norethindrone acetate / ethinyl estradiol / ferrous fumarate

• Risk factors: Over 35 years old who smoke cigarettes

If you smoke cigarettes, using combined oral contraceptives (COCs), like Junel Fe 24, raises your risk for blood clots. These blood clots can lead to more serious problems, such as heart attack and stroke. People aged 35 years and older who smoke are at even higher risk for these problems. If you smoke, talk with your OB-GYN provider about safer birth control alternatives.

• Risk factors: Age 35 or older and smoke | Recent surgery with a long period of bed rest | Starting Junel Fe 24 less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen

Junel Fe 24 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.

• Brain: weakness or numbness in your arms, legs, or face on one side of the body, trouble speaking, blurred vision, dizziness, loss of balance, trouble walking, or confusion
• Eyes: trouble seeing, bulging eye, double vision
• Heart: chest pain, sweating, nausea, or dizziness
• Lungs: trouble breathing, chest pain, or cough
• Legs: cramps, swelling, pain, or muscle tightness

If you need to have surgery, tell your care team you're taking Junel Fe 24. They might have you stop taking it 4 weeks before until 2 weeks after your surgery to lower your risk of blood clots. If you recently delivered a baby, you shouldn't start Junel Fe 24 until 4 weeks after delivery if you're not breastfeeding your child.

• Risk factors: History of liver problems | Taking certain hepatitis C combination medications

Don't take Junel Fe 24 if you have liver problems. Although rare, COCs like Junel Fe 24 can raise your risk of benign liver tumors. Signs of liver problems can include jaundice (yellowing of the skin or eyes), along with fever, tiredness, loss of appetite, or dark colored urine.

• Risk factors: Older age | Taking COCs for a long time

Junel Fe 24 can raise your blood pressure, so you might want to check your blood pressure while you're taking this medication. The risk is higher in older adults that have taken birth control for a long time. Stop taking Junel Fe 24 and let your care team know if your blood pressure is unusually high.

• Risk factors: Prediabetes or diabetes | History of high triglycerides

Junel Fe 24 can raise your blood sugar and triglyceride (fat) levels. If you have diabetes or prediabetes, let your prescriber know if you experience any changes in your blood sugar. A rise in triglycerides can lead to serious conditions like inflammation of the pancreas (pancreatitis). Get emergency medical help if you notice symptoms of pancreatitis, which can include stomach pain, nausea, or vomiting.

Let your HCP know if you experience new or worsening migraines or headaches while taking Junel Fe 24. You'll have to stop this medication if your migraine or headache doesn't go away or becomes severe.

People who take Junel Fe 24 can sometimes experience breakthrough bleeding and spotting, especially during the first 3 months of taking this medication. Irregular bleeding can vary from slight staining to bleeding similar to a regular period. This problem might be temporary, so continue taking your medication as directed. Let your OB-GYN provider know if the bleeding is a problem for you. If you missed your period(s), contact your OB-GYN provider or get a pregnancy test to make sure you're not pregnant.

Talk to your OB-GYN provider if you experience symptoms of depression or worsening depression while taking Junel Fe 24. Your prescriber might consider stopping this medication if you have serious depression.

• Risk factors: History of breast or cervical cancer | Taking COCs for a long time

Study results are mixed, but there's a possibility that Junel Fe 24 and other COCs can raise your risk for breast and cervical cancer.

Don't take Junel Fe 24 if you currently have or have had breast cancer because some types of breast cancer grow faster in the presence of estrogen, an ingredient in this medication. You can perform breast self-checks regularly at home and get yearly breast exams with your HCP to help with early breast cancer detection. Let your HCP know if you notice any new or abnormal lumps, pain, or swelling in your breasts.

Make sure you follow up with your OB-GYN provider to get proper screenings for cervical cancer. Report any signs of vaginal bleeding or discharge that's not normal.

• Risk factors: History of hereditary angioedema | History of chloasma gravidarum

If you have certain conditions, such as hereditary angioedema or chloasma (a skin condition that causes dark patches on the face), talk to your healthcare professional before taking Junel Fe 24 because it might worsen your symptoms. If you have a history of chloasma, limit exposure to the sun or UV light while taking birth control pills like Junel Fe 24.