(Norethindrone (Norethisterone)/Ethinyl Estradiol)
Loestrin is an oral contraceptive used to prevent pregnancy.
Instructions for use of the 21-tablet pack:
About the pack:
This memo-pack has been specially designed to help your memory; in fact it does the counting for you. Each pill is placed in a section marked with the day of the week on which it should be taken. If you are in any doubt whether you have taken your pill, just look at the appropriate day on the memo-pack.
Your doctor or nurse will check your blood pressure before you start Loestrin and at regular intervals while you are still taking it. Other examinations, such as breast and pelvic examinations are not done routinely and should only be done if your doctor feels they are necessary in your case. Before you start Loestrin it might be necessary to check you are not pregnant - this is done by a test on your urine.
Taking your first course:
If you are having periods as usual, count the first day of bleeding of your next period as day 1, and take your first pill on that day. Choose a pill marked with the correct day of the week. One Loestrin tablet should be taken daily for three weeks. Following the direction of the arrows, take a pill each day, at the same time of day, until the pack is empty. If you start after the fourth day of your period, use additional precautions such as sheaths, cap plus spermicide or intra-uterine devices for the first 7 days.
After birth and after abortion use:
After a normal delivery with no complications and if you are not breast feeding you can start using Loestrin 21 days after the delivery, providing you are up and about and not suffering from any complications.
If you start to use Loestrin more than 21 days after delivery, additional precautions such as sheaths, cap plus spermicide or intra-uterine devices should be used until you start to take Loestrin and for 7 days after you start.
After a miscarriage or abortion, oral contraceptives can normally be started immediately.
Changing from another 21 day combined oral contraceptive to Loestrin:
Take the first Loestrin tablet on the first day immediately after the end of your previous oral contraceptive course. Additional contraception is not required. A regular bleed should not be expected until the end of the first Loestrin pack.
Changing from an Every Day (ED) 28 day combined oral contraceptive to Loestrin: Take the first tablet of Loestrin on first day immediately after the day on which you took the last active pill in the ED pack. The remaining (inactive) tablets in the ED pack should be discarded. Additional contraception is not required. A regular bleed should not be expected until the end of the first pack of Loestrin.
Changing from Progestogen-Only-Pill (POP) to Loestrin:
Take the first tablet of Loestrin on the first day of menstruation, even if you have already taken the POP for that day. The remaining tablets in the POP pack should be discarded. Additional contraception is not required.
All subsequent courses:
Allow an interval of one tablet-free week before commencing the second and subsequent courses of tablets. Each new course of tablets is always started on the same day of the week.
If bleeding is missed:
If, as may occasionally happen, you should have no bleeding at all in the seven days after a course of pills, and you have taken the tablets correctly, it is very unlikely that you are pregnant, but the possibility should be ruled out by your doctor before you start a new course of pills.
If bleeding starts while you are taking tablets:
If bleeding occurs during the three weeks in which you are taking the pills do not stop taking them. The bleeding should stop in a day or two. However, if the bleeding is troublesome, very heavy, prolonged or recurrent, you should consult your doctor. Bleeding while the pills are being taken does not necessarily mean that the pill does not suit you, nor does it necessarily mean the contraceptive protection is lost (but see "Interaction with other medicines"). If bleeding does occur during pill-taking, it is usually only in the first two or three months, while your body is adjusting itself to the pill.
If you forget to take your pill:
If you forget to take a pill at the usual time, it must be taken as soon as possible and the next tablet taken at the normal time. Do not take two doses at the same time. If the delay is more than twelve hours, use additional contraception (which must be a sheath or cap and spermicide) for the next seven days, while continuing to take the next seven Loestrin tablets; then continue as usual according to instructions. If your period fails to occur, consult your doctor immediately before starting your next course. If pills have been missed during the last seven days of the pack, there should be no break before the next pack is started.
If you have a stomach upset:
Vomiting and diarrhoea may interfere with absorption of the pill and reduce its contraceptive effect. If you do get a stomach upset, continue to take the pills, but you should use another method of contraception, which must be a sheath or cap plus spermicide, during the upset and for seven days after recovery. If those seven days overrun the end of the pack, the next pack should be started without a break. This means you may not get a regular bleed until the end of your second pack. If you do not get a regular bleed after your second pack, talk to your doctor straight away.
If you accidentally take too much Loestrin tell your doctor at once.
Reasons for stopping oral contraceptives immediately:
You should take no further oral contraceptive tablets and should consult your doctor immediately if you experience any of the following:
very first attack of migraine (typically a throbbing headache and nausea, preceded by visual disturbances) that you have ever experienced
any unusually frequent or unusually severe headaches
pain, tingling or numbness in any part of the body
worsening of pre- existing migraine,
inflamed veins (phlebitis),
sudden disturbance of vision,
disturbance of speech ,
pains in the chest or abdomen ,
swelling in the limbs ,
unexplained cough ,
pain on breathing ,
dizziness or fainting.
Any of these symptoms might indicate the beginning of risk of a serious thrombosis.
The risk of thrombosis is increased after many injuries, especially fractures, during and after many surgical operations (the pill should be stopped for six weeks before surgery), and during and following immobilisation, e.g. after accidents. Combined oral contraceptives should be stopped immediately when immobilisation (i.e. inability to move freely) is necessary.
Your doctor will probably stop the pill at once if you become jaundiced, or if he finds your blood pressure to be significantly raised, or if any of the conditions known to be capable of deteriorating during oral contraception or pregnancy (mentioned under "Special Warnings") show clear signs of deteriorating.
You should stop the pill immediately if pregnancy is diagnosed, or if there are reasonable grounds for suspecting that you may be pregnant, since it has been suggested that combined oral contraceptives, in common with many other substances, might be capable of affecting the normal development of the child in the early stages of pregnancy. It can be definitely concluded, however, that if a risk of abnormality (foetal malformation) exists at all, it is very small.
Loestrin Side Effects
Loestrin can sometimes cause side-effects. These might be: nausea, vomiting, stomach upset and bloating, headaches, changes in body weight or interest in sex (libido) and depressive moods, breakthrough bleeding, spotting, heavier or lighter bleeding, missed periods during and after treatment, water retention, brownish patches may occur on your face and body, breasts may become sore or increase in size or leak, changes in the cervix, reduction in breast milk after birth, yellowing of the skin, migraine, rash (allergic), rise in blood pressure, temporary infertility after discontinuation of treatment, reduced tolerance to carbohydrates, thrush, changes to the shape of the cornea (a part of the eye).
Although the following side-effects have been reported in women taking oral contraceptives, an association has been neither confirmed nor denied: missed periods for some time after stopping your pill, premenstrual like syndrome, nervousness, dizziness, tiredness, cataracts, backache, increase in hair growth, loss of scalp hair, serious skin rashes, itching, changes in appetite, cystitis-like syndrome, inflamed vagina, porphyria, reduced kidney function including changes in blood urea levels, changes in the liver, acne, inflammation of the gut.
It is not easy to decide whether or not something that you notice is the result of taking the pill, since among millions of women during long periods of treatment many symptoms are bound to appear that are quite unconnected with the use of the pill. Studies comparing oral contraceptives with dummy tablets (placebo) have suggested that true side-effects experienced by the users are few, and are mainly short lasting. However, such studies may not detect the rare or long term side-effects. Most known or suspected side-effects are of a minor nature and are reversible, but not all.
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