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When using hormonal birth control methods such as the pill, patch, or ring, there are important safety considerations you should be aware of, especially regarding smoking and tobacco use:

• Individuals over the age of 35 who smoke cigarettes or use tobacco should not use this medication.
• Smoking can significantly increase the risk of severe health issues, including stroke, heart attack, blood clots, and high blood pressure while on hormonal birth control.
• The likelihood of these serious conditions is higher for those who smoke more cigarettes and as they age.
• It is strongly advised to refrain from smoking or using tobacco while on this medication.

These guidelines are critical for your health and safety. If you have any concerns or need more information, it is advisable to consult with a healthcare professional.

Common side effects:

• Nausea
• Vomiting
• Headaches
• Bloating
• Breast tenderness
• Swelling of the ankles or feet
• Weight changes
• Vaginal bleeding between periods (spotting)
• Missed or irregular periods

Less common but important to monitor:

• Breast lumps
• Significant mood changes
• New or worsening depression
• Severe stomach or abdominal pain
• Unusual changes in vaginal bleeding patterns
• Liver issues (indicated by dark urine or yellowing of the eyes or skin)
• Increased blood pressure

Serious side effects:

• Severe blood clot complications (heart attack or stroke)
• Chest pain
• Confusion
• Sudden dizziness or fainting
• Pain or swelling in the groin or calf
• Difficulty speaking
• Shortness of breath
• Severe headaches
• Sudden vision changes
• Serious allergic reaction (rash, itching, swelling especially of the face or throat, severe dizziness, breathing difficulties)

Interactions with high risk of serious adverse effects and should be avoided:

• 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)

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• aromatase inhibitors (such as anastrozole, exemestane)
• fezolinetant
• ospemifene
• tamoxifen
• tizanidine
• tranexamic acid