(dienogest / ethinyl valerate) monophasic

Basics, Side Effects, Reviews & More

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Natazia (estradiol valerate / dienogest) is a combined hormonal medication taken by mouth every day as a type of birth control to prevent pregnancy. It was specifically designed to improve the bleeding pattern and is also used to ease heavy menstrual bleeding. Compared to other birth control pills, it can be more complicated if you miss a dose.




Estrogen / Progestin combined contraceptive


Not a controlled medication


No lower-cost generic available


Prescription only

Reviewed by:

Kristianne Hannemann, PharmD

Allison Barnes, PharmD

Last reviewed on:

June 6, 2022


What is Natazia (estradiol valerate / dienogest)?

How Natazia (estradiol valerate / dienogest) works

Natazia (estradiol valerate / dienogest) is a combined contraceptive that contains two hormones: estradiol valerate (an estrogen) and dienogest (a progestin). Both hormones work together to prevent pregnancy by:

  • Suppressing ovulation (release of an egg from the ovary)
  • Changing cervical mucus to block sperm movement
  • Creating an unfriendly environment for the fertilized egg by changing the lining in the uterus. These hormones thin the lining of the uterus, which can help reduce period bleeding in females who experience heavy bleeding.

What is Natazia (estradiol valerate / dienogest) used for?

  • To prevent pregnancy
  • Heavy period bleeding not due to infection, bleeding problems, or other specific health conditions

Natazia (estradiol valerate / dienogest) dosage forms

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Typical dosing for Natazia (estradiol valerate / dienogest)

Natazia (estradiol valerate / dienogest) comes in a 28-day pack. There are 26 active tablets and they contain different dosages of dienogest and ethinyl valerate. There are also 2 placebo tablets and they don't contain any active medications.

  • Day 1 through 2: 3 mg ethinyl valerate only
  • Day 3 through 7: 2 mg of dienogest and 2 mg ethinyl valerate
  • Day 8 through 24: 3 mg of dienogest and 2 mg ethinyl valerate
  • Day 25 through 26: 1 mg ethinyl valerate only
  • Day 27 through 28: Placebo tablets, no active medication

The typical dose is 1 tablet by mouth at the same time every day. Tablets must be taken in the order instructed on the blister pack.

Frequently asked questions about Natazia (estradiol valerate / dienogest)

Pros and cons of Natazia (estradiol valerate / dienogest)


Thumbs UpFirst and only birth control pill FDA-approved to treat heavy periods

Thumbs UpOnly need to take once a day

Thumbs UpWorks very well to prevent pregnancy when taken as instructed

Thumbs UpAvailable as a lower-cost generic


Thumbs DownTablets shouldn't be skipped or delayed by more than 12 hours

Thumbs DownMust be taken in order as instructed on the blister pack

Thumbs DownCan raise the risk for blood clotting problems

Thumbs DownNot recommended during breastfeeding

Thumbs DownUnknown if works well for females with a body mass index (BMI) greater than 30 kg/m2

Pharmacist tips for Natazia (estradiol valerate / dienogest)

Capsule IconDon't skip pills or delay taking your pill by more than 12 hours, or you could get pregnant. You can set an alarm to help yourself remember to take Natazia (estradiol valerate / dienogest) on time.

Capsule IconIf you happen to miss your pill, refer to the patient instructions or call your provider. What you'll need to do will depend on how long it has been since you've missed your pill and where you are in your pack.

Capsule IconHormonal contraceptives like Natazia (estradiol valerate / dienogest) don't protect against sexually transmitted diseases (STDs), such as chlamydia, gonorrhea, genital warts, or herpes. Using a latex or polyurethane condom during sex can help lower your risk of an STD.

Capsule IconTell your provider if you're breastfeeding, since birth control pills that contain estrogen like Natazia (estradiol valerate / dienogest) can lower the amount of breast milk you make and can enter your breast milk. If you aren't breastfeeding, you can start this medication as soon as four weeks after your baby is born.

Capsule IconNatazia (estradiol valerate / dienogest) can cause some females to not have a period. However, if you miss two periods in a row or feel like you might be pregnant, call your provider.

Capsule IconStop taking Natazia (estradiol valerate / dienogest) if you become pregnant. Studies haven't shown a risk of birth defects in females who took birth control pills before or during early pregnancy, but it's no longer necessary to take it.

Capsule IconIt's common to experience breakthrough bleeding (spotting), especially during the first 3 months of taking Natazia (estradiol valerate / dienogest). Call your provider if you continue to have bleeding when you aren't on your period or if you start having spotting after you have had regular cycles.

Capsule IconIf you develop new headaches that keep coming back, don't seem to go away, or if they're severe, contact your provider to discuss if Natazia (estradiol valerate / dienogest) might be causing them.

Capsule IconNatazia (estradiol valerate / dienogest) can interfere with many lab tests, so make sure to tell your provider you're taking it beforehand.

Capsule IconYou can stop Natazia (estradiol valerate / dienogest) any time you'd like, but if you want to prevent pregnancy, speak with your provider about alternative birth control options.

What are the side effects of Natazia (estradiol valerate / dienogest)?

With any medication, there are risks and benefits. Even if the medication is working, you may experience some unwanted side effects.

Warning Small Contact your doctor immediately if you experience any of the following:

  • Heart attack: chest pain, stomach discomfort, sweating, nausea, dizziness
  • Stroke: sudden numbness or weakness in the arm, leg, or face, confusion, trouble seeing, headache, difficulty walking
  • Deep vein thrombosis (blood clot in the leg): leg cramp, swelling, pain, muscle tightness
  • Pulmonary embolism (blood clot in the lung): cough, chest pain, trouble breathing, racing heart
  • Serious liver problems: yellowing of the skin or the whites of the eyes, tiredness, stomach pain
  • Ruptured ovarian cyst: stomach pain, nausea, vomiting, fever, dizziness, vaginal bleeding

Caution Small The following side effects may get better over time as your body gets used to the medication. Let your doctor know immediately if you continue to experience these symptoms or if they worsen over time.

Common side effects

  • Headache (13%)
  • Breast pain, discomfort, or tenderness (7%)
  • Irregular vaginal bleeding (7%)
  • Nausea or vomiting (6%)
  • Acne (4%)
  • Mood changes (3%)
  • Weight gain (3%)

Other side effects

  • Stomach pain
  • Dizziness
  • Fluid build up
  • Rash
  • Vaginal yeast infection

Source: DailyMed

The following side effects have also been reported:

Side effects that you should report to your doctor or health care professional as soon as possible:

  • allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
  • breast tissue changes or discharge
  • changes in vision
  • chest pain
  • confusion, trouble speaking or understanding
  • dark urine
  • general ill feeling or flu-like symptoms
  • light-colored stools
  • nausea, vomiting
  • pain, swelling, warmth in the leg
  • right upper belly pain
  • severe headaches
  • shortness of breath
  • sudden numbness or weakness of the face, arm or leg
  • trouble walking, dizziness, loss of balance or coordination
  • unusual vaginal bleeding
  • yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

What are the risks and warnings for Natazia (estradiol valerate / dienogest)?

Natazia (estradiol valerate / dienogest) 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

Cigarette smoking and serious heart problems

  • Risk factors: Females over 35 years old who smoke cigarettes

Warning Icon If you smoke cigarettes, using combined oral contraceptives (COCs), like Natazia (estradiol valerate / dienogest), 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.

Blood clots and strokes

  • 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 Natazia (estradiol valerate / dienogest) less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen

Natazia (estradiol valerate / dienogest) 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 provider you're taking Natazia (estradiol valerate / dienogest). They might have you stop taking it 4 weeks before until 2 weeks after your surgery to lower your risk of blood clots.

Risk of breast and cervical cancer

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

Study results are mixed, but there's a possibility that Natazia (estradiol valerate / dienogest) and other COCs can raise your risk for breast and cervical cancer.

Don't use Natazia (estradiol valerate / dienogest) if you have breast cancer because some types of breast cancer grow faster in the presence of estrogen, an ingredient in this birth control pill. To help with early breast cancer detection, you can do monthly breast self-checks at home and yearly breast exams with your healthcare provider. Call your healthcare provider if you notice any abnormal changes or feel lumps, pain, or swelling in your breasts.

Get medical help right away if you experience abnormal vaginal bleeding, discharge, or pain during sex, since these could be signs of cervical cancer.

Liver problems

  • Risk factors: Liver problems or infection in the liver | Taking COCs with 50 mcg of estrogen or higher

Though rare, Natazia (estradiol valerate / dienogest) 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). 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.

High blood pressure

  • Risk factors: High blood pressure | Older age | Using COCs for a long time | Kidney problems

Natazia (estradiol valerate / dienogest) 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, Natazia (estradiol valerate / dienogest) might not be the best option for you.

High blood sugar and triglycerides

  • Risk factors: Prediabetes or diabetes | Personal or family history of high triglycerides

COCs like Natazia (estradiol valerate / dienogest) might raise your blood sugar and triglyceride (fat) levels. If you have diabetes, let your provider 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.


  • Risk factors: History of depression

Let your provider know if you experience symptoms of depression or worsening depression while taking Natazia (estradiol valerate / dienogest). In cases of serious depression, your provider might have you stop taking it.

Interactions with other medications

Certain medications can make Natazia (estradiol valerate / dienogest) get broken down faster in your body, which can make Natazia (estradiol valerate / dienogest) work less well and lead to pregnancy. Some examples include carbamazepine (Tegretol), phenytoin (Dilantin), rifampicin, and St. John’s wort. You shouldn't take Natazia (estradiol valerate / dienogest) for at least 28 days after stopping any of these medications, since it might not work as well for you until after this time. Make sure to tell your provider or pharmacist all of your medications so they can make sure they don't interact with Natazia (estradiol valerate / dienogest).

Worsening of other health conditions

  • 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 brown patches on the face), talk to your healthcare provider before taking Natazia (estradiol valerate / dienogest) because it might worsen your symptoms. If you have a history of chloasma, avoid exposure to the sun or UV light while taking COCs like Natazia (estradiol valerate / dienogest).

How much does Natazia (estradiol valerate / dienogest) cost?

There is currently no generic for Natazia (estradiol valerate / dienogest), so it can be expensive, even with insurance. GoodRx coupons, copay cards and patient assistance programs may help lower the cost.

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Natazia (brand)


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Pricing based on most commonly-filled versions: 1 packages of estradiol valerate/dienogest 28 tablets

What are alternatives to Natazia (estradiol valerate / dienogest)?

There are a number of medications that your doctor can prescribe in place of Natazia (estradiol valerate / dienogest). Compare a few possible alternatives below.

Natazia (estradiol valerate / dienogest)
Drug Class:Estrogen / Progestin combined contraceptive


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What is the latest news about Natazia (estradiol valerate / dienogest)?

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