Desogestrel / ethinyl estradiol Side Effects
Commonly reported side effects of desogestrel/ethinyl estradiol include: vulvovaginal candidiasis, spotty menstruation, headache, migraine, increased blood pressure, decreased glucose tolerance, breakthrough bleeding, vaginitis, and dizziness. Other side effects include: acne vulgaris, abdominal cramps, nausea, vomiting, abdominal distention, and breast changes. See below for a comprehensive list of adverse effects.
For the Consumer
Applies to desogestrel / ethinyl estradiol: oral tablet
In addition to its needed effects, some unwanted effects may be caused by desogestrel / ethinyl estradiol. In the event that any of these side effects do occur, they may require medical attention.
Major Side Effects
You should check with your doctor immediately if any of these side effects occur when taking desogestrel / ethinyl estradiol:Incidence not known:
- Abdominal or stomach pain
- absent, missed, or irregular menstrual periods
- change in vision
- changes in skin color
- chest pain or discomfort
- clay-colored stools
- dark urine
- dizziness, lightheadedness, fainting
- hives or welts
- itching skin or rash
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
- nausea and vomiting
- pain or discomfort in the arms, jaw, back, or neck
- pain, tenderness, or swelling of the foot or leg
- pains in the chest, groin, or legs, especially in the calves of the legs
- severe headaches of sudden onset
- slow or fast heartbeat
- sudden loss of coordination or slurred speech
- sudden onset of shortness of breath for no apparent reason
- sudden shortness of breath or troubled breathing
- unusual tiredness or weakness
- vomiting of blood
Minor Side Effects
Some of the side effects that can occur with desogestrel / ethinyl estradiol may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:Incidence not known:
- blotchy spots on the exposed skin
- breast enlargement or tenderness
- feeling sad or empty
- itching of the vagina or outside the genitals
- loss of interest or pleasure
- pain during sexual intercourse
- thick, white curd-like vaginal discharge without odor or with mild odor
- trouble wearing contact lenses
For Healthcare Professionals
Applies to desogestrel / ethinyl estradiol: oral tablet
Many of the adverse effects experienced by women on oral contraceptive combination products are related to a relative excess or deficiency of the estrogen and progestin components of these formulations. The following categorizes many of the frequent adverse effects by relative excess or deficiency of these components.
Progestin Excess: acne, oily skin; breast tenderness; depression; tiredness, fatigue; hair loss; hypertension; increased appetite; weight gain; cholestatic jaundice.
Progestin Deficiency: late breakthrough bleeding; amenorrhea; hypermenorrhea.
Estrogen Excess: nausea; headache; melasma; hypertension; breast tenderness; edema.
Estrogen Deficiency: early/mid-cycle breakthrough bleeding; increased spotting; hypomenorrhea.[Ref]
Gastrointestinal side effects have included nausea,vomiting, abdominal pain, cramps, bloating, cholestatic jaundice and change in weight or appetite. Some reports suggested an association between oral contraceptive use and gallbladder disease.[Ref]
Cases of oral contraceptive-induced esophageal ulceration and geographic tongue have been reported rarely.
More recent studies have suggested that the risk of gallbladder disease is minimal.[Ref]
Oncologic side effects have included hepatic adenomas or benign liver tumors. A number of studies have examined a possible relationship between the use of oral contraceptives and the development of breast cancer. Many of the studies have reported conflicting results. A committee of the World Health Organization evaluated these studies and the risks of breast cancer and concluded that: "Numerous studies have found no overall association between oral contraceptive use and risk of breast cancer." In addition, the same committee also examined a possible relationship between oral contraceptive use and neoplasms of the uterine cervix and concluded that: "There are insufficient data to draw any firm conclusions regarding the effects of combined oral contraceptives on the risk of cervical adenocarcinoma."[Ref]
The World Health Organization committee also noted that some studies "have found a weak association between long-term use of oral contraceptives and breast cancer diagnosed before the age of 36, and perhaps up to the age 45....It is unclear whether this observed association is attributable to bias, the development of new cases of cancer, or accelerated growth of existing cancers."
The World Health Organization committee further concluded that there is no increased risk of breast cancer in women over the age of 45 who have previously taken oral contraceptives. In addition, studies suggest that use of oral contraceptives does not place specific groups of women (like those with a family history of breast cancer) at higher or lower risk, and variations in the hormonal content of oral contraceptives do not influence the risk of breast cancer.
In general, studies evaluating the potential risk of cervical cancer in patients taking oral contraceptives have been complicated by the large number of confounding factors which make investigations into the epidemiology of this neoplasm difficult. Some studies have suggested that women taking oral contraceptives are at increased risk of dysplasia, epidermoid carcinoma, and adenocarcinoma of the cervix. However, other studies have not found such an association.[Ref]
Detailed information concerning the effects of oral contraceptive therapy on lipid metabolism is available in the Endocrine paragraph of this side effect monograph.
Some early investigations of women taking high dose estrogen combinations (50 mcg or more of ethinyl estradiol or equivalent daily) suggested that such women may be at increased risk of cardiovascular complications (myocardial infarction, stroke, and vascular thrombosis, including venous thromboembolism). However, more recent large investigations of women taking low dose estrogen combinations have suggested that oral contraceptive use is not associated with an increased risk of serious cardiovascular complications in healthy non smoking women up to the age of 45. (For women aged 35 to 44 who smoke or who have preexisting systemic diseases that may affect the cardiovascular system, use of oral contraceptives is not recommended.)
However, some investigators have suggested that even the new low dose products may result in adverse effects on lipid metabolism and should prompt careful review of a woman's cardiovascular risk factors before a decision to use oral contraceptive combinations is made.
The frequency of both subarachnoid hemorrhage and thrombotic stroke has been reported by some investigators to be higher in women taking oral contraceptive hormones. However, other investigators have suggested that the risk of these effects for women using newer low dose formulations are very small for young women without underlying cardiovascular disease or other risk factors.
Recent data indicate that users of third-generation oral contraceptives, those containing the new progestins, desogestrel, gestodene, and norgestimate, have 2 to 3 times the risk of venous thromboembolism faced by users of second generation oral contraceptives. The American College of Obstetrics and Gynecology's Committee on Gynecologic Practice reconfirms the increased risk over other progestins.[Ref]
Cardiovascular side effects have included hypertension, thrombophlebitis and venous thrombosis with or without embolism, cerebral hemorrhage, cerebral thrombosis, arterial thromboembolism, and myocardial infarction.[Ref]
Endocrine and metabolic side effects have included complex alterations in plasma lipid profiles and carbohydrate metabolism. In addition, oral contraceptive use has been reported to cause conception delay.[Ref]
All the progestins which occur in commercially available oral contraceptive combinations have adverse effects on lipid profiles. Specifically, these progestins exert antiestrogen and androgen effects and decrease HDL (and HDL2) cholesterol levels and increase LDL cholesterol levels. However, the estrogens in oral contraceptive combinations exert opposing effects. Consequently, alterations in lipid profiles are related to the relative amount and potency of the specific estrogen and progestin in a given product. (Desogestrel exerts pronounced progestin and antiestrogen effects and a weak androgen effect.)
A number of investigations have suggested that oral contraceptive combinations may decrease glucose tolerance. However, some recent studies with low dose preparations have suggested that decreases in glucose tolerance due to oral contraceptive combinations are generally minimal.
Despite the potentially adverse effects of oral contraceptives on lipid levels and glucose tolerance, some investigators have suggested that young diabetic women without existing vascular disease or severe lipidemias may be candidates for low dose oral contraceptive combinations provided that they receive close monitoring for adverse metabolic effects.[Ref]
The rate of death due to hepatocellular carcinoma in the United States has not changed during the last 25 years (a time during which use of oral contraceptive hormones has increased dramatically).
A committee of the World Health Organization has reported that in developing countries where hepatitis B virus infection and hepatocellular carcinoma are common, "short term use of oral contraceptives does not appear to be associated with an increased risk. Data on the effects of long term use are scarce."
A recent Italian case-control study of women with hepatocellular carcinoma has suggested that the relative risk of hepatocellular carcinoma is 2.2 for oral contraceptive users compared to women who never used oral contraceptives.
A similar American case-control study from 1989 also reported a strong association between oral contraceptive use and hepatocellular carcinoma but concluded that: "If this observed association is causal, the actual number of cases of liver cancer in the United States attributable to oral contraceptive use is small. Therefore, these findings do not have public health importance in the United States and other Western nations."[Ref]
Hepatic side effects have rarely included focal nodular hyperplasia, intrahepatic cholestasis, liver cell adenomas, hepatic granulomas, hepatic hemangiomas and well differentiated hepatocellular carcinomas.[Ref]
Cases of venous thrombosis, pulmonary embolism (sometimes fatal), and arterial thrombosis have been reported rarely.
Previous thrombotic disease is considered a contraindication to use of oral contraceptive combinations.[Ref]
Hematologic side effects have included thromboembolism, including mesenteric thrombosis.[Ref]
Some women have experienced oligomenorrhea and amenorrhea following termination of oral contraceptive use.[Ref]
Genitourinary side effects have commonly included breakthrough bleeding and spotting, especially during the first several cycles of oral contraceptive use. Additional side effects have included changes in menstrual flow, amenorrhea, temporary infertility after discontinuation of treatment, and vaginitis, including candidiasis.[Ref]
Psychiatric side effects have included depression and precipitation of panic disorder.[Ref]
Immunologic side effects have rarely included cases of oral contraceptive-induced systemic lupus erythematosus.[Ref]
Nervous system side effects have included migraine headache and one report of chorea.[Ref]
Ocular side effects have rarely included retinal thrombosis. In addition, the manufacturers of oral contraceptive products report that some patients develop changes in contact lens tolerance. Optic neuritis, which may lead to partial or complete loss of vision, has been reported[Ref]
Respiratory side effects have included pulmonary embolism.[Ref]
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Not all side effects for desogestrel / ethinyl estradiol may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
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