levonorgestrel / ethinyl estradiol

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

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

Vienva 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 Vienva. 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 Vienva and other COCs can raise your risk for breast and cervical cancer.

Don't use Vienva 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.

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

Though rare, Vienva 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 of higher), and less so with Vienva since it only contains 20 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.

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

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

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

Vienva 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, Vienva might not be the best option for you.

Headaches are a common side effect of COCs like Vienva. 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 provider 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 Vienva. Let your provider 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 provider will evaluate.

Research suggests that females who take that COCs are at a higher risk of pregnancy occuring outside of the womb (ectopic pregnancy) if the birth control pills don't work like they're supposed to. The chance of becoming pregnant is higher when you don't take Vienva as instructed at the same time every day. Symptoms of an ectopic pregnancy include low back pain, abnormal vaginal bleeding, and cramping. If you experience any of these symptoms, contact your provider.

• Risk factors: History of depression

Let your provider know if you experience symptoms of depression or worsening depression while taking Vienva. In cases of serious depression, your provider might have you stop taking it.

Certain medications can make Vienva 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 Vienva 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 Vienva.

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 Vienva before starting Viekira Pak because taking them together can cause liver problems. You can start Vienva again 2 weeks after you stop Viekira Pak.