Lo Loestrin FE is a biphasic combination oral contraceptive (COC) used to prevent pregnancy. This birth control pill contains ethinyl estradiol (an estrogen), norethindrone acetate (a progestin), and ferrous fumarate (an iron supplement). The dose of ethinyl estradiol in Lo Loestrin FE is lower compared to that of many other COCs. Lo Loestrin FE is taken by mouth at the same time every day. It comes as a 28-day pack, with 26 days of active pills and 2 days of placebo pills. Some common side effects of this COC include spotting, nausea, and breast tenderness.
To prevent pregnancy
Lo Loestrin FE is a combination of two hormones, norethindrone (a progestin) and ethinyl estradiol (an estrogen). These two hormones work together to help prevent pregnancy by:
Stops ovulation (release of an egg from the ovary) by blocking luteinizing hormone (LH) and follicle stimulating hormone (FSH)
Thickens cervical mucus (fluid from the cervix), which makes it more challenging for sperm to move and fertilize an egg
Thins the lining of the uterus (womb) so a fertilized egg can't implant
Lo Loestrin FE also contains placebo (inactive or hormone-free) tablets with ferrous fumarate (iron supplement). Since you can have bleeding while taking placebo tablets, taking ferrous fumarate might potentially lower your risk of low iron levels.
Source: DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Breast tenderness
heavy non-menstrual vaginal bleeding
irregular menstrual periods
longer or heavier menstrual periods
normal menstrual bleeding occurring earlier, possibly lasting longer than expected
Incidence not known
chills
clay-colored stools
confusion
dark urine
difficulty with speaking
dizziness
double vision
fast or irregular heartbeat
headache
inability to move the arms, legs, or facial muscles
inability to speak
indigestion
itching or rash
loss of appetite
pain, redness, or swelling in the arm or leg
pains in the chest, groin, or legs, especially in the calves
severe headaches of sudden onset
severe nausea or vomiting
slurred speech
stomach pain
sudden loss of coordination
sudden onset of slurred speech
sudden vision changes
tightness in the chest
unpleasant breath odor
unusual tiredness or weakness
unusual warmth or flushing of the skin
unusually heavy or unexpected menstrual bleeding
vaginal bleeding or spotting
vomiting of blood
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Vomiting
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Taken by mouth once daily, so it's convenient for people with a busy schedule
On average, bleeding periods last less than 2 days per cycle
Lighter bleeding periods than you usually have
Must take it at the same time every day for the medication to work well
More likely to cause breakthrough bleeding or spotting compared to other birth controls with higher dose of estrogen
Can raise risk of heart attacks, blood clots, and stroke
Lo Loestrin FE can prevent pregnancy, but it can't protect you from human immunodeficiency virus (HIV), hepatitis, or other sexually transmitted infections (STI). Using a condom along with Lo Loestrin FE can help lower your risk of an STI.
Lo Loestrin FE isn't an emergency contraception (morning-after pill) and shouldn't be used after unprotected sex to prevent pregnancy. Talk to your care team if you had unprotected sex and need an emergency contraception, such as levonorgestrel (Plan B One-Step) or Ella (ulipristal).
Try to take Lo Loestrin FE around the same time every day, which can help this medication work better. Consider setting an alarm to remind yourself to take your doses at the scheduled time.
If you missed a tablet in week 1 or 2, take your missed dose as soon as possible and take your next scheduled dose at the regular time. You might need to take two tablets in one day. If you've missed more than one tablet in a blister pack, refer to the instructions that came with your pack or call your care team for further instructions.
Make sure to get your yearly physical exam done while you’re taking Lo Loestrin FE so your gynecologist can make sure this medication is safe for you. During your appointment, your gynecologist might check your blood pressure, do a breast or cervical exam, as well as other relevant blood work.
It's normal to have spotting (a small amount of vaginal bleeding) while using Lo Loestrin FE. This doesn't mean that your medication isn't working. Continue to take Lo Loestrin FE every day as directed by your gynecologist. Speak with your gynecologist if your bleeding doesn't stop or is heavy.
If you have a history of chloasma gravidarum (a medical condition that darkens the skin), you might develop brown patches on your skin during treatment with Lo Loestrin FE. Make sure to avoid too much sun exposure or tanning beds during treatment. Apply sunscreen when going outside.
Let your gynecologist know if you experience symptoms of depression or worsening mood while taking Lo Loestrin FE. In cases of serious depression, your care team might ask you to stop taking this medication.
If you wear contact lens, let an eye specialist know if you have changes in vision or discomfort with your lenses after starting Lo Loestrin FE. Though not common, this medication can cause dry eyes.
Lo Loestrin FE can interact with other medications. Let your care team know what medications you're taking, including over-the-counter products and supplements, before you start Lo Loestrin FE. Talk with your care team if you have any questions about interactions with this medication.
Lo Loestrin FE can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factor: Females over 35 years old who smoke cigarettes
Smoking cigarettes while taking COCs, like Lo Loestrin FE, can significantly raise the risk of serious heart problems, including heart attack and stroke. The risk is greater if you're over 35 years old and have a history of smoking cigarettes. If you smoke, talk with your gynecologist about safer birth control alternatives.
Risk factors: Females over 35 years old who smoke | Females over 40 years old who don't smoke | Recent surgery with a long period of bed rest | Starting COCs less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen | First year of using COCs | Restarting COCs after a month
Lo Loestrin FE can cause serious blood clots because it contains ethinyl estradiol (an estrogen). More estrogen can lead to more blood proteins that stimulate clot formation. These blood clots can be life-threatening and can happen anywhere in your body. Get medical attention right away if you have any signs or symptoms of a blood clot:
1) Brain: weakness or numbness in your arms, legs, or face on one side of the body, trouble speaking, blurry vision, dizziness, loss of balance, trouble walking, or confusion
2) Eyes: trouble seeing, bulging eye, double vision
3) Heart: chest pain, sweating, nausea, or dizziness
4) Lungs: trouble breathing, chest pain, or cough
5) Legs: cramps, swelling, pain, or muscle tightness
Your risk of getting a blood clot is higher if you're older, smoke cigarettes, or have certain medical conditions. Your risk is also higher if you're on bedrest after surgery or if you've just given birth. Typically your surgeon will temporarily stop Lo Loestrin FE for 4 weeks before surgery, then restart it 2 weeks after. If you just gave birth, start Lo Loestrin FE at least 4 weeks after delivery. Talk with your gynecologist if you have any questions regarding your risk of blood clots.
Risk factors: History of breast or cervical cancer | Taking COCs for a long time | Taken COCs in the last 6 months
It's not clear whether Lo Loestrin FE and other COCs can significantly raise your risk for breast and cervical cancer. In one study, people who used COCs for more than 5 years seemed to be at a greater risk for cervical cancer than those who never used these medications. Certain breast cancers also have tumor cells that spread faster in the presence of estrogen. Since there's a risk of serious harm, don't take Lo Loestrin FE if you currently have or have had breast cancer or cervical cancer.
If you currently take this medication or have taken it in the last 6 months, make sure to get a yearly breast exam with your gynecologist to check for early signs of breast cancer. Your gynecologist can also make sure you get appropriate screenings for cervical cancer. Let your gynecologist know if you notice any signs of breast cancer (e.g., new or abnormal lumps, pain, or swelling in your breasts) or cervical cancer (e.g., vaginal bleeding or discharge that's not normal).
Risk factors: Taking COCs for more than 8 years | Certain hepatitis C medications
Don't take Lo Loestrin FE if you have liver problems, such as liver infection caused by a virus (e.g., hepatitis) or liver tumors. Although rare, this medication can raise your risk of getting benign liver tumors. If you experience signs of liver problems, you should stop taking Lo Loestrin FE and ask your gynecologist for an alternative birth control. Signs of liver problems can include jaundice (yellowing of the skin or whites of the eyes), fever, tiredness, loss of appetite, or dark colored urine.
Additionally, Lo Loestrin FE shouldn’t be taken together with Viekira Pak (a medication to treat hepatitis C infection) because it might cause liver problems. You can restart Lo Loestrin FE two weeks after completing hepatitis C treatment.
Risk factors: Older age | Using COCs for a long time | History of high blood pressure | Taking higher dose of norethindrone (a progestin)
Lo Loestrin FE can raise your blood pressure, so make sure you get your blood pressure check at least once a year while you're taking this medication. The risk is higher if you're older and have been taking birth control for a long period of time. If you have a history of uncontrolled high blood pressure, don't use this medication. Talk with your gynecologist so you can discuss the benefits and risks of taking Lo Loestrin FE.
Risk factors: history of gallbladder disease | Taking higher dose of progestin and estrogen
Some studies show that COCs, like Lo Loestrin FE, can raise the risk of gallbladder disease. This is because more progestin and estrogen in the body can lead to higher chance of gallstones. Although the risk is low, talk to your gynecologist if you a history of gallbladder disease before starting Lo Loestrin FE.
Risk factors: Prediabetes or diabetes | High triglycerides
Lo Loestrin FE can raise your levels of blood sugar and triglycerides (a type of fat). If you have prediabetes or diabetes, your risk of having your blood sugar rise is much higher. This is because Lo Loestrin FE can prevent your body from breaking down sugar efficiently. Additionally, this medication can also affect your level of triglycerides. High triglycerides might lead to a higher risk of pancreatitis (pancreas inflammation). Speak with your gynecologist before starting Lo Loestrin FE if you have a history of high blood sugar or triglycerides. Your gynecologist might help you choose another birth control or monitor your blood works more closely if you take this medication.
Let your gynecologist know if you experience new or worsening migraines or headaches while taking Lo Loestrin FE. You might need to stop your medication if your migraine or headache doesn't go away or becomes severe.
Risk factor: First 3 months of COCs
People who take Lo Loestrin FE can sometimes experience irregular 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 is often temporary, so continue taking your medication as directed. If your bleeding doesn't stop, becomes heavier, or you miss a period after the initial bleeding, let your gynecologist know. Your gynecologist can perform blood tests to rule out other potential causes for bleeding.
Some medications can interfere with how your body gets rid of Lo Loestrin FE. This can affect the amount of Lo Loestrin FE in your body, how well it works, and the risk of side effects.
Taking medications like ketoconazole and atorvastatin (Lipitor) can raise the amount of Lo Loestrin FE in your body, which can cause a higher risk of side effects.
Taking certain medications like rifampin (Rifadin) can lower the amount of Lo Loestrin FE in your body. This can cause your birth control to not work as well and raise the risk of bleeding. Use a condom when you take these medications together.
Lo Loestrin FE also interferes with how your body gets rid of other medications. For example, it shouldn’t be taken with lamotrigine (Lamictal). Doing so can drop levels of lamotrigine (Lamictal) in your body and raise your risk for seizures or mood changes.
If you take Lo Loestrin FE and a medication to replace your thyroid hormone, such as levothyroxine (Synthroid), you might need to take a higher dose of your thyroid medication since Lo Loestrin FE can cause it to not work as well.
Let your care team know what other medications you’re taking before and while taking Lo Loestrin FE so they can help you check for interactions.
Dosage | Quantity | Price as low as | Price per unit |
---|---|---|---|
28 tablets of 1mg/10mcg/10mcg | 1 package | $189.00 | $189.00 |
Lo Loestrin FE is available in a 28-day pack (26 active tablets and 2 placebo tablets). Make sure to take this medication as instructed by your gynecologist or follow the directions on the package. In general, the typical dose is to take 1 active tablet by mouth daily for 26 days, followed by 1 placebo tablet daily for the remaining 2 days.
There are 26 active tablets (with different dosages of norethindrone acetate and ethinyl estradiol) and 2 placebo tablets:
Day 1-24: 1 mg norethindrone acetate and 10 mcg ethinyl estradiol
Day 25-26: 10 mcg ethinyl estradiol
Day 27-28: 75 mg ferrous fumarate
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Females over 35 years old who smoke cigarettes
Currently have or history of DVT, PE, or other blood clotting problems
Cerebrovascular disease (problems with blood flow in the brain)
Coronary artery disease (problems with blood flow in the heart)
Certain heart valve or rhythm problems
Uncontrolled high blood pressure
Diabetes with blood vessel problems
Certain types of headaches with neurological symptoms
Currently have or have a history of breast cancer
Endometrial cancer or other estrogen-dependent tumor
Undiagnosed abnormal vaginal bleeding
Liver tumors
Liver problems
Taking hepatitis C medication containing ombitasvir / paritaprevir / ritonavir, with or without dasabuvir
Pregnancy
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Allergan, Inc. (2022). Lo Loestrin FE- norethindrone acetate and ethinyl estradiol, ethinyl estradiol and ferrous fumarate [package insert]. DailyMed.
American Cancer Society. (2024). Signs and symptoms of cervical cancer.
American College of Obstetricians and Gynecologists. (n.d.). Effectiveness of birth control methods.
Archer, D. F., et al. (2013). Norethindrone acetate 1.0 milligram and ethinyl estradiol 10 micrograms as an ultra low-dose oral contraceptive. Obstetrics and Gynecology.
Family Planning Information Service. (1978). Mode of action of oral contraceptives. National Library of Medicine.
Fischer, J. A. J., et al. (2021). Iron-containing oral contraceptives and their effect on hemoglobin and biomarkers of iron status: A narrative review. Nutrients.
French, V. (2023). What you should know about breakthrough bleeding with birth control. The American College of Obstetricians and Gynecologists.
National Cancer Institute. (2018). Oral contraceptives and cancer risk.
Thijs, C., et al. (1993). Oral contraceptives and the risk of gallbladder disease: A meta-analysis. American Journal of Public Health.
Villavicencio, J., et al. (2016). Unscheduled bleeding and contraceptive choice: Increasing satisfaction and continuation rates. Open Access Journal of Contraception.
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