desogestrel / ethinyl estradiol

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

If you smoke cigarettes, using combined oral contraceptives (COCs), like Kariva, 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 prescriber 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 Kariva less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen

Kariva 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 prescriber you're taking Kariva. They might have you stop taking it 4 weeks before until 2 weeks after your surgery to lower your risk of blood clots.

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

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

Don't use Kariva 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 HCP 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.

• Risk factors: Liver problems or infection in the liver | Taking a COC for 8 years or longer

Though rare, Kariva can cause liver problems, such as liver damage and liver tumors. These problems are linked more with earlier formulations of COCs that contained higher doses of estrogen (50 mcg or higher), and less so with Kariva since it only contains up to 20 mcg of estrogen. Don't use this medication if you already have liver problems. Call your HCP right away if you experience symptoms of liver problems, such as tiredness, stomach pain, or yellowing of the skin or whites of the eyes.

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

COCs like Kariva 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. Make sure to go to all of your check-ups so your prescriber can monitor any changes.

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

Kariva and other COCs can raise your blood pressure. Your HCP 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 HCP. If you have uncontrolled high blood pressure, Kariva might not be the best option for you.

Headaches are a common side effect of COCs like Kariva. This is likely caused by changes in estrogen levels and tends to get better after a few months. 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.

Breakthrough bleeding and spotting are common side effects of hormonal birth control pills. This is more common during the first 3 months of using Kariva. 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.

• Risk factors: History of depression

Let your prescriber know if you experience symptoms of depression or worsening depression while taking Kariva. Some people start to notice mood changes within weeks of starting this medication. In cases of serious depression, your prescriber might have you stop taking it.

Some studies suggest that Kariva can raise the risk of gallbladder disease since more progestin and estrogen 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 Kariva.

Certain medications can make Kariva get broken down faster in your body, making it less effective and can lead to pregnancy. Some examples include carbamazepine (Tegretol) and phenytoin (Dilantin). Use a back-up method or other form of birth control for at least 28 days after stopping any of these medications. Other medications can raise the amount of Kariva in your body, which can lead to more side effects. Make sure to tell your prescriber or pharmacist all of your medications so they can make sure they don't interact with Kariva.

If you're taking medications to treat hepatitis C, immediately let your HCP know that you're taking a COC. Certain hepatitis C medications can affect the level of Kariva in your body, either making it work not as well in preventing pregnancy or raising your risk of side effects. Your healthcare team can give you instructions about what to do if you're taking a hepatitis C medication that can interact with Kariva.