Estradiol Valerate and Dienogest
Natazia is an oral contraceptive, a type of birth control, used to prevent pregnancy. It was specifically designed to improve the bleeding pattern and is also used to ease heavy periods. It contains 2 medications: estradiol valerate (an estrogen) and dienogest (a progestin). The usual dosage is one tablet by mouth once a day. Common side effects include headache, breast tenderness, and nausea.
What is Natazia?
What is Natazia used for?
To prevent pregnancy
Heavy period bleeding not caused by any diagnosed conditions of the uterus
How Natazia works
Natazia 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 a fertilized egg by thinning the lining of the uterus. This can also help reduce period bleeding.
Drug Facts
What are the side effects of Natazia?
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
- Mood changes
Serious Side Effects
- 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
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
- Breast tissue changes, new lumps, redness, pain, or discharge from the nipple
- Gallbladder problems—severe stomach pain, nausea, vomiting, fever
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Increase in blood pressure
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- New or worsening migraines or headaches
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
- Unusual vaginal discharge, itching, or odor
- Worsening mood, feelings of depression
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Acne
- Breast pain or tenderness
- Dark patches of skin on the face or other sun-exposed areas
- Irregular menstrual cycles or spotting
- Nausea
- Weight gain
Pros and cons of Natazia
Pros
Birth control pill that's FDA approved to also treat heavy periods
Only need to take once a day
Might cause less breakthrough bleeding than other birth control pills
Works very well to prevent pregnancy when taken as instructed
Cons
Tablets shouldn't be skipped or delayed by more than 12 hours
Must be taken in order as instructed on the blister pack
Not recommended during breastfeeding
Unknown if works well for people with a body mass index (BMI) greater than 30 kg/m2
Pharmacist tips for Natazia
Don'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 on time.
If you happen to miss a dose of Natazia, refer to the patient instructions or call your prescriber. What you'll need to do will depend on how long it's been since you missed your pill and where you are in your pack.
Hormonal contraceptives like Natazia don't protect against sexually transmitted infections (STIs), such as chlamydia, gonorrhea, genital warts, or herpes. Using a latex or polyurethane condom during sex can help lower your risk of an STI.
Tell your prescriber if you're breastfeeding, since birth control pills containing estrogen like Natazia can reduce your breast milk supply and pass into your breast milk. If you aren't breastfeeding, you can start this medication as soon as four weeks after your baby is born.
Natazia can cause some people to not have a period. But, if you miss two periods in a row or feel like you might be pregnant, call your prescriber.
Stop taking Natazia if you become pregnant. Studies haven't shown a risk of birth defects in people who took birth control pills before or during early pregnancy, but it's no longer necessary to take it.
Natazia can interfere with many lab tests, so make sure to tell your prescriber you're taking it beforehand.
You can stop Natazia any time you'd like, but if you want to prevent pregnancy, speak with your prescriber about alternative birth control options.
Frequently asked questions about Natazia
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What are the risks and warnings for Natazia?
Natazia 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
If you smoke cigarettes, using combined oral contraceptives (COCs), like Natazia, 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 healthcare professional 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 less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen
Natazia 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 Natazia. 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 and other COCs can raise your risk for breast and cervical cancer.
Don't use Natazia 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 professional. Call your care team 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: History of liver problems | Taking COCs for a long time
Though rare, Natazia can cause liver problems, such as liver damage and liver tumors. Call your prescriber 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
Natazia and other COCs can raise your blood pressure. Your prescriber 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 prescriber. If you have uncontrolled high blood pressure, Natazia 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 might raise your blood sugar and triglyceride (fat) levels. If you have diabetes, 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.
Headache
Headaches are a common side effect of COCs like Natazia. 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 prescriber so you can be checked out.
Irregular bleeding
Breakthrough bleeding and spotting are common side effects of hormonal birth control pills. This is more common during the first 3 months of using Natazia. Let your prescriber know if you experience any vaginal bleeding outside of your period, or if your period has stopped completely. There are other causes besides your birth control pills for irregular bleeding that your prescriber will evaluate.
Depression
Risk factors: History of depression
Let your care team know if you experience symptoms of depression or worsening depression while taking Natazia. In cases of serious depression, your prescriber might have you stop taking it.
Interactions with other medications
Certain medications can make Natazia get broken down faster in your body, which can make Natazia work less well and lead to pregnancy. Some examples include carbamazepine (Tegretol), phenytoin (Dilantin), and St. John’s wort. You shouldn't take Natazia for at least 28 days after stopping any of these medications, since it might not work as well until after this time. Make sure to tell your care team all of your medications so they can make sure they don't interact with Natazia.
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 professional before taking Natazia 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.
Natazia dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 28 tablets | 1 package | $246.40 | $246.40 |
Typical dosing for Natazia
Natazia 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 that 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.
How much does Natazia cost?
Natazia contraindications
Smoke and over age 35 years old
Currently have or history of DVT or PE (clotting in the legs or lungs)
Coronary artery disease
Cerebrovascular disease (problems with blood flow in the brain)
Certain heart valve or heart rhythm problems
Blood clotting problems
Uncontrolled high blood pressure
Diabetes with blood vessel problems
Certain types of headaches
Migraine with or without aura if over age 35 years old
Undiagnosed abnormal uterine bleeding
Currently have or have a history of breast cancer
Liver tumors or liver disease
What are alternatives to Natazia?
To prevent pregnancy
Heavy period bleeding not caused by any diagnosed conditions of the uterus
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References
Best studies we foundAmerican College of Obstetricians and Gynecologists. (2023). How to prevent sexually transmitted infections.
Bayer. (2022). FAQs.
Bayer HealthCare Pharmaceuticals Inc. (2024). Natazia- estradiol valerate and estradiol valerate/dienogest kit [package insert]. DailyMed.
Cortés, M. E., et al. (2014). The effects of hormonal contraceptives on glycemic regulation. The Linacre Quarterly.
Lethaby, A., et al. (2019). Combined hormonal contraceptives for heavy menstrual bleeding. The Cochrane Database of Systematic Reviews.
Micks, E., et al. (2011). Estradiol valerate and dienogest: A novel four-phasic oral contraceptive pill effective for pregnancy prevention and treatment of heavy menstrual bleeding. Women’s Health.
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