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

If you smoke cigarettes, using combined oral contraceptives (COCs), like Quartette, 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.

• 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 Quartette less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen

Quartette 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 Quartette. They might have you stop taking it 4 weeks before until 2 weeks after your surgery to lower your risk of blood clots. If you recently delivered a baby, you shouldn't start Quartette until 4 weeks after delivery if you're not breastfeeding your child.

People who take Quartette 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 might be temporary, so continue taking your medication as directed. Let your provider know if the bleeding is a problem for you and they can change your birth control. If you are missed your periods, make sure you get a pregnancy test to make sure you're not pregnant.

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

Quartette can raise your blood pressure, so make sure you check your blood pressure while you're taking this medication. The risk is higher in females who are older and have been taking birth control for a long period of time. Quartette can't be taken by females who have high blood pressure that's not under control. Speak to your provider if this medication raises your blood pressure and they can help you pick a different method of birth control that's safer for you.

• Risk factors: Prediabetes or diabetes | High triglycerides

Quartette can raise your blood sugar and cholesterol levels. Females who have high triglycerides (a type of cholesterol) might have a higher risk of experiencing pancreatitis (inflammation of the pancreas) when taking COCs. Speak with your provider before starting Quartette if you have diabetes, prediabetes, or high cholesterol. If you choose to take Quartette with those health conditions, your provider will monitor you regularly.

Let your provider know if you experience new or worsening migraines or headaches while taking Quartette. You will have to stop your medication if your migraine or headache doesn't go away or becomes severe.

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

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

Don't take Quartette if you currently have or have had breast cancer because some breast cancers grow faster in the presence of estrogen, a hormone in this medication. You can examine your breasts regularly at home or get yearly breast exams with your healthcare provider to help with early breast cancer detection. Let your provider know if you notice any new or abnormal lumps, pain, or swelling in your breasts.

Make sure you follow up with your provider to get proper screenings for cervical cancer. Report any signs of vaginal bleeding or discharge that's not normal.

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

Though rare, Quartette 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), and less so with Quartette since it at most only contains 30 mcg of estrogen. Don't use this medication if you already have liver problems. 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.

Certain medications can make Quartette get broken down faster in your body, making it less effective (not work as well) and can lead to pregnancy. Some examples include carbamazepine (Tegretol) and phenytoin (Dilantin). You'll likely need to use a back-up method or other form of birth control for several weeks after stopping any of these medications. Other medications can raise the amount of Quartette in your body, which can lead to more side effects. Make sure to tell your provider or pharmacist all of your medications so they can make sure they don't interact with Quartette.

If you have hepatitis C and need to be treated with Viekira Pak (dasabuvir / ombitasvir / paritaprevir / ritonavir), let your provider know right away that you're taking a COC. You'll need to stop Quartette before starting Viekira Pak because taking them together can cause liver problems. You can start Quartette again 2 weeks after you stop Viekira Pak.