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Overview: Norethindrone acetate/ethinyl estradiol is a hormonal birth control pill used to help prevent pregnancy. Common side effects include nausea, breast tenderness, and headaches. This medicine does not protect against HIV or sexually transmitted infections, and you may need to use backup birth control like condoms if you miss doses or have diarrhea or vomiting. Before taking norethindrone acetate/ethinyl estradiol, make sure to tell your health care provider about any health conditions you have or medicines you are taking. Get emergency help if you have trouble breathing, chest pain, vision changes, or trouble speaking.

Uses

What is norethindrone acetate/ethinyl estradiol used for?

Norethindrone acetate/ethinyl estradiol is a combination birth control pill that is commonly used to prevent pregnancy.

Norethindrone acetate/ethinyl estradiol may also be used for other conditions as determined by your health care provider.

How does norethindrone acetate/ethinyl estradiol work (mechanism of action)?

Norethindrone acetate/ethinyl estradiol contains two types of hormones, norethindrone (a progestin) and ethinyl estradiol (an estrogen). It prevents pregnancy by stopping the release of an egg from your ovaries. The medicine also works by thickening the mucus in your cervix to block sperm from reaching the uterus and by changing the lining of your uterus to make it less likely for a pregnancy to happen.

How is norethindrone acetate/ethinyl estradiol supplied?

21-Day Monophasic (one phase)

Junel 1/20, Larin 1/20, Loestrin 1/20, Microgestin 1/20

  • Days 1-21: norethindrone acetate/ethinyl estradiol oral tablets (1 mg/0.02 mg)

Hailey 1.5/30, Junel 1.5/30, Larin 1.5/30, Loestrin 1.5/30, Microgestin 1.5/30

  • Days 1-21: norethindrone acetate/ethinyl estradiol oral tablets (1.5 mg/0.03 mg)

28-Day Monophasic (one phase)

Femlyv

  • Days 1-24: norethindrone acetate/ethinyl estradiol orally disintegrating tablets (1 mg/0.02 mg)
  • Days 25-28: inactive orally disintegrating tablets

How should I store norethindrone acetate/ethinyl estradiol?

Norethindrone acetate/ethinyl estradiol should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when you’re transporting it. Store it in a cool, dry place.

Only remove a tablet from the blister pack when you are ready to take it.

Side Effects

What are the most common side effects of norethindrone acetate/ethinyl estradiol?

The most common side effects of norethindrone acetate/ethinyl estradiol are listed below. Tell your health care provider if you have any of these side effects that bother you.

There may be other side effects of norethindrone acetate/ethinyl estradiol that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of norethindrone acetate/ethinyl estradiol?

While less common, the most serious side effects of norethindrone acetate/ethinyl estradiol are described below, along with what to do if they happen.

Severe Allergic Reactions. Norethindrone acetate/ethinyl estradiol may cause allergic reactions, which can be serious. Stop taking norethindrone acetate/ethinyl estradiol and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown, depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Blood Clots. Norethindrone acetate/ethinyl estradiol may cause a blood clot in your arteries or veins and could cause a stroke, heart attack, or venous thromboembolism, including a blood clot in the lungs (pulmonary embolism) or deep vein thrombosis (DVT). Stop taking norethindrone acetate/ethinyl estradiol and get emergency help if you have any of the following signs of blood clots. 

  • Chest pain or pressure
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, jaw, throat, or arm
  • Sweating, upset stomach, vomiting, or dizziness
  • Sudden weakness on one side of your body
  • Sudden and severe headache
  • Slurred speech or trouble understanding speech
  • Pain, swelling, or tenderness in your arm or leg
  • Vision loss
  • Bulging eyes 
  • Double vision

Increased Blood Pressure (Hypertension). Norethindrone acetate/ethinyl estradiol may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your health care provider if your blood pressure increases while taking this medicine.

If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for and tell your health care provider right away if you have any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea or vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heartbeats

Headache. Stop taking norethindrone acetate/ethinyl estradiol and call your health care provider right away if you get new headaches or migraines that keep coming back or cause you a lot of pain.

Cancer. Norethindrone acetate/ethinyl estradiol is a combination birth control pill that contains two hormones. Certain cancers, including breast cancer and cervical cancer, may be sensitive to hormones. Make sure you keep all appointments with your health care provider.

Liver Problems. Norethindrone acetate/ethinyl estradiol may cause changes to your liver function, including an increase in your liver enzymes or possibly liver tumors. Call your health care provider if you have any of the following symptoms of liver problems.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Gallbladder Problems. Taking norethindrone acetate/ethinyl estradiol can cause gallbladder problems, including cholecystitis and cholelithiasis (also known as gallstones). Call your health care provider right away if you have any of the following symptoms.

  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)
  • Fever
  • Pain in your upper stomach area
  • Stool (poop) that is clay-colored

Changes in Menstrual Bleeding. Norethindrone acetate/ethinyl estradiol can cause irregular bleeding, spotting, or light bleeding between periods, especially during the first three months of use. For some people, periods may stop. Call your health care provider right away if you continue to have spotting or breakthrough bleeding between periods, or if you have spotting after having regular cycles while taking norethindrone acetate/ethinyl estradiol. Call your health care provider if you miss a period or your periods stop.

Depression. Norethindrone acetate/ethinyl estradiol may cause changes in mood, including depression. Call your health care provider right away if you have new or increased depression or other unusual changes in mood or behavior. If you are about to harm yourself, call 911 or call or text 988, the Suicide & Crisis Lifeline.

Warnings & Precautions

Who should not use norethindrone acetate/ethinyl estradiol?

Allergies to Ingredients. People who are allergic to any of the following should not take norethindrone acetate/ethinyl estradiol.

  • Norethindrone acetate
  • Ethinyl estradiol
  • Hailey
  • Junel
  • Larin
  • Loestrin
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific norethindrone acetate/ethinyl estradiol products they stock.

Smoking. Norethindrone acetate/ethinyl estradiol should not be used if you smoke and are over age 35.

Blood Clots. Norethindrone acetate/ethinyl estradiol should not be used if you have or have had blood clots, including a blood clot in the lungs (pulmonary embolism) or deep vein thrombosis (DVT). This medicine should also not be used if you have a condition that makes your blood more prone to getting blood clots (thrombophilia). Norethindrone acetate/ethinyl estradiol can increase the risk of developing a blood clot that could be dangerous or even deadly.

Heart Attack or Stroke. Norethindrone acetate/ethinyl estradiol should not be used if you have had a stroke or heart attack. Norethindrone acetate/ethinyl estradiol can increase the risk of having a heart attack or stroke that could be dangerous or even deadly.

Blood Vessel Problems. Norethindrone acetate/ethinyl estradiol should not be used if you have or have had a history of plaque buildup in your blood vessels (coronary artery disease) or if you have or have had a condition that affects blood flow to your brain (cerebrovascular disease). Norethindrone acetate/ethinyl estradiol could increase your chances of having a heart attack, stroke, or blood clots.

Heart Problems. Norethindrone acetate/ethinyl estradiol should not be used if you have heart rhythm problems (such as atrial fibrillation) or heart valve problems, as heart rhythm problems may increase your chance of having a blood clot.

Increased Blood Pressure (Hypertension). Norethindrone acetate/ethinyl estradiol should not be used if you have high blood pressure that is not managed or high blood pressure with a condition that affects your blood vessels (vascular disease). Norethindrone acetate/ethinyl estradiol could increase your chance of having a heart attack, stroke, or blood clots.

Diabetes. Norethindrone acetate/ethinyl estradiol should not be taken if you have diabetes with high blood pressure or diabetes with kidney, eye, nerve, or blood vessel damage. Norethindrone acetate/ethinyl estradiol should also not be taken if you have had diabetes for more than 20 years.

Headaches or Migraine. Norethindrone acetate/ethinyl estradiol should not be used if you are over age 35 and have any type of migraine headaches (with or without aura). This medicine should not be used by anyone who has had a migraine with vision or hearing changes, muscle weakness, tingling, or trouble speaking (known as migraine with aura). These types of headaches can increase your risk of having a stroke. 

Breast Cancer. Norethindrone acetate/ethinyl estradiol should not be used if you have or have had breast cancer or uterine cancer. Some breast cancers are sensitive to hormones and could get worse if you use norethindrone acetate/ethinyl estradiol.

Liver Problems. Norethindrone acetate/ethinyl estradiol should not be used if you have a liver tumor or your liver is not working as well as it should be. If there is a concern about the health of your liver, your health care provider may do tests to see if it is working well enough for you to take this medicine.

Unusual Vaginal Bleeding. Norethindrone acetate/ethinyl estradiol should not be used if you are bleeding between your monthly periods without any specific causes. Any unusual uterine bleeding needs to be checked out by your health care provider.

Jaundice. Norethindrone acetate/ethinyl estradiol should not be taken if you have had a history of jaundice when taking birth control or have had cholestatic jaundice during pregnancy.

Drug Interactions. Norethindrone acetate/ethinyl estradiol should not be taken while you are using certain other medicines. Before taking norethindrone acetate/ethinyl estradiol, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

What should I know about norethindrone acetate/ethinyl estradiol before using it?

Do not take norethindrone acetate/ethinyl estradiol unless it has been prescribed to you by a health care provider. Take it as prescribed.

Do not share norethindrone acetate/ethinyl estradiol with other people, even if they have the same condition as you. It may harm them.

Keep norethindrone acetate/ethinyl estradiol out of the reach of children.

Norethindrone acetate/ethinyl estradiol does not protect against human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), or other sexually transmitted infections (STIs).

Expect to start norethindrone acetate/ethinyl estradiol during a specific time of your menstrual period or within a certain time after having a baby or abortion. The timing will determine whether and for how long you need to use backup birth control (such as condoms or spermicide) after starting norethindrone acetate/ethinyl estradiol. Ask your health care provider if you are not sure how or when to start norethindrone acetate/ethinyl estradiol.

If you have vomiting or diarrhea within a few hours of taking norethindrone acetate/ethinyl estradiol, it may not work as well. Follow the Patient Labeling on what to do if this happens or call your health care provider. You may need to use  backup birth control (such as condoms or spermicide).

What should I tell my health care provider before using norethindrone acetate/ethinyl estradiol?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if norethindrone acetate/ethinyl estradiol is right for you.

In particular, make sure that you discuss any of the following.

 Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Nodules or fibroids in the breast
  • Diabetes
  • High cholesterol or triglycerides
  • High blood pressure
  • Headaches or migraine
  • Epilepsy
  • Depression
  • Gallbladder, heart, or kidney problems
  • History of irregular periods
  • A condition called hereditary angioedema

Smoking. Smoking can increase your risk of getting heart disease, which increases your risk of having a heart attack, stroke, or blood clots. Tell your health care provider if you smoke before starting norethindrone acetate/ethinyl estradiol.

Skin Darkening. Talk to your health care provider if you have had a condition that led to dark patches of skin around your forehead, nose, cheeks, and around your mouth (chloasma) during pregnancy because you may have an increased chance of having chloasma while taking norethindrone acetate/ethinyl estradiol. If you have had chloasma, avoid exposure to the sun and to ultraviolet (UV) rays from tanning booths or sun lamps.

Upcoming Surgery or Bed Rest. You may be at increased risk for some side effects of norethindrone acetate/ethinyl estradiol if you do not move around normally for an extended period of time. Tell your health care provider if you have any upcoming surgeries or need to be on bed rest. Your health care provider can tell you if or when you need to stop taking norethindrone acetate/ethinyl estradiol.

Contact Lenses. Norethindrone acetate/ethinyl estradiol may make it hard to wear contact lenses. Tell your health care provider if you become sensitive or intolerant to wearing them while taking this medicine.

Pregnancy. Do not take norethindrone acetate/ethinyl estradiol and tell your health care provider if you are pregnant or plan to become pregnant. If you become pregnant, stop taking norethindrone acetate/ethinyl estradiol right away and contact your health care provider.

Breastfeeding. Norethindrone acetate/ethinyl estradiol passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Norethindrone acetate/ethinyl estradiol may decrease the amount of breast milk you make. Your health care provider will let you know if you should take norethindrone acetate/ethinyl estradiol while breastfeeding.

Interactions

Does norethindrone acetate/ethinyl estradiol interact with foods or drinks?

Eating grapefruit or drinking grapefruit juice while taking norethindrone acetate/ethinyl estradiol can increase the level of estrogens in your body. Talk to your health care provider if you eat grapefruit or drink grapefruit juice.

There are no known interactions between norethindrone acetate/ethinyl estradiol and alcohol.

Does norethindrone acetate/ethinyl estradiol interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking norethindrone acetate/ethinyl estradiol.

  • A medicine for HIV, AIDS, or hepatitis C
  • Carbamazepine (Carbatrol, Tegretol, and others), which is a medicine commonly used to treat seizures or nerve pain
  • Phenytoin (Dilantin, Phenytek, and others), which is a medicine to control seizures
  • Lamotrigine (Lamictal), which is a medicine to control seizures
  • Felbamate (Felbatol) or oxcarbazepine (Trileptal, Oxtellar XR), which is a medicine to control seizures
  • Topiramate (Qudexy XR, Topamax, Trokendi XR), which is a medicine commonly used to treat seizures or prevent migraine
  • A barbiturate, such as butalbital, phenobarbital, or primidone, which is a medicine that may be used to treat insomnia, migraine, or seizures
  • Bosentan, which is a medicine used to treat a condition called pulmonary arterial hypertension (PAH)
  • Fluconazole (Diflucan), griseofulvin, itraconazole (Sporanox, Tolsura), ketoconazole, or voriconazole (Vfend), which are medicines used for fungal infections
  • Rifampin (Rifadin), which is a medicine commonly used to treat an infection called tuberculosis
  • St. John’s wort, which is a supplement that may be used for depression
  • A thyroid medicine, such as levothyroxine, which is used to raise thyroid hormone levels
  • A tetracycline, such as doxycycline, minocycline, omadacycline (Nuzyra), sarecycline (Seysara), or tetracycline, which is a medicine used to treat infections or other conditions
  • Cyclosporine (Gengraf, Neoral, Sandimmune, and others), which is a medicine that suppresses your immune system
  • Theophylline (Elixophyllin, Theo-24), which is a medicine for asthma or certain other breathing problems

Some other medicines may alter the blood levels of norethindrone acetate/ethinyl estradiol, and vice versa. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with norethindrone acetate/ethinyl estradiol. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much norethindrone acetate/ethinyl estradiol?

If you or someone else has used too much norethindrone acetate/ethinyl estradiol, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of norethindrone acetate/ethinyl estradiol?

Norethindrone acetate/ethinyl estradiol may not work well if you miss tablets. Follow the Patient Labeling on how to take norethindrone acetate/ethinyl estradiol when you miss a dose, as this can change depending on how many tablets you have missed and which weeks they were missed on. In some cases, you may need to avoid sexual intercourse or use backup birth control (such as condoms or spermicide).

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