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This safety and warning information outlines critical considerations when using Junel 1/20, a combined oral contraceptive. Please read carefully and discuss with your healthcare provider if you have any questions or concerns.

• Cigarette Smoking and Heart Risks: Smoking cigarettes while taking Junel 1/20 significantly increases the risk of severe heart problems, such as strokes, heart attacks, and blood clots. This risk is particularly high for females aged 35 and older. It's advised to consult your healthcare provider about alternative birth control options if you are a smoker.

• Blood Clots and Strokes: Using Junel 1/20 can elevate the risk of blood clots, which may lead to pulmonary embolism, deep vein thrombosis, strokes, or heart attacks. Seek immediate medical attention if you notice signs of blood clots, especially if you are over 35 and smoke, over 40 and don't smoke, have recently had surgery, or have risk factors like obesity, high blood pressure, high cholesterol, diabetes, or a higher estrogen dose.

• Irregular Bleeding: Some users may experience irregular bleeding or spotting, especially in the initial three months. The severity can range from light spotting to bleeding similar to a menstrual period. Continue taking your medication as prescribed, but consult your provider if bleeding persists or if you miss a period to rule out pregnancy.

• High Blood Pressure: Junel 1/20 may increase blood pressure. Regularly monitor your blood pressure, and discuss safer birth control alternatives with your provider if you have high blood pressure or kidney problems. Blood pressure levels typically normalize after discontinuing the medication.

• High Blood Sugar and Cholesterol Levels: The medication can raise blood sugar and cholesterol levels. If you have diabetes, prediabetes, or high cholesterol, consult your provider before starting Junel 1/20, as regular monitoring will be necessary.

• Headaches: Report any new or worsening migraines or headaches to your provider. Discontinuation of the medication may be required if symptoms persist or become severe.

• Cancer Risks: There is a potential increased risk of breast and cervical cancer associated with long-term use of Junel 1/20. Discuss your medical history, particularly if you have had breast or cervical cancer, with your healthcare provider.

• Medication Interactions: Some medications can reduce the effectiveness of Junel 1/20, potentially leading to pregnancy, while others can increase side effects. Inform your provider or pharmacist of all medications you are taking to avoid interactions. Use an alternative birth control method for at least 28 days after stopping medications like carbamazepine or phenytoin.

Contraindications: Do not use Junel 1/20 if you have a current or history of blood clots, conditions increasing clotting risk, cerebral vascular or coronary artery disease, breast cancer, unexplained vaginal bleeding, jaundice from previous contraceptive use, liver tumors or cancer, are pregnant, or are taking certain hepatitis C medications.

Consult your healthcare provider for further guidance and to ensure that Junel 1/20 is safe for your use.

Common side effects:

• Nausea
• Vomiting
• Stomach cramps
• Bloating
• Menstrual cycle irregularities
• Swelling
• Breast changes
• Weight fluctuations
• Feelings of depression
• Vaginal yeast infection

Less common but important to monitor:

• Skin conditions causing brown spots or patches
• Migraines
• Allergic rashes

Serious side effects:

• Heart attack symptoms
• Stroke symptoms
• Deep vein thrombosis
• Pulmonary embolism