How does this medication work? What will it do for me?
This is a combination medication that contains norethindrone acetate and ethinyl estradiol. Ethinyl estradiol belongs to the class of medications called estrogens. Norethindrone acetate belongs to the class of medications known as progestins.
This medication is used as an oral hormone replacement therapy to relieve menopausal symptoms and vaginal symptoms associated with menopause. It is also used for the prevention of osteoporosis when there are low estrogen levels in the body, in addition to other measures to help prevent osteoporosis such as calcium and vitamin D supplements, quitting smoking, and regular weight-bearing exercise.
Estrogens and progestins are female hormones. They are produced by the body and are needed for normal female sexual development and to regulate the menstrual cycle during the childbearing years. During and after menopause, the ovaries start to produce less of these hormones. A deficiency of estrogen can result in symptoms associated with menopause such as hot flashes, unusual sweating, chills, dryness of the vagina, sleep disturbances, and reduction of bone mineral density leading to osteoporosis.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each white, D-shaped tablet, engraved with "PD" on one side and "144" on the other side, contains norethindrone acetate 1 mg and ethinyl estradiol 5 µg. Nonmedicinal ingredients: calcium stearate, cornstarch, lactose monohydrate, and microcrystalline cellulose.
How should I use this medication?
The recommended dose of norethindrone acetate - ethinyl estradiol is one tablet daily at approximately the same time each day, with or without food.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as you remember and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to norethindrone acetate, ethinyl estradiol, or any ingredients of this medication
- are breast-feeding
- are or may be pregnant
- have active liver disease
- have classical migraines
- have endometrial hyperplasia (thickening of the inner lining of the uterus)
- have known or suspected estrogen-dependent or progestin-dependent tumours such as breast cancer or endometrial cancer, or a history of any of these cancers
- have partial or complete loss of vision from blood vessel disease of the eyes
- have unusual vaginal bleeding that has not been checked by a doctor
- have had a hysterectomy (removal of the uterus)
- have or have had a stroke or heart attack or coronary heart disease
- have or have had active blood clotting disorders (e.g., thrombophlebitis, deep vein thrombosis, or pulmonary embolism)
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- bloating of the stomach
- change in appetite
- change in sexual desire
- cramps of the lower stomach
- diarrhea (mild)
- dizziness (mild)
- headaches (mild)
- nausea or vomiting
- problems in wearing contact lenses
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occurs:
- breast lumps or discharge from breast
- breast pain
- changes in vaginal bleeding (spotting, breakthrough bleeding, prolonged or heavier bleeding, or complete stoppage of bleeding)
- increased breast size or tenderness
- pains in stomach, side, or abdomen
- retention of extra fluid (edema)
- rapid weight gain
- swelling of feet and lower legs
- yellow eyes or skin
Stop taking the medication and seek immediate medical attention if any of the following occur:
- pains in chest, groin, or leg, especially in calf of leg
- sudden and unexplained shortness of breath
- sudden loss of coordination
- sudden loss or change of vision
- sudden or severe headache
- sudden slurring of speech
- weakness or numbness in arm or leg
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Note the following important information about estrogen replacement therapy:
The Women's Health Initiative (WHI) study results indicated an increased risk of heart attack, stroke, breast cancer, blood clots in the lungs, and blood clots in the leg veins in postmenopausal women during 5 years of treatment with 0.625 mg conjugated equine estrogens and 2.5 mg medroxyprogesterone compared to women receiving sugar tablets. Other combinations of estrogen and progestins were not studied. However, until additional data are available, the risks should be assumed to be similar for other hormone replacement products. Therefore,
- estrogens with or without progestins should be used at the lowest dose that relieves your menopausal symptoms for the shortest time period possible, as directed by your doctor; and
- estrogens with or without progestins should not be used to prevent heart disease, heart attacks, or strokes.
Blood clotting disorders: Estrogens with or without progestins are associated with an increased risk of blood clots in the lungs and legs. This risk also increases with age, a personal or family history of blood clots, smoking, and obesity. The risk of blood clots is also increased if you are immobilized for prolonged periods and with major surgery. If possible, this medication should be stopped 4 weeks before major surgery. Talk about the risk of blood clots with your doctor.
Blood pressure: Women may experience increased blood pressure when using hormone replacement therapy. Blood pressure should be monitored, especially if high doses of estrogen are used. Ask your doctor how often you should have your blood pressure checked.
Breast and ovarian cancer: Studies indicate an increased risk of breast and ovarian cancer with the use of combined estrogen and progestin therapy. If you have a history of breast cancer, do not use estrogens. If you have a family history of breast cancer or if you have had breast lumps, breast biopsies, or abnormal mammograms, your doctor will closely monitor your condition while you are using estrogens.
Have a mammogram before starting hormone replacement therapy, have regular breast examinations while taking it, and become familiar with your breasts so you can let your doctor know if anything has changed.
Dementia: Women over age 65 receiving combined hormone replacement therapy (estrogen and progestin) may be at increased risk of developing dementia (loss of memory and intellectual function). If you are over 65, talk to your doctor about whether you should be tested for dementia.
Diabetes: If you have diabetes, your doctor should closely monitor your condition while you are taking this medication, as it may affect blood sugar control.
Endometrial cancer: There is evidence that estrogen replacement therapy can increase the risk of cancer of the endometrium (lining of the uterus). Taking a progestin at the right time along with the estrogen reduces this risk of endometrial cancer to the same level as that of a woman who does not take estrogen. Women who have not had surgical removal of the uterus and are taking norethindrone acetate - ethinyl estradiol estrogen are at risk for developing a condition called endometrial hyperplasia, which can lead to the development of cancer of the uterus.
Endometriosis: Estrogen replacement therapy can cause endometriosis to reappear or get worse. If you have or have had endometriosis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Fibroids: Existing uterine fibroids may increase in size during estrogen use. This increase is usually minimal. However, if pain or tenderness occurs, inform your doctor as soon as possible. In some cases, the medication may need to be stopped.
Fluid retention: Estrogen may cause fluid retention, which can worsen some medical conditions (e.g., heart disease, kidney disease, epilepsy, asthma). Talk to your doctor if you have any concerns.
Follow-up examinations: It is important to have a follow-up examination 3 to 6 months after starting this medication to assess the response to treatment. Examinations should be done at least once a year after the first one.
Gallbladder disease: This medication can aggravate gallbladder disease or increase the risk of developing it. If you have gallbladder disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Heart disease and stroke: Studies indicate an increased risk of heart disease and stroke with estrogen (with or without progestin) for postmenopausal women. Get immediate medical attention if you experience symptoms of a heart attack (chest pain, tightness or pressure, sweating, nausea, feeling of impending doom) or stroke (sudden dizziness, headache, loss of speech, changes in vision, weakness or numbness in the arms and legs).
High cholesterol or triglycerides: Estrogen may increase triglyceride levels in those who already have high levels. Your doctor will monitor your cholesterol and triglyceride levels while you are taking this medication.
If you have a condition known as familial hypertriglyceridemia (a disorder leading to high levels of fats known as triglycerides in the blood), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Hypercalcemia and kidney disease: Prolonged use of estrogens can change the metabolism of calcium and phosphorus. Norethindrone acetate - ethinyl estradiol contains estrogens. If you have a disorder that changes the levels of calcium and phosphorus in the blood, such as metabolic or malignant bone diseases or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver disease: People with active liver disease or liver tumours should not use norethindrone acetate - estradiol. If you have or have had liver problems, you may require special monitoring by your doctor while you use this medication. Make sure to tell your doctor if you have ever had liver problems.
Migraine headaches: For some people who experience migraine headaches, estrogen can aggravate the condition. Talk to your doctor if you notice any change in your migraine pattern while using estrogen.
Other medical conditions: Discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed, if you have any of the following conditions:
- heart disease
- reduced kidney function
Systemic lupus erythematosis (SLE, or lupus): Estrogen has been shown to make the symptoms of SLE worse. If you have SLE, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Pregnancy: This medication must not be used during pregnancy. If you become pregnant while using this medication, contact your doctor immediately.
Breast-feeding: Estrogen passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. This medication is not recommended for breast-feeding women.
Children: The safety and effectiveness of using this medication have not been established for children. This medication is not intended for use by children.
What other drugs could interact with this medication?
There may be an interaction between norethindrone acetate - ethinyl estradiol and any of the following
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.