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This medication may cause serious bone loss which may not return to normal after you stop using it. The risk of bone loss increases with longer use of this medication and smoking. An important time when your bones continue to build up is during your teenage and young adult years. Use of this medication may increase the risk of weak/brittle bones (osteoporosis), which can lead to broken bones when you are older. Talk with your doctor about the risks and benefits of this medication and other birth control choices. This medication should not be used longer than 2 years for birth control or for treatment of endometriosis unless other methods/treatments will not work for you.

Nausea, bloating, headache, changes in appetite, weight gain, tiredness, swelling, acne, hot flashes, or breast tenderness may occur. Vaginal bleeding between periods (spotting) or missed/irregular periods may occur, especially during the first few months of use. Injection site pain, swelling, redness, bruising, or a hardened mass or lump may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. Your periods may stop completely after you have been using this medication for about a year. If this occurs, your periods will normally return after you stop using this medication. If you miss a period and have missed an injection, or if more than 14 weeks pass between injections and you think you might be pregnant, contact your doctor for a pregnancy test. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor right away if you have any serious side effects, including: nausea/vomiting that doesn't stop, mental/mood changes (such as new/worsening depression), changes in sexual interest/ability, swelling of the ankles/feet, bone pain, unusual changes in vaginal bleeding (such as continuous spotting, sudden heavy bleeding), severe stomach/abdominal/pelvic pain, unusual weakness/tiredness, dark urine, yellowing skin/eyes, seizure. This medication may increase your risk of breast cancer. Tell your doctor right away if you have symptoms such as a lump in the breast, nipple discharge. Ask your doctor for more details. Rarely, people using this medication have had very serious (possibly fatal) problems from blood clots (such as heart attack, stroke, blood clots in the lungs, legs, or eyes). Get medical help right away if you have: shortness of breath/rapid breathing, chest/jaw/left arm pain, unusual sweating, confusion, sudden dizziness/fainting, pain/swelling/warmth in the groin/calf, sudden/severe headaches, trouble speaking, weakness on one side of the body, sudden vision changes. A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

A product that may interact with this drug is: warfarin. Some drugs may cause hormonal birth control to work less well by decreasing the amount of birth control hormones in your body. This effect can result in pregnancy. Examples include griseofulvin, modafinil, rifamycins (such as rifampin, rifabutin), ritonavir, St. John's wort, drugs used to treat seizures (such as barbiturates, carbamazepine, felbamate, phenytoin, primidone, topiramate), HIV drugs (such as nelfinavir, nevirapine), among others. Tell your doctor when you start any new drug, and discuss if you should use reliable backup birth control. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well. This medication may interfere with certain lab tests (such as certain hormone levels, blood tests for clotting factors, thyroid/liver function tests), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.