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If you smoke cigarettes, using combined oral contraceptives (COCs), like Amethyst, raises your risk for serious health problems, such as strokes, heart attacks, and blood clots. Females age 35 years and older who smoke are at even higher risk for these problems. If you smoke, talk with your provider about safer birth control alternatives.

Amethyst raises your risk of blood clots. These clots can occur anywhere in your body, including your lungs (pulmonary embolism or PE), legs (deep vein thrombosis or DVT), brain (stroke), and heart (heart attack). Get emergency help right away if you have any signs of a blood clot:

Study results are mixed, but there's a possibility that Amethyst and other COCs can raise your risk for breast and cervical cancer.

Though rare, Amethyst can cause liver problems, such as liver damage and liver tumors. These problems are linked more with earlier formulations of COCs that contained higher levels of estrogen (50 mcg or higher), and less so with Amethyst since it only contains 20 mcg of estrogen. Don't use this medication if you already have liver problems. Call your provider right away if you experience symptoms of liver problems, such as tiredness, stomach pain, or yellowing of the skin or whites of the eyes.

Amethyst might raise your blood sugar and triglyceride (fat) levels. If you have diabetes, you might need to monitor your blood sugar more closely after you start Amethyst. Let your provider know if you experience any changes in your blood sugar.

Amethyst and other COCs can raise your blood pressure. Your provider might ask you to check your blood pressure regularly. If you notice your blood pressure is higher while you're taking this medication, contact your provider. If you have uncontrolled high blood pressure, Amethyst might not be the best option for you.

Headaches are a common side effect of COCs like Amethyst. But, if you experience a new migraine, a migraine that's worse than normal, or a new headache that keeps coming back or is severe, call your provider so you can be checked out.

Breakthrough bleeding and spotting are common side effects of Amethyst. This is more common at first, but should get better over time. Let your provider know if you experience any irregular vaginal bleeding so they can help you figure out why you're bleeding.

Research suggests that females who take that COCs are at a higher risk of pregnancy occuring outside of the womb (ectopic pregnancy) if the birth control pills don't work like they're supposed to. The chance of becoming pregnant is higher when you don't take Amethyst as instructed at the same time every day. Symptoms of an ectopic pregnancy include low back pain, abnormal vaginal bleeding, and cramping. If you experience any of these symptoms, contact your provider.

Let your provider know if you experience symptoms of depression or changes in your mood while taking Amethyst. In cases of serious depression, your provider might have you stop taking it.

Certain medications can make Amethyst get broken down faster in your body, making it less effective and can lead to pregnancy. Some examples include carbamazepine (Tegretol) and phenytoin (Dilantin). Use a back-up method or other form of birth control for at least 28 days after stopping any of these medications. Other medications can raise the amount of Amethyst in your body, which can lead to more side effects. Make sure to tell your provider or pharmacist all of your medications so they can make sure they don't interact with Amethyst.