dienogest and estradiol
Generic Name: dienogest and estradiol (dye EN oh jest and ESS tra DYE ole)
Brand Name: Natazia
What is dienogest and estradiol?
Dienogest and estradiol is a combination drug that contains female hormones that prevent ovulation (the release of an egg from an ovary). This medication also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.
Dienogest and estradiol is used as contraception to prevent pregnancy. Dienogest and estradiol is also used to treat heavy menstrual bleeding that is not caused by any medical condition of the uterus.
Dienogest and estradiol may also be used for purposes not listed in this medication guide.
What is the most important information I should know about dienogest and estradiol?
Do not use dienogest and estradiol if you are pregnant or if you have recently had a baby.
You should not take dienogest and estradiol if you have any of the following conditions: uncontrolled high blood pressure, heart disease, a blood-clotting disorder, circulation problems, diabetic problems with your eyes or kidneys, unusual vaginal bleeding, liver disease or liver cancer, severe migraine headaches, if you smoke and are over 35, or if you have ever had breast or uterine cancer, jaundice caused by birth control pills, a heart attack, a stroke, or a blood clot.
You may need to use back up birth control, such as condoms or a spermicide, when you first start using this medication or if you miss a dose. Follow your doctor's instructions.
Missing a pill increases your risk of becoming pregnant. Carefully follow the "missed dose" instructions if you forget to take your medicine.
Some drugs can make dienogest and estradiol less effective in preventing pregnancy, including antibiotics, hepatitis C medications, HIV/AIDS medications, seizure medications, or barbiturate sedatives. Tell your doctor about all other medications you use.
What should I discuss with my healthcare provider before taking dienogest and estradiol?
This medication can cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant, or if you miss two menstrual periods in a row. If you have recently had a baby, wait at least 4 weeks before taking dienogest and estradiol.
You should not take dienogest and estradiol if you have:
untreated or uncontrolled high blood pressure;
heart disease (coronary artery disease, uncontrolled heart valve disorder, history of heart attack, stroke, or blood clot);
a blood-clotting disorder or circulation problems;
problems with your eyes, kidneys or circulation caused by diabetes;
a history of hormone-related cancer such as breast or uterine cancer;
unusual vaginal bleeding that has not been checked by a doctor;
liver disease or liver cancer;
severe migraine headaches (with aura, numbness, weakness, or vision changes), especially if you are older than 35;
a history of jaundice caused by pregnancy or birth control pills; or
if you smoke and are over 35 years old.
To make sure you can safely take dienogest and estradiol, tell your doctor if you have any of these other conditions:
high blood pressure, high cholesterol or triglycerides, or if you are overweight;
a history of depression;
underactive thyroid, diabetes;
seizures or epilepsy; or
a history of fibrocystic breast disease, lumps, nodules, or an abnormal mammogram.
The hormones in dienogest and estradiol can pass into breast milk and may harm a nursing baby. This medication may also slow breast milk production. Do not use if you are breast feeding a baby.
How should I take dienogest and estradiol?
This medication contains 5 different colors of pills. Take 1 pill each day in the exact order directed on the blister pack. Use a back-up birth control, such as condoms or a spermicide, for the first 9 days when you first start using this medication. Do not take two different kinds of birth control pills at the same time.
If you are switching from another birth control pill, start taking dienogest and estradiol on the first day of your withdrawal bleeding. If you were taking progestin-only pills, start taking dienogest and estradiol on the day you would have taken your next pill.
If you are switching from a birth control implant, intrauterine device (IUD), vaginal ring, or skin patch, start taking dienogest and estradiol on the day the other birth control device is removed.
If you are switching from a birth control injection, start taking dienogest and estradiol on the day you would have received your next scheduled injection.
You may have breakthrough bleeding. Tell your doctor if this bleeding continues or is very heavy. You may also have very little or no bleeding during your periods.
If you need surgery or medical tests or if you will be on bed rest, you may need to stop using this medication for a short time. Any doctor or surgeon who treats you should know that you are using dienogest and estradiol.
Store this medication at room temperature away from moisture and heat.
What happens if I miss a dose?
Follow the patient instructions provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions. Missing a pill increases your risk of becoming pregnant.
If you miss one pill:
During Days 1 through 17, take the missed pill as soon as you remember, then take your next pill at the usual time. Use back-up birth control for at least 9 days.
During Days 18 through 24, throw out the rest of the pack and start a new one the same day. Take the Day 1 pill from the new pack and then take one pill per day in the order directed on the pack. Use back-up birth control for at least 9 days.
During Days 25 through 28, take the missed pill as soon as you remember, then take your next pill at the usual time. You do not need back-up birth control if you miss one pill during Days 25 through 28.
If you miss two pills:
During Days 1 through 16, skip the missed pills and start with the pill that corresponds to the day you remember you missed your doses. Then take one pill per day in the order directed on the pack. Use your back up birth control for at least 9 days
During Days 17 through 24, throw out the rest of the pack and start a new one the same day. Take the Day 3 pill from the new pack and then take one pill per day in the order directed on the pack. Use your back up birth control for at least 9 days.
During Days 25 through 28, throw out the rest of the pack. Start a new pack on the same day or on the day you would normally start a new pack. Take one pill per day in the order directed on the pack. No back up birth control is needed.
If you miss a period for two months in a row, call your doctor because you might be pregnant.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, vomiting, and vaginal bleeding.
What should I avoid while taking dienogest and estradiol?
Smoking can increase your risk of blood clots, stroke, or heart attack caused by dienogest and estradiol, especially if you are older than 35.
This medication will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.
Dienogest and estradiol side effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Stop using dienogest and estradiol and call your doctor at once if you have a serious side effect such as:
sudden numbness or weakness, especially on one side of the body;
sudden and severe headache, confusion, problems with vision, speech, or balance;
chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
sudden cough, wheezing, rapid breathing, coughing up blood;
pain, swelling, warmth, or redness in one or both legs;
a change in the pattern or severity of migraine headaches;
nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
swelling in your hands, ankles, or feet;
a breast lump; or
symptoms of depression (sleep problems, weakness, tired feeling, mood changes).
Less serious side effects may include:
mild nausea (especially when you first start taking this medicine), vomiting, bloating, stomach cramps;
breast pain or tenderness;
freckles or darkening of facial skin, acne;
problems with contact lenses;
vaginal itching or discharge, very light menstrual periods; or
decreased sex drive.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
Dienogest and estradiol dosing information
Usual Adult Dose for Contraception:
To prevent pregnancy and for the treatment of heavy menstrual bleeding in women without organic pathology who choose to use an oral contraceptive as their method of contraception:
One tablet taken orally, once a day, consecutively in the order directed on the package for 28 days with the next pack to be started the day after the last pack.
Dienogest-estradiol products are packaged in 28 day dosage preparations.
The cycle length for oral contraceptives is generally considered to be 28 days. (The first day of menstrual bleeding is counted as day 1).
Initiation of Oral Contraceptive Therapy:
This product can be started one of the following ways:
1. No preceding hormonal contraceptive use in the past month: Start on day 1 of the woman's natural cycle;
2. For postpartum women who do not breastfeed or after a second trimester abortion: Start on day 28 after delivery or abortion. The patient should be advised to use additional barrier methods for the first 9 days of tablet taking. However, if intercourse has already taken place, pregnancy should be excluded before use or the patient should wait until the first menstrual cycle.
3. Changing from a combined oral contraceptive, vaginal ring, or transdermal patch: Instruct her to take the first dark yellow pill on the first day of her withdrawal bleed. She should not continue taking the pills from her previous birth control pack. If she does not have a withdrawal bleed, rule out pregnancy before starting dienogest-estradiol. If she previously used a vaginal ring or transdermal patch, she should start using dienogest-estradiol on the day the ring or patch is removed. Instruct the patient to use a nonhormonal backup method such as a condom or spermicide for the first 9 days.
4. Changing from a progesterone only method: Instruct her to take the first dark yellow pill on the day she would have taken her next progestin only pill or on the day of removal of her implant or intrauterine system or on the day when she would have had her next injection. Instruct the patient to use a nonhormonal backup method such as a condom or spermicide for the first 9 days.
If a woman is less than 12 hours late for an active tablet, the missed dose should be taken as soon as it is remembered and the normal schedule should be resumed.
If a woman is more than 12 hours late for an active tablet, please follow the following principles:
Day 1 to 17: Take the missed tablet immediately and the rest as usual. Use backup contraception for the next 9 days.
Day 18 to 24: Discard the current cycle, start a new cycle immediately. Use backup contraception for the next 9 days.
Day 25 to 28: Take the missed tablet immediately and following tablets as usual. No backup contraception is required.
If a woman misses TWO PILLS in a row, please follow the following principles:
Days 1-17 (if she misses the pills for Days 17 and 18, follow the instructions for Days 17-25 instead):
Do not take the missed pills. Instead, take the pill for the day on which you first noticed you had missed pills. Use backup contraception for the next 9 days. Continue taking one pill each day at the same time for the rest of the cycle.
Days 17-25 (if she misses the pills for Days 25 and 26, follow the instructions for Days 25-28 instead):
Do not take any pills from the current blister pack and throw the pack away. Take Day 3 pill from a new blister pack. Use backup contraception for the next 9 days. Continue taking one pill from the new blister pack at the same time each day.
Do not take any pills from the current blister pack and throw the pack away. Start a new pack on the same day or start a new pack on the day you usually start a new pack. No backup contraception is needed. Continue taking one pill from the new pack at the same time each day, for the rest of the cycle.
What other drugs will affect dienogest and estradiol?
Some drugs can make dienogest and estradiol less effective, which may result in pregnancy. Tell your doctor if you are using any of the following drugs:
an antibiotic or tuberculosis medication;
drugs to treat hepatitis C, HIV, or AIDS;
phenobarbital (Solfoton) and other barbiturates;
St. John's wort; or
Tell your doctor about all other medicines you use, especially:
tizanidine (Zanaflex); or
tranexamic acid (Cyklokapron, Lysteda).
This list is not complete and other drugs may interact with dienogest and estradiol. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
More about dienogest/estradiol
- Estradiol valerate/dienogest
- Estradiol and dienogest (Advanced Reading)
- Estradiol valerate and dienogest (Advanced Reading)
- Other brands: Natazia
Related treatment guides
Where can I get more information?
- Your pharmacist can provide more information about dienogest and estradiol.
- Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
- Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2012 Cerner Multum, Inc. Version: 6.01. Revision Date: 2012-04-23, 3:39:13 PM.