norelgestromin / ethinyl estradiol

• Risk factors: Over 35 years old who smoke cigarettes

Smoking cigarettes while using Xulane can significantly raise your risk for blood clots. These blood clots can lead to more serious problems, such as 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: Age 35 or older and smoke | Recent surgery with a long period of bed rest | Starting Xulane less than a month after childbirth | High blood pressure | | High cholesterol | People identified as obese | Diabetes | Higher dose of estrogen

Xulane can raise the risk of serious blood clots because it contains ethinyl estradiol (an estrogen). Higher estrogen levels can lead to more blood proteins that stimulate clot formation. Some studies also suggest that birth control pills with drospirenone, like Xulane, might have a higher risk of blood clots compared to pills with levonorgestrel or other progestins. These clots can be life-threatening and can form anywhere in your body. Get medical attention right away if you have any signs or symptoms of a blood clot:

• Brain (e.g., stroke): 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
• Eyes (e.g., retinal thrombosis): trouble seeing, bulging eye, or double vision
• Heart (e.g., heart attack): chest pain, sweating, nausea, or dizziness
• Lungs (e.g., pulmonary embolism or PE): trouble breathing, chest pain, or cough
• Legs (e.g., deep vein thrombosis or DVT): cramps, swelling, pain, or muscle tightness

Your risk of blood clots is higher if you're older, smoke cigarettes, or have certain medical conditions. It also increases if you're on bedrest after surgery or have just given birth. Your gynecologist will usually stop Xulane 3-4 weeks before surgery and restart it 2 weeks after to lower your risk. If you recently delivered a baby, you should wait at least 4 weeks after delivery to start this medication, and only if you aren't breastfeeding. Talk with your gynecologist if you have any questions regarding your risk of blood clots.

• Risk factors: Liver problems or infection in the liver | Taking Xulane for more than 8 years | Certain hepatitis C medications

Don't use Xulane if you have liver problems, such as hepatitis, severe cirrhosis, or liver tumors. Although rare, this medication can raise your risk of benign liver tumors. If you notice signs of liver problems, stop using Xulane and talk to your gynecologist about other birth control options. Signs of liver problems include jaundice (yellowing of the skin or whites of the eyes), fever, tiredness, loss of appetite, or dark urine.

• Risk factors: High blood pressure | Older age | Using CHCs for a long time

Xulane can raise your blood pressure. The risk is higher if you're older and have been using birth control for a long time. If you have a history of high blood pressure that's well-controlled, your prescriber might monitor you while you use Xulane. If you have concerns, talk with them about the risks and benefits of using this medication.

• Risk factors: History of gallbladder problems

Some studies suggest that Xulane can raise the risk of gallbladder problems since more progestin and estrogen can lead to higher chance of gallstones. Although the risk is low, talk to your gynecologist if you have a history of gallbladder problems before starting this medication.

• Risk factors: Prediabetes or diabetes | High triglycerides

Xulane can raise your blood sugar and triglycerides levels. If you have prediabetes or diabetes, your prescriber will likely monitor your blood sugar while you take this medication. High triglycerides can lead to a higher risk of pancreatitis (inflammation of the pancreas). Speak with your gynecologist before starting Xulane if you have a history of high blood sugar or triglycerides. They might suggest a different birth control option or monitor your lab work more closely while you're using this medication.

Let your gynecologist know if you experience new or worsening migraines or headaches while using Xulane. If you develop frequent, severe, or new headaches, you might need to stop the medication.

People who use Xulane can sometimes experience breakthrough bleeding or spotting. If this happens, talk to your gynecologist to rule out pregnancy, infections, or other medical conditions. If no serious cause is found, the bleeding might stop over time or after switching to a different birth control.

In clinical trials, most people started their withdrawal bleeding on the fourth day of the patch-free week, lasting about 5 to 6 days. If you have concerns about irregular bleeding, talk to your gynecologist.

• Risk factors: History of depression

If you have a history of depression, your prescriber will monitor you while using Xulane. If your depression gets worse or becomes serious, they might stop the medication. Let your prescriber know if you experience mood changes, sadness, or loss of interest in activities while taking this medication.

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

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

Study results are mixed, but Xulane and other combined hormonal birth control pills might raise your risk for breast and cervical cancer.

Don't take Xulane if you currently have or have had breast cancer because some types of breast cancer grow faster in the presence of estrogen, which is in this medication. Perform breast self-checks regularly at home and get yearly breast exams with your gynecologist to help with early detection. Let them know if you notice any new or abnormal lumps, pain, or swelling in your breasts.

Make sure you follow up with your gynecologist 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 prescriber before taking Xulane because it might worsen your symptoms. If you have a history of chloasma, limit exposure to the sun or UV light while taking Xulane.