Estradiol & Dienogest

Estradiol/dienogest is a prescription medication used to prevent pregnancy. Estradiol/dienogest contains two medications, an estrogen (estradiol) and a progestin (dienogest) which belong to a group of drugs called hormonal contraceptives. These hormones prevent pregnancy by stopping ovulation, and by altering cervical mucus and the lining of the uterus. 

Estradiol/dienogest is the first four-phase oral contraceptive (birth control pill). Four-phasic means the doses of estrogen and progestin vary four times throughout each 28-day cycle.

This medication comes in a packet of 28 tablets. It is taken once daily, at the same time every day, for 28 days and then a new pack is started. Estradiol/dienogest tablets can be taken with or without food.

Common side effects include headaches, nausea, and spotting or bleeding between menstrual periods.

Estradiol/dienogest is a prescription medicine used to prevent pregnancy and to treat heavy monthly periods.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

The recommended estradiol/dienogest dosage is one tablet taken once daily.

If you start taking estradiol/dienogest and you did not use a hormonal birth control method before:

• Take the first dark yellow pill on the first day (Day 1) of your natural menstrual cycle. The first day of your menstrual cycle is the first day you start spotting or bleeding.
• Use non-hormonal back-up contraception such as a condom and spermicide for the first 9 days that you take estradiol/dienogest.

If you start taking estradiol/dienogest and you are switching from a combination hormonal method such as:

• another pill
• vaginal ring
• patch

• Take the first dark yellow pill on the first day of your period. Do not continue taking the pills from your previous birth control pack. If you do not have a period, contact your healthcare provider before you start estradiol/dienogest.
• If you previously used a vaginal ring or transdermal patch, you should start using estradiol/dienogest on the day the ring or patch is removed.
• Use a non-hormonal back-up method such as a condom and spermicide for the first 9 days you take estradiol/dienogest.

If you start taking estradiol/dienogest and you are switching from a progestin-only method such as a:

• progestin-only pill
• implant
• intrauterine system
• injection

• Take the first dark yellow pill on the day you would have taken your next progestin-only pill or on the day of removal of your implant or intrauterine system or on the day when you would have had your next injection.
• Use a non-hormonal back-up method such as a condom and spermicide for the first 9 days you take estradiol/dienogest.

WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS

Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptives (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs should not be used by women who are over 35 years of age and smoke.

• Estradiol/dienogest, like other birth control pills, increases the risk of blood clots, strokes, and heart attacks. See "FDA Warning".
• Estradiol/dienogest is used to prevent pregnancy. It does not protect against the spread of HIV, AIDs or other sexually transmitted diseases.
• Birth control pills increase the risk of liver tumors, both benign (non-cancerous) and cancerous.
• Estradiol/dienogest may worsen gallbladder disease.
• Estradiol/dienogest may also worsen depression.
• Estradiol/dienogest may affect your blood sugar levels, blood pressure, cholesterol, and menstrual bleeding patterns (periods).
• Estradiol/dienogest can cause changes to the eyes making it difficult to tolerate contact lenses.

Estradiol/dienogest, like other birth control pills can cause serious side effects including:

• Increased Risk of Blood Clots: Birth control pills increase the risk of serious blood clots in the legs, lungs, eyes, heart, and brain. Women who smoke, are obese, or over the age of 35, are at an increased risk. This increased risk is highest when you first start taking birth control pills and when you restart the same or different birth control pills after not using them for a month or more.

• High Blood Pressure
• Gallbladder problems
• Liver Tumors

Call your healthcare provider right away if you have:

• Persistent leg pain
• Sudden shortness of breath
• Sudden blindness, partial or complete
• Severe pain in your chest
• Sudden, severe headache unlike your usual headaches
• Weakness or numbness in an arm or leg, or trouble speaking
• Yellowing of the skin or whites of the eyes

The most common side effects include:

• spotting or bleeding between menstrual periods
• nausea
• breast tenderness
• headache

Less common side effects are:

• acne
• less sexual desire
• bloating or fluid retention
• blotchy darkening of the skin, especially on the face
• high blood sugar, especially in women who already have diabetes
• high fat levels in the blood
• depression, especially if you have had depression in the past
• problems tolerating contact lenses
• weight changes

​This is not a complete list of side effects. Ask your doctor or pharmacist for more information.

Tell your doctor about all medicines, both prescription and non-prescription, and herbal products that you take. Especially tell your doctor if you take:

• carbamazepine (Carbatrol, Epitol, Equetro, Tegretol, Tegretol XR)
• phenytoin (Dilantin, Phenytek)
• rifampicin (Rifadin)
• St. John's wort 
• barbiturates such as butalbital (Fioricet, Fiorinal), phenobarbital (Luminal) and others
• bosentan (Tracleer)
• felbamate (Felbatol)
• griseofulvin
• oxcarbazepine (Trileptal)
• topiramate (Topamax)
• lamotrigine (Lamictal)
• protease inhibitors
• thyroid medications

​This is not a complete list of estradiol/dienogest drug interactions. Ask your doctor or pharmacist for more information.

Estradiol/dienogest should not be used during pregnancy. Notify your doctor if you have symptoms of pregnancy such as morning sickness or unusual breast tenderness. It is important that your doctor checks you to find out if you are pregnant. Stop taking estradiol/dienogest if you are pregnant.

If you wish to become pregnant you may stop taking estradiol/dienogest at any time. Talk to your doctor before you stop taking this medication.

If you are breastfeeding, consider another birth control method until you are ready to stop breastfeeding. Birth control pills that contain estrogen, like estradiol/dienogest, may decrease the amount of milk you make. A small amount of the pill's hormones pass into breast milk.