seizure medications such as carbamazepine (Tegretol®), phenytoin (Dilantin®), oxcarbazepine (Trileptal®), primidone or topiramate (Topamax®)
• Antifungal medications such as griseofulvin (Gris-PEG®), ketoconazole (Extina®, Nizoral®, Xolegel®)
• Antiretrovirals: ritonavir, ombitasvir, paritaprevir, dasabuvir
• Herbal medications such as St. John’s wort, Saw Palmetto, Alfalfa, Garlic Pills, Flax Seed.
• HIV Medications
• Modafinil (Provigil®)
  
  

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 oral contraception is 4-7 pregnancies per 100 women. The biggest cause of pregnancy is missed doses.

If one dose is late (<24 hours since dose should have been taken) or if one dose is missed (24 to <48 hours since dose should have been taken): Take dose as soon as possible. Continue remaining doses at the usual time (even if that means 2 doses on the same day).

If more than 2 consecutive doses are missed (≥48 hours since dose should have been taken): Take the most recently missed dose as soon as possible, discard any other missed doses. Continue remaining doses at the usual time (even if that means taking 2 doses on the same day); use back-up contraception until hormonal pills have been taken for 7 consecutive days.

If doses were missed during the last week of hormonal (active) tablets (eg, days 15 to 21 of a 28-day pack), omit the hormone-free interval by finishing any remaining hormonal tablets in the current pack and starting a new pack immediately (ie, the day after finishing the hormonal tablets). If unable to start a new pack immediately, back up contraception (male condoms) is needed until hormonal pills from a new pack have been taken for 7 consecutive days.

Consider use of emergency contraception in some situations (refer to guidelines for details). Also refer to prescribing information for product specific information.

If you miss two consecutive menstrual cycles, you should take a pregnancy test.

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 primary care 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
  
  

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.