Norethindrone-E.Estradiol-Iron

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Sep 29, 2023

Warnings

Norethindrone, Ethinyl Estradiol, Iron Risks, Warnings, and Complications

Norethindrone, ethinyl estradiol, and iron can cause serious adverse effects in some people. Talk to your doctor about other birth control pills or non-hormonal birth control if you are at a high risk of complications from hormonal birth control. Some of the potential risks of taking norethindrone, ethinyl estradiol, iron include:

CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS: Smoking cigarettes and using combined oral contraceptives is associated with an increased risk of serious cardiovascular side effects, including stroke, heart attack, and blood clots. The risk is higher in women over the age of 35 years and heavy smokers. If you are taking combined oral contraceptives, your healthcare provider will strongly advise you to stop smoking or use other, safer, non-hormonal birth control options.
BLOOD CLOTS: Combined oral contraceptive pills can increase your risk of venous thrombotic diseases or blood clots in the legs (deep vein thrombosis or DVT), lungs (pulmonary embolism or PE), brain (stroke), heart (heart attack), or eyes. Get emergency help if you develop signs and symptoms of a blood clot:
Legs: Cramps, pain, swelling, warmth, muscle tightness
Lungs: Difficulty breathing, chest pain, cough
Brain: Focal neurological symptoms such as weakness or numbness on one side of the body, dizziness, trouble speaking, trouble walking, loss of balance, blurred vision, confusion
Heart: Chest pain, sweating, nausea, dizziness
Eyes: Loss of vision, double vision, blurred vision, eye pain, swollen or bulging eyes
Women over age 40, women over age 35 who are smokers, those who are on bed rest or have reduced mobility due to recent surgery, women with high blood pressure, high cholesterol, diabetes, obesity, and those taking oral contraceptives containing higher doses of estrogen are at increased risk of these complications. Your doctor may ask you to temporarily stop taking oral contraceptives prior to planned surgery.
CERVICAL AND BREAST CANCER RISK: Taking a combined contraceptive pill can increase your cervical and breast cancer risk. Your healthcare provider might recommend against this birth control method if you have a personal or family history of breast cancer. Follow your provider’s recommendations and perform monthly self-breast examinations at home and yearly mammograms. Tell your doctor without delay if you notice any changes, such as pain, lumps, or swelling in your breasts. Seek immediate medical evaluation if you have abnormal vaginal bleeding, vaginal discharge, or pain during sexual intercourse.
LIVER ENZYME ELEVATION: Ethinyl estradiol was found to cause elevation in liver enzymes during clinical trials with certain hepatitis C drug combinations. Talk to your doctor about taking combined oral contraceptive pills if you are on HCV drug combinations containing ombitasvir, paritaprevir, and ritonavir with or without dasabuvir. You may need to discontinue your birth control pills before starting antiviral therapy. The hormonal birth control can be restarted approximately 2 weeks after you complete hepatitis C treatment.
IRREGULAR BLEEDING: Breakthrough bleeding and spotting can occur while on oral contraceptives, especially during the first three months of use. Tell your doctor if this happens - they may want to evaluate irregular bleeding and rule out non-hormonal causes, pregnancy, or malignancy. Once pathological causes for breakthrough bleeding are excluded, changing to another birth control pill might solve the problem.
METABOLIC EFFECTS: Taking combined oral contraceptive pills can lead to an increase in blood pressure, blood sugar, and blood cholesterol. Monitor blood pressure at home. Prediabetic and diabetic women should discuss the pros and cons of hormonal birth control with their provider. Keep all your lab and medical appointments during treatment. The risk of metabolic effects is higher if you are older or have been taking birth control pills for a long time.
HEADACHE: Tell your healthcare provider if you develop migraine or any new or worsening headaches that are recurrent, persistent, or severe while on hormonal birth control. You may need to stop taking the hormonal contraceptives.

Precautions Before Starting Norethindrone, Ethinyl Estradiol, Iron

Tell your doctor if you have ever had an allergic reaction to norethindrone, ethinyl estradiol, iron, other oral contraceptives, or any other medications. Your pharmacy can give you a list of active and inactive ingredients in the prescribed birth control pills.

Give your doctor a complete medical history. Norethindrone, ethinyl estradiol, and iron may not be right for people with certain health conditions such as breast cancer, liver tumors, hepatic impairment (reduced liver function), liver disease, renal impairment (kidney disease), adrenal insufficiency, undiagnosed abnormal uterine bleeding, cigarette smoking, history of blood clots, thrombophilia, diabetes, high blood pressure, high cholesterol, coronary artery disease, heart attack, or migraine headaches. Also tell your doctor if you have had major surgery or are immobile for some reason.

Give your doctor or pharmacist a complete list of your other medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products, especially St. John’s Wort. This will help avoid possible drug interactions between your birth control pills and your other medications.

Tell your doctor if you are pregnant, could be pregnant, are planning a pregnancy, or are nursing an infant with breast milk.

Precautions During Use of Norethindrone, Ethinyl Estradiol, Iron

Keep all your medical and lab appointments. Take norethindrone, ethinyl estradiol, iron on a Sunday or day 1 of your menstrual period. If you take it on the first day of your menstrual period, you will be immediately protected against pregnancy. If you start the pills on a Sunday, use a backup method of contraception for at least 48 hours.

If you miss a period while on the birth control pill, you may be pregnant. If you have taken all the pills and you miss one period, continue taking the birth control pills. However, if you missed a pill or you miss two menstrual periods in a row, call your doctor and use a backup method of birth control until you have a pregnancy test.

Call your doctor if you have a positive home pregnancy test or other signs and symptoms of pregnancy, such as nausea and breast tenderness while on norethindrone, ethinyl estradiol, iron.

If you vomit or have diarrhea while on norethindrone, ethinyl estradiol, iron, use a backup method of contraception for 48 hours. Talk to your doctor about an appropriate backup method before starting birth control pills.

Ask your doctor when to start taking the pill after childbirth, abortion, or miscarriage.

Tell all your healthcare providers that you are on norethindrone, ethinyl estradiol, and iron before any surgical treatment, including dental procedures.

Avoid smoking while on birth control pills because it can increase your risk of blood clots, heart attack, and stroke.

Norethindrone, Ethinyl Estradiol, Iron Drug Interactions

Certain medicines can affect how well birth control pills work. Taking norethindrone and ethinyl estradiol with other drugs can also increase the risk of severe adverse effects. Your doctor may change the doses of your medications or monitor you carefully for adverse effects if there are known interactions between norethindrone, ethinyl estradiol, iron, and your other medicines.

The following medications can have possible interactions with norethindrone, ethinyl estradiol, and iron:

Tuberculosis medications such as rifampin
Antiepileptic drugs such as phenytoin, phenobarbital, and carbamazepine
Diabetes medications such as troglitazone
Certain antibiotics such as ampicillin, and tetracycline
Antifungal drugs like griseofulvin
Cholesterol-lowering medications like atorvastatin
Combination drug regimen for hepatitis C
Ascorbic acid (vitamin C)
Acetaminophen
Anti-inflammatories such as phenylbutazone
Steroid medications such as prednisolone
Immunosuppressants like cyclosporine
Medications used to treat lung conditions, such as theophylline

The above list may not include all the possible interactions of norethindrone, ethinyl estradiol, and iron. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal remedies. Also, tell your healthcare provider if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medicines.

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