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Ethinyl Estradiol / Norgestrel Review

Ethinyl Estradiol / Norgestrel is a combination of female hormones used as contraception to prevent unwanted pregnancy


Indications for use

  • Contraception.

Mechanism of action

Ethinyl Estradiol / Norgestrel provides a reliable contraceptive effect when used correctly. The contraceptive effect of the drug is due to the temporary suppression of ovulation in the ovaries and an increase in the viscosity of mucus in the cervical canal.

Taking birth control pills for 3 consecutive months and more contributes to the normalization of the menstrual cycle, reducing the pain of menstruation and reducing the amount of blood loss during menstruation. Besides the drug reduces the risk of developing mastopathy, endometriosis, ovarian cancer, uterine cancer and some other gynecological diseases.

Dosage and mode of application

Start taking tablets on the first day of your period (the first day of menstruation). Take one tablet a day, at about the same time, regardless of food intake, for 28 days in a row. During the use of the last seven tablets, you will have menstrual bleeding. Once you have taken the last tablet from the blister, start a new package, without interruption.

The contraceptive effect of the preparation occurs immediately if you started to take tablets on the first day of menstruation. In this case, you may not use additional birth control methods.

If you took the first tablet of the drug on day 2-5 of your period, you need to use condoms for 7 days.

If you took other hormonal contraceptives (without omissions and without factors that reduce the effect of the drug) in the previous month, then the contraceptive effect of Ethinyl Estradiol / Norgestrel persists in the break between packages, and you do not need to use additional methods of contraception.

If you missed previous oral contraceptives or the effect of the pills could be lowered for other reasons (diarrhea, vomiting, large amounts of alcohol, taking other medications), you need to use condoms for 7 days.

In order to get the most reliable contraceptive effect, read the following advice of gynecologists:

  • Never cancel oral contraception in the middle of the package. Even if you decide to get pregnant as soon as possible, finish the current package and then do not start a new one;
  • After taking the last birth control pill, the contraceptive effect disappears. That is, you can get pregnant in the first 7 days after the withdrawal of the drug. If you are not yet planning a pregnancy, start using other contraceptives right after the end of taking these pills.

Side effects

Like all medicines, Ethinyl Estradiol / Norgestrel can cause side effects. They may include:

  • headaches or migraines;
  • nausea;
  • visual impairment;
  • soreness of chest;
  • weight change or fluid retention (bloating);
  • change in sexual desire (libido);
  • depressive conditions;
  • discomfort when wearing contact lenses;
  • pigmentation on the face, similar to the one that appears during pregnancy (chloasma);
  • irregular bleeding or lack of bleeding;
  • changes in vaginal secretions or vaginal candidiasis;
  • skin rashes, such as acne, rashes;
  • bleeding and spotting between menstruation in the first few months (see a doctor if bleeding or spotting continues, becomes heavy or starts again).


It is not recommended to start taking Ethinyl Estradiol / Norgestrel tablets if you have any of the conditions listed below. If any of these conditions occur during the use of birth control pills, they should be discontinued immediately.

  • vaginal bleeding of unknown origin;
  • confirmed or suspected diagnosis of breast cancer;
  • confirmed or suspected diagnosis of hormone-dependent precancerous disease or hormone-dependent malignant tumors;
  • acute arterial thrombosis or thromboembolism (myocardial infarction, stroke);
  • deep vein thrombosis in the acute stage, thromboembolism (including in the anamnesis);
  • pregnancy and lactation;
  • severe hypertriglyceridemia;
  • hypersensitivity to the components of the drug;
  • benign or malignant liver tumors (including in the anamnesis);
  • severe liver disease.

With caution:

  • endometriosis;
  • arterial hypertension;
  • congenital hyperbilirubinemia (Gilbert syndrome, Dubin-Johnson syndrome and Rotor syndrome);
  • cholestatic jaundice or cholestatic itching during the previous pregnancy;
  • uterine myoma;
  • diabetes.


If you are taking or have recently taken any medications, inform your doctor or pharmacist.

Some medicines may affect the efficacy of birth control pills. The doctor will decide whether you should use additional contraception and for how long.

The medicines that can reduce the contraceptive effect of Ethinyl Estradiol / Norgestrel tablets include:

  • antibiotics (ampicillin, tetracycline and rifampicin);
  • medicines for treating epilepsy or other diseases (primidone, carbamazepine, oxcarbazepine, topiramate, hydantoin or barbiturates;
  • ritonavir (a drug used to treat HIV infections);
  • griseofulvin (a drug used to treat fungal infections);
  • medicinal products that include St. John’s wort (hypericum perforatum).

During the use of these medicines and for 7 days after the end of their admission, you need to use an additional method of contraception, for example, condoms. The doctor may advise you to use additional birth control pills for a longer period.

Ethinyl Estradiol / Norgestrel can reduce the effectiveness of other medicines, for example, cyclosporine, lamotrigine, so in such cases, it is necessary to consult a doctor.

Pregnancy and breastfeeding

The drug is not prescribed during pregnancy or lactation (breastfeeding).

Large-scale epidemiological studies of steroid hormones used for contraception did not reveal an increased risk of developing birth defects in children born to women who used hormonal tablets before pregnancy or in the early stages of pregnancy.

A small amount of sex hormones can be excreted in the mother’s milk.

What if I miss a pill?

If you forget to take a tablet, count how many hours have passed since the last pill was taken.

If the delay is less than 36 hours, the contraceptive effect will not decrease. Take the missed tablet as soon as possible and continue to take the tablets in the usual order.

If the delay is more than 36 hours, the contraceptive effect may decrease. In this case, your further actions depend on the number of the missed tablet:

  • 1-7 tablets (first week): take the missed pill as soon as possible, even if you have to take two tablets at a time. Another 7 days after admission, you need to use condoms or other methods of contraception;
  • 8-14 tablets (second week): take the missed pill as soon as possible, even if you have to take 2 tablets at once. The contraceptive effect will not decrease if the previous 7 pills were taken correctly. In this case, you do not need to use condoms or other additional methods of contraception. If you missed tablets in the previous week, you need to use additional contraception for 7 days;
  • 15-21 tablets (third week): take the missed tablet as soon as possible, even if you have to take two tablets at the same time. Continue to take tablets in the usual order until the last active tablet. Then discard the remaining inert tablets and start taking pills from the new package. You do not need to use additional contraception if the previous 7 pills were taken correctly. If you have missed pills during the previous week, you should use condoms for 7 days;
  • 22-28 tablets (fourth week): these are inactive tablets without hormones, so missing these pills will not lead to a decrease in the contraceptive effect. Discard the missed pill and continue to take the pills in the usual order.

When missing 2 tablets in a row, the contraceptive effect may be reduced. To avoid unwanted pregnancy, you should follow the instructions:

  • If these are pills of the first or second week (1-14 tablets), take 2 tablets as soon as you remember about the mistake and 2 more tablets the next day. Then take one tablet a day before the end of the package. Use condoms for 7 days;
  • If the missed tablets refer to the 3 week of admission (15-21 tablets), you should discard the remaining tablets and start a new package of Ethinyl Estradiol / Norgestrel. If you did not miss any pills in the previous 7 days, you do not need to use condoms or other additional methods of contraception;

If you miss 3 tablets in a row, discard the packing and start a new one from the first active tablet. Use additional contraception for 7 days. If you had unprotected sexual intercourse during no-medication days or just before missing a pill, the risk of pregnancy is increased. In this case, you should make a pregnancy test 3.5 weeks after the last unprotected intercourse or take a blood test for HCG 11 days after the last unprotected sexual intercourse.

If you are not sure how to act in your situation, use additional contraceptives (condoms) until you consult a gynecologist.


Some factors may increase the risk of thrombosis. These include:

  • age (risk of heart attack or stroke increases with age);
  • smoking (heavy smoking and age increase the risk of thrombosis). If you are planning to take Ethinyl Estradiol / Norgestrel pills, you need to quit smoking, especially if you are over 35 years;
  • excessive weight (obesity);
  • high blood pressure (hypertension);
  • recent labor (the risk of developing thrombosis increases after the birth of a child);
  • if one of your close relatives ever suffered a disease caused by the formation of blood clots, for example, a heart attack or stroke;
  • diabetes;
  • systemic lupus erythematosus (an inflammatory disease that affects numerous areas of the body, including the skin, joints and internal organs);
  • a blood disease called hemolytic-uremic syndrome (a disease in which blood clots result in kidney failure);
  • disruption of the heart valves or heart rhythm disturbances;
  • Crohn’s disease or ulcerative colitis (chronic inflammatory bowel disease);
  • sickle-cell anemia;
  • a disorder of lipid metabolism or other rare blood diseases;
  • the first occurrence of a migraine or its intensification;
  • if you are planning a serious operation, for example, an operation on your legs, or if your mobility is limited for some time.

When taking Ethinyl Estradiol / Norgestrel, you may have spotting of varying degrees of abundance (scanty spotting or discharge, similar to menstruation). Especially often, bloody discharge occurs in the first 3 months of taking the drug. As a rule, such spotting is not dangerous, does not indicate pregnancy and does not require an urgent visit to a doctor. Despite these discharges, continue taking birth control pills as usual. Do not stop taking the pills without consulting a doctor, as this may increase bleeding. If you did not have missed active pills, the contraceptive effect persists despite these spotting, so you can continue to have sex without fear of becoming pregnant.

If spotting occurs as a result of skipping one or more active tablets, continue taking the drug despite these discharges. Use additional contraception, because missing tablets can reduce the contraceptive effect of the preparation.

During the use of tablets, menstrual bleeding may not come in a 7-day break. As a rule, this is not dangerous but requires special attention.

If you become pregnant when taking birth control pills, stop taking them immediately and contact your gynecologist.

The effectiveness of contraception can be reduced in the following cases:

  • if you miss one or more active tablets;
  • as a result of digestive disorders (vomiting, diarrhea);
  • when you consume large amounts of alcohol;
  • when taking certain medications (see “Interactions”).

If you suspect that the contraceptive effect of the drug could be reduced, use additional contraceptives (condoms) within the next 7 days.

Some studies have revealed that prolonged intake of birth control pills containing ethinyl estradiol and norgestrel increases the risk of developing cervical cancer. But with the same share of probability, cervical cancer can be a consequence of sexual behavior or other causes.

If you want to get pregnant, start taking folic acid for 3 months before planning a pregnancy.

Please note that pregnancy may occur in the first month after the withdrawal of tablets. Nevertheless, gynecologists recommend beginning attempts to conceive not earlier than 3 months after the withdrawal of tablets.

If any of the following symptoms occur while taking Ethinyl Estradiol / Norgestrel pills, stop taking them and consult a doctor immediately. In the meantime, use an additional non-hormonal method of contraception, for example, condoms:

  • an unusual migraine or a headache;
  • a sharp rise in blood pressure;
  • change in lipid levels in the blood;
  • unexpected changes in vision or visual impairment;
  • difficulty in speaking;
  • unusual swelling of the legs;
  • severe pain or a feeling of heaviness in the chest;
  • an obsessive cough or hemoptysis;
  • numbness of the limbs;
  • skin yellowing;
  • pregnancy;
  • significant deterioration in well-being;
  • acute pain in the abdominal cavity;
  • acute pain in the chest;
  • sudden difficulty in breathing.

If you notice any unusual effects not listed in this manual, consult your doctor.

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