Specific laboratory test interference has not been reported. Norgestimate; ethinyl estradiol does not protect against human immunodeficiency virus HIV infection or other sexually transmitted disease. Patients with known HIV infection or acquired immunodeficiency syndrome AIDS should be aware that the use of oral hormonal contraceptives will not prevent the transmission of HIV or other diseases to their partner s.
Surgery can increase the risk for thromboembolism from combined hormonal contraceptives. If feasible, discontinue norgestimate; ethinyl estradiol products at least 4 weeks before and through 2 weeks after major surgery or other surgeries known to have an elevated risk of thromboembolism, and during and following any prolonged immobilization.
Because of the increased potential for embolic risk, combined oral contraceptives COCs containing norgesimate; ethinyl estradiol are contraindicated in women who currently have diabetes mellitus and are over 35 years of age, diabetes mellitus with hypertension or with vascular disease or end-organ damage, or diabetes mellitus of greater than 20 years duration.
Patients with diabetes mellitus should be observed for changes in glucose tolerance when initiating or discontinuing estrogen therapy, since estrogen therapy may exacerbate diabetes.
Altered glucose tolerance secondary to decreased insulin sensitivity has been reported. Women who are being treated for dyslipidemia should be followed closely if they elect to use combined oral contraceptives COCs. Some progestogens may elevate LDL levels and may render the control of hyperlipidemia more difficult.
Females with hypertriglyceridemia, or a family history thereof, may be at an increased risk of pancreatitis when using COCs. Norgestimate; ethinyl estradiol is contraindicated in patients with migraine or other headache that is accompanied by focal neurological symptoms, such as aura, or women over age 35 with any migraine headaches. COCs may cause an exacerbation of migraine or a change in headache patterns and should be used with caution in women with migraine. Patients who complain of migraine with focal neurologic visual changes should be medically evaluated, and in some patients, such changes may indicate cerebrovascular events.
Consistent with potential thrombotic effects of combined oral hormonal contraceptives COCs , there have been clinical case reports of retinal thrombosis with COC use. The COC should be discontinued if there is unexplained visual disturbance, partial or complete loss of vision, onset of proptosis or diplopia, papilledema, or retinal vascular lesions.
Appropriate diagnostic and therapeutic measures should be undertaken immediately. Estrogens can increase the curvature of the cornea; patients using contact lenses wearers who develop visual changes or changes in lens tolerance should be assessed by an ophthalmologist.
Norgestimate; ethinyl estradiol is contraindicated in patients with hypersensitivity to any of the product components. Ethinyl estradiol is generally contraindicated in patients who have a history of anaphylaxis or history of angioedema to the drug. Cases of both anaphylactic reactions and angioedema have been reported in patients taking estrogens.
Events have developed in minutes and have required emergency medical treatment. Exogenous estrogens may induce or exacerbate symptoms of angioedema, particularly in women with hereditary angioedema, which may be hormonally sensitive.
Given the increased prevalence of hypercoagulable states in patients with systemic lupus erythematosus SLE in particular antiphospholipid antibodies and lupus anticoagulant and the risk factors for thromboembolism, consider risks vs.
Avoid COC use in SLE patients with a history of venous or arterial thrombosis or the presence of a hypercoagulable state. Combined hormonal oral contraceptive COC use has also been reported to induce, unmask, or exacerbate SLE; more data are needed.
Discontinue norgestimate; ethinyl estradiol if pregnancy is detected; there is no reason to continue combined oral hormonal contraceptives COCs during pregnancy.
Epidemiologic studies and meta-analyses have not found an increased risk of genital or nongenital birth defects including cardiac anomalies and limb-reduction defects following exposure to COCs before conception or during early pregnancy. For any patient who has missed two consecutive periods, pregnancy should be ruled out. If the patient has not adhered to the prescribed COC schedule, consider the possibility of pregnancy at the first missed period.
Discontinue COC use if pregnancy is confirmed. Manufacturers recommend avoidance of combined hormonal oral contraceptives COCs if possible during breast-feeding until a mother has completely weaned her child. Small amounts of oral contraceptive steroids estrogens and progestins have been identified in the milk of nursing mothers and a few reports of effects on the infant exist, including jaundice and breast enlargement. Experts often recommend avoidance of estrogen-containing hormonal contraceptives, in the first 21 days postpartum due to maternal post-partum risks for thromboembolism following obstetric delivery, and the potential for COCs to interfere with the establishment of lactation.
It is generally accepted that estrogen-containing combined hormonal contraceptives may be used after this period in healthy women without other risk factors; general monitoring of the infant for effects such as appetite changes, breast changes and proper weight gain and growth should occur.
Estrogens, including ethinyl estradiol EE , have been reported to interfere with milk production and duration of lactation in some women, particularly at doses of 30 mcg per day or more. One study found that lower dose oral combined contraceptives e. However, a systematic review concluded that the available evidence, even from randomized controlled trials, is limited and of poor quality; proper trials are needed. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition.
Alternate contraceptive agents for consideration for use during breast-feeding include non-hormonal contraceptive methods and also progestin-only contraceptives e. Norgestimate; ethinyl estradiol products are contraindicated in patients with hepatic disease. Because of the association with cholestasis and hepatic neoplasms, estrogens are contraindicated in the presence of hepatocellular cancer, hepatic adenoma, other liver tumors benign or malignant , or markedly impaired liver function e.
Discontinue use of norgestimate; ethinyl estradiol if jaundice develops during COC use. Steroid hormones may be poorly metabolized in patients with liver impairment. Acute or chronic disturbances of liver function may necessitate the discontinuation of COC use until markers of liver function return to normal and COC causation has been excluded. Patients with hepatitis C who are being treated with ombitasvir; paritaprevir; ritonavir, with or without dasabuvir, are also contraindicated to receive COCs.
During clinical trials with the hepatitis C combination drug regimen that contains ombitasvir; paritaprevir; ritonavir, with or without dasabuvir, ALT elevations greater than 5 times the upper limit of normal ULN , including some cases greater than 20 times the ULN, were significantly more frequent in women using ethinyl estradiol-containing medications.
Discontinue COCs prior to starting hepatitis C therapy with the combination drug regimen ombitasvir; paritaprevir; ritonavir, with or without dasabuvir; COCs can be restarted approximately 2 weeks after completing treatment with the hepatitis C combination drug regimen. Hepatic adenomas are associated with COC use. An estimate of the attributable risk is 3. Rupture of hepatic adenomas may cause death through intra-abdominal hemorrhage. Studies have shown an increased risk of developing hepatocellular carcinoma in long term more than 8 years COC users.
However, the attributable risk of liver cancers in COC users is less than 1 case per million users. Use COCs with caution in patients with pre-existing gallbladder disease; however, recent studies have shown that the relative risk of developing gallbladder disease among COC users appears minimal due to the use of products that contain lower doses of hormones.
Mood disorders, like depression, may be aggravated in women taking hormones or combined oral hormonal contraceptives COCs. Data regarding the association of COCs with onset of depression or exacerbation of existing depression are limited. If significant depression occurs, norgestimate; ethinyl estradiol should be discontinued. Norgestimate; ethinyl estradiol products are contraindicated in patients with a history of, or known or suspected breast cancer, as breast cancer is a hormonally-sensitive tumor.
All women taking combined oral contraceptives COCs should receive clinical breast examinations and perform monthly self-examinations as recommended by their health care professional based on patient age, known risk factors, and current standards of care.
There is substantial evidence that use of COCs does not increase the incidence of breast cancer. With perfect use, less than one will become pregnant. The type and amount of hormones in combination birth control pills don't change how effective the pill is. All combination pills prevent pregnancy the same way. Research confirms Ortho Tri-Cyclen Lo is still an extremely effective contraceptive method despite having lower hormone levels than some pills.
A generic alternative called Tri-Lo Sprintec is available, as well. Under the Affordable Care Act , you should be able to get the generic version of these birth control pills for free. But, if you want to buy Ortho Tri-Cyclen Lo and not its generic alternative , you are probably going to have a co-pay when buying this birth control pill brand. Because the hormone levels are different in each week of an Ortho Tri-Cyclen Lo pill pack, the directions for forgetting a pill or two depend on which week it's in.
If you missed ONE pill that was white , light blue , or dark blue :. If you missed TWO pills in a row that were white or light blue :. If you missed any of the seven dark green "reminder pills":. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. National Library of Medicine DailyMed. Ortho Tri Cyclen Lo. Updated April 25, Scheduled and unscheduled bleeding patterns with two combined hormonal contraceptives: application of new recommendations for standardization.
Fertil Steri l. Int J Fertil Womens Med. A Review of hormone-based therapies to treat adult acne vulgaris in women. Int J Womens Dermatol. Published Mar Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth.
At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data. When you begin on a certain day it is important that you follow that schedule, even if you miss a dose.
Do not change your schedule on your own. If the schedule that you use is not convenient, talk with your doctor about changing it.
For a Sunday start, you need to use another form of birth control eg, condom, diaphragm, spermicide for the first 7 days. You should begin your next and all subsequent day regimens of therapy on the same day of the week as the first regimen began and follow the same schedule.
Do not eat grapefruit or drink grapefruit juice while you are using this medicine. Grapefruit and grapefruit juice may change the amount of this medicine that is absorbed in the body. This medicine has specific patient instructions on what to do if you miss a dose. Read and follow these instructions carefully and call your doctor if you have any questions. Make sure your doctor knows if you miss your period 2 months in a row, because this could mean that you are pregnant.
You could have light bleeding or spotting if you do not take a pill on time. The more pills you miss, the more likely you are to have bleeding. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
Keep from freezing. It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and does not cause unwanted effects.
These visits will usually be every 6 to 12 months, but some doctors require them more often. Your doctor may also want to check your blood pressure while taking this medicine. Although you are using this medicine to prevent pregnancy, you should know that using this medicine while you are pregnant could harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away. Make sure your doctor knows if you had given birth within 4 weeks before you start using this medicine.
Tell your doctor if you or your partner begin to have sexual intercourse with other people, or you or your partner tests positive for a sexually transmitted disease. If this is a concern for you, talk with your doctor. 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. Check with your doctor right away if you miss a menstrual period. Missed periods may occur if you skip one or more tablets and have not taken your pills exactly as directed. If you miss two periods in a row, talk to your doctor. You might need a pregnancy test.
If you suspect that you may be pregnant, stop taking this medicine immediately and check with your doctor. Do not use this medicine if you smoke cigarettes or if you are over 35 years of age. If you smoke while using birth control pills, you increase your risk of having a blood clot, heart attack, or stroke.
Your risk is even higher if you are over age 35, if you have diabetes, high blood pressure, high cholesterol, or if you are overweight. Talk with your doctor about ways to stop smoking. Keep your diabetes under control. Ask your doctor about diet and exercise to control your weight and blood cholesterol level. Using this medicine may increase your risk of having blood clotting problems.
Check with your doctor right away if you have pain in the chest, groin, or legs, especially the calves, difficulty with breathing, a sudden, severe headache, slurred speech, a sudden, unexplained shortness of breath, a sudden unexplained shortness of breath, a sudden loss of coordination, or vision changes while using this medicine. Using this medicine may increase your risk of breast cancer or cervical cancer. Talk with your doctor about this risk.
Check with your doctor immediately if your experience abnormal vaginal bleeding. Check with your doctor immediately if you wear contact lenses or if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. Your doctor may want an eye doctor ophthalmologist to check your eyes. Check with your doctor right away if you have pain or tenderness in the upper stomach, dark urine or pale stools, or yellow eyes or skin.
These could be symptoms of a serious liver problem. Using this medicine may increase your risk for gallbladder surgery. This medicine may make your skin more sensitive to sunlight.
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