Version July 2025
Contraception: Oral: One tablet once daily at the same time each day in the order presented in the blister pack. Do not skip days.
If not currently using a contraceptive, the first dose may be started on any day during the month. Use a condom or other barrier method of contraception for the first 2 days (48 hours) after the first dose. If switching from another contraceptive (another oral contraceptive, vaginal ring, or patch), take the first dose the day after stopping the other method.
Missed or late dose: If more than 3 hours since last dose or if missed dose completely: Take 1 tablet immediately, then continue taking 1 tablet once daily at the usual time. Use a condom or other barrier method of contraception for the first 2 days (48 hours) after the missed dose.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Not indicated for use post menopause.
(For additional information see "Norgestrel: Pediatric drug information")
Contraception: Postmenarche patients: Oral: One tablet once daily at the same time each day in the order presented in the blister pack. Do not skip days.
If not currently using a contraceptive, the first dose may be started on any day during the month. Use a condom or other barrier method of contraception for the first 2 days (48 hours) after the first dose. If switching from another contraceptive (another oral contraceptive, vaginal ring, or patch), take the first dose the day after stopping the other method.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no adverse reactions listed in the manufacturer's labeling.
OTC labeling: When used for self-medication, do not use if allergic to norgestrel or any component of the formulation; have or ever had breast cancer; during pregnancy; concomitantly with another oral contraceptive, vaginal ring, patch, implant, injection, or an IUD (intra-uterine device); as an emergency contraceptive; or in males.
Concerns related to adverse effects:
• Allergic reaction: Stop taking norgestrel and contact health care provider if allergic symptoms develop. Symptoms may include asthma (wheezing), blisters, facial swelling, hives, rash, red skin, or shock.
• Bleeding irregularities: Changes in menstrual bleeding (irregular periods), spotting, or bleeding in between menstrual cycles (periods) may occur during treatment. Contact health care provider if bleeding occurs during sex, or if periods last more than 8 days or become unusually heavy. Menstrual cycles may stop during use of norgestrel. When used for self-medication (OTC labeling), contact health care provider if there is vaginal bleeding in between menstrual cycles (periods) prior to taking norgestrel.
Disease-related concerns:
• Cancer: When used for self-medication (OTC labeling), contact health care provider prior to use if you have or ever had any type of cancer.
• Hepatic impairment: When used for self-medication (OTC labeling), contact health care provider prior to use if you have liver problems.
• HIV infection: When used for self-medication (OTC labeling), contact health care provider prior to use if you are taking medications for HIV/AIDS.
• Migraine: When used for self-medication (OTC labeling), contact health care provider if you have migraine headaches that get worse, or migraine headaches with aura (vision changes) while taking norgestrel.
• Seizure: When used for self-medication (OTC labeling), contact health care provider prior to use if you are taking medications for seizures.
• Tuberculosis: When used for self-medication (OTC labeling), contact health care provider prior to use if you are taking medications for tuberculosis.
• Pulmonary hypertension: When used for self-medication (OTC labeling), contact health care provider prior to use if you are taking medications for pulmonary hypertension.
Concurrent drug therapy issues:
• St John's wort: When used for self-medication (OTC labeling), contact health care provider prior to use if taking an herbal supplement containing St John’swort.
• Ulipristal: When used for self-medication (OTC labeling), contact health care provider prior to use if you have taken ulipristal for emergency contraception (morning after pill) within the previous 5 days.
Dosage form specific issues:
• Tartrazine: Contains tartrazine (FD&C yellow #5), which may cause allergic reactions (including asthma) in susceptible individuals, particularly those with aspirin allergy.
Other warnings/precautions:
• HIV infection protection: Use does not protect against HIV infection or other sexually transmitted diseases.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Opill: 0.075 mg (28s)
Oral: Administer at the same time each day. When one pack is done, start a new pack the next day; do not skip days between starting a new pack. If severe diarrhea or vomiting occur within 4 hours after taking a tablet, use a condom or other barrier method of contraception for the next 2 days (48 hours).
Oral: Administer at the same time each day. When one pack is done, start a new pack the next day; do not skip days between starting a new pack. If severe diarrhea or vomiting occur within 4 hours after taking a tablet, use a condom or other barrier method of contraception for the next 2 days (48 hours).
Missed or late dose: If >3 hours late taking dose or if missed dose completely: Take 1 tablet immediately, then continue taking 1 tablet once daily at the usual time. Use a condom or other barrier method of contraception for the first 2 days (48 hours) after the missed dose.
Hazardous agent (NIOSH 2024 [table 2]).
Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2023; NIOSH 2024; USP-NF 2020).
Note: Facilities may perform risk assessment of some hazardous drugs to determine if appropriate for alternative handling and containment strategies (USP-NF 2020). Refer to institution-specific handling policies/procedures.
Contraception: For the prevention of pregnancy.
Limitations of use: Progestin-only contraceptives are for use in patients who may become pregnant; not for use prior to menarche or post menopause (CDC [Curtis 2016a]).
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs (contraindicated in pregnancy) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Community/Ambulatory Care Settings).
Substrate of CYP3A4 (Major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Adalimumab: May decrease serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor
Antidiabetic Agents: Hyperglycemia-Associated Agents may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor
Aprepitant: May decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration with aprepitant, and to continue back-up contraception for 28 days after discontinuing aprepitant to ensure contraceptive reliability. Risk D: Consider Therapy Modification
Asparaginase Products: Hormonal Contraceptives may increase thrombogenic effects of Asparaginase Products. Management: Consider discontinuing hormonal contraceptives and using an alternative contraceptive method in patients treated with asparaginase products. Risk D: Consider Therapy Modification
Atazanavir: May decrease serum concentration of Hormonal Contraceptives. Specifically, atazanavir/ritonavir may decrease concentrations of estrogens. Atazanavir may increase serum concentration of Hormonal Contraceptives. Specifically, atazanavir alone may increase concentrations of estrogens and atazanavir alone or boosted may increase concentrations of progestins. Management: Dose adjustment of hormonal contraceptives or use of alternative or additional nonhormonal contraceptive may be needed when combined with atazanavir. See full interact monograph for details. Atazanavir/cobicistat with drospirenone is contraindicated. Risk D: Consider Therapy Modification
Bimekizumab: May decrease serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor
Brigatinib: May decrease serum concentration of Hormonal Contraceptives. Management: Use a non-hormonal contraceptive during brigatinib use and for at least 4 months after the last brigatinib dose. Males with partners of reproductive potential should use contraception during treatment with brigatinib and for 3 months after brigatinib use. Risk D: Consider Therapy Modification
Carfilzomib: Hormonal Contraceptives may increase thrombogenic effects of Carfilzomib. Management: Consider alternative, non-hormonal methods of contraception in patients requiring therapy with carfilzomib, especially patients using carfilzomib in combination with dexamethasone, lenalidomide plus dexamethasone, or daratumumab plus dexamethasone. Risk D: Consider Therapy Modification
Chlorprothixene: Progestins may increase therapeutic effects of Chlorprothixene. Progestins may increase adverse/toxic effects of Chlorprothixene. Risk C: Monitor
Clofazimine: May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor
Cobicistat: May decrease serum concentration of Hormonal Contraceptives. Specifically, cobicistat may decrease serum concentrations of estrogens. Cobicistat may increase serum concentration of Hormonal Contraceptives. Specifically, cobicistat may increase serum concentrations of progestins. Management: Use alternative or additional nonhormonal forms of contraception when estrogen-containing hormonal contraceptives are combined with cobicistat. Progestin-only contraceptives can be used without back up, but monitor for progestin toxicities. Risk D: Consider Therapy Modification
Colchicine: May increase adverse/toxic effects of Hormonal Contraceptives. Risk C: Monitor
CYP3A4 Inducers (Moderate): May decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing a moderate CYP3A4 inducer to ensure contraceptive reliability. Risk D: Consider Therapy Modification
CYP3A4 Inducers (Strong): May decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing a strong CYP3A4 inducer to ensure contraceptive reliability. Risk D: Consider Therapy Modification
CYP3A4 Inducers (Weak): May decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing a weak CYP3A4 inducer to ensure contraceptive reliability. Risk D: Consider Therapy Modification
CYP3A4 Inhibitors (Strong): May increase serum concentration of Hormonal Contraceptives. Risk C: Monitor
Deferasirox: May decrease serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor
Efavirenz: May decrease serum concentration of Hormonal Contraceptives. Management: Use a back-up method during coadministration, and to continue back-up contraception for 12 weeks after stopping efavirenz to ensure contraceptive reliability. Injected depot medroxyprogesterone acetate does not appear to participate in this interaction. Risk D: Consider Therapy Modification
Elafibranor: May decrease serum concentration of Hormonal Contraceptives. Risk X: Avoid
Elagolix: Hormonal Contraceptives may decrease therapeutic effects of Elagolix. Specifically, estrogen-containing hormonal contraceptives may diminish the therapeutic effects of elagolix. Elagolix may decrease serum concentration of Hormonal Contraceptives. Specifically, concentrations of progestins may be decreased with elagolix therapy. Elagolix may increase serum concentration of Hormonal Contraceptives. Specifically, concentrations of ethinyl estradiol may be increased with elagolix therapy. Management: Use an alternative, nonhormonal contraceptive during treatment with elagolix and for at least 28 days following discontinuation of elagolix treatment. Use of elagolix 200 mg twice daily with an estrogen-containing hormonal contraceptive is not recommended Risk D: Consider Therapy Modification
Elexacaftor, Tezacaftor, and Ivacaftor: Hormonal Contraceptives may increase adverse/toxic effects of Elexacaftor, Tezacaftor, and Ivacaftor. Specifically, the risk for rash may be increased. Risk C: Monitor
Encorafenib: May decrease serum concentration of Hormonal Contraceptives. Risk X: Avoid
Etravirine: May decrease serum concentration of Hormonal Contraceptives. Specifically, progestin concentrations may decrease. Etravirine may increase serum concentration of Hormonal Contraceptives. Specifically, estrogen concentrations may increase. Risk C: Monitor
Exenatide: Hormonal Contraceptives may decrease therapeutic effects of Exenatide. Exenatide may decrease serum concentration of Hormonal Contraceptives. Management: Administer oral hormonal contraceptives at least one hour prior to exenatide. Monitor blood glucose more frequently when patients treated with exenatide initiate therapy with a hormonal contraceptive. Increases in exenatide doses may be needed. Risk D: Consider Therapy Modification
Felbamate: May decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing felbamate to ensure contraceptive reliability. Risk D: Consider Therapy Modification
Flibanserin: Hormonal Contraceptives may increase serum concentration of Flibanserin. Risk C: Monitor
Fosaprepitant: May decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration with fosaprepitant, and to continue back-up contraception for 28 days after discontinuing fosaprepitant to ensure contraceptive reliability. Risk D: Consider Therapy Modification
Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification
Griseofulvin: May decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing griseofulvin to ensure contraceptive reliability. Risk D: Consider Therapy Modification
Interleukin-6 (IL-6) Inhibiting Therapies: May decrease serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor
Ivosidenib: May decrease serum concentration of Hormonal Contraceptives. Management: Consider alternative methods of contraception (ie, non-hormonal) in patients receiving ivosidenib. Risk D: Consider Therapy Modification
Ixazomib: May decrease serum concentration of Hormonal Contraceptives. More specifically, use of ixazomib with dexamethasone may decrease the serum concentrations of hormonal contraceptives. Management: Patients of reproductive potential should use a non-hormonal contraceptive method during treatment with ixazomib and for at least 90 days after the last ixazomib dose. Risk D: Consider Therapy Modification
Levomethadone: Hormonal Contraceptives may increase serum concentration of Levomethadone. Risk C: Monitor
Lixisenatide: Hormonal Contraceptives may decrease therapeutic effects of Lixisenatide. Lixisenatide may decrease serum concentration of Hormonal Contraceptives. Management: Administer oral hormonal contraceptives 1 hour before or at least 11 hours after administration of lixisenatide. Additionally, monitor blood glucose more frequently when patients treated with lixisenatide initiate therapy with a hormonal contraceptive. Risk D: Consider Therapy Modification
Mavacamten: May decrease serum concentration of Hormonal Contraceptives. Management: Use with ethinyl estradiol/norethindrone is permitted. With other hormonal contraceptives, use a back-up (eg, condoms) or alternative (eg, IUD) method during coadministration, and to continue back-up contraception for 4 months after stopping mavacamten. Risk D: Consider Therapy Modification
MetyraPONE: Coadministration of Progestins and MetyraPONE may alter diagnostic results. Management: Consider alternatives to the use of the metyrapone test in patients taking progestins. Risk D: Consider Therapy Modification
MiFEPRIStone: May decrease therapeutic effects of Hormonal Contraceptives. Management: Nonhormonal contraception should be used during, and for 4 weeks following, mifepristone treatment for hyperglycemia due to Cushing syndrome. If used for pregnancy termination, hormonal contraceptives can be used after pregnancy expulsion is confirmed. Risk D: Consider Therapy Modification
Mirikizumab: May decrease serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor
Mitotane: May decrease serum concentration of Hormonal Contraceptives. Management: Effective nonhormonal contraception is recommended for those of reproductive potential during treatment with mitotane as well as after discontinuation of mitotane for as long as mitotane plasma levels are detectable. Risk X: Avoid
Mobocertinib: May decrease serum concentration of Hormonal Contraceptives. Risk X: Avoid
Mycophenolate: May decrease serum concentration of Hormonal Contraceptives. Management: Patients of childbearing potential who are taking hormonal contraceptives should use an additional form of barrier contraception during treatment with mycophenolate and for 6 weeks after mycophenolate discontinuation. Risk D: Consider Therapy Modification
Nemolizumab: May decrease serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor
Nirmatrelvir and Ritonavir: May decrease serum concentration of Hormonal Contraceptives. Specifically, nirmatrelvir and ritonavir may decrease concentrations of estrogens. Nirmatrelvir and Ritonavir may increase serum concentration of Hormonal Contraceptives. Specifically, nirmatrelvir and ritonavir may increase concentrations of progestins. Management: Use additional nonhormonal forms of contraception (back-up method) when estrogen-containing hormonal contraceptives are combined with nirmatrelvir/ritonavir. Progestin-only contraceptives can be used without back-up, but monitor for progestin toxicities. Risk D: Consider Therapy Modification
Octreotide: May decrease serum concentration of Hormonal Contraceptives. Management: Women should use an alternative non-hormonal method of contraception or a back-up method when octreotide is combined with hormonal contraceptives. Risk D: Consider Therapy Modification
Olutasidenib: May decrease serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Management: Avoid use of olutasidenib with sensitive or narrow therapeutic index CYP3A4 substrates when possible. If concurrent use with olutasidenib is unavoidable, monitor closely for evidence of decreased concentrations of the CYP3A4 substrates. Risk D: Consider Therapy Modification
Omaveloxolone: May decrease serum concentration of Hormonal Contraceptives. Risk X: Avoid
OXcarbazepine: May decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing oxcarbazepine to ensure contraceptive reliability. Risk D: Consider Therapy Modification
Pacritinib: May decrease serum concentration of Hormonal Contraceptives. Management: Avoid use of hormonal contraceptives with pacritinib, except for intrauterine systems containing levonorgestrel. If contraception is needed, use a nonhormonal contraceptive or an intrauterine system for at least 30 days after the last dose of pacritinib. Risk D: Consider Therapy Modification
Perampanel: May decrease serum concentration of Hormonal Contraceptives. Management: Patients should use an alternative, nonhormonal-based form of contraception during the concurrent use of perampanel and for 1 month after discontinuing perampanel. Risk D: Consider Therapy Modification
Pexidartinib: May decrease serum concentration of Hormonal Contraceptives. Risk X: Avoid
Pitolisant: May decrease serum concentration of Hormonal Contraceptives. Management: Patients using hormonal contraception should be advised to use an alternative non-hormonal contraceptive method during treatment with pitolisant and for at least 21 days after discontinuation of pitolisant treatment. Risk D: Consider Therapy Modification
Protease Inhibitors: May decrease serum concentration of Hormonal Contraceptives. Specifically, protease inhibitors may decrease concentrations of estrogens. Protease Inhibitors may increase serum concentration of Hormonal Contraceptives. Specifically, protease inhibitors may increase concentrations of progestins. Management: Use alternative or additional nonhormonal forms of contraception when estrogen-containing hormonal contraceptives are combined with protease inhibitors. Progestin-only contraceptives can be used without back up, but monitor for progestin toxicities. Risk D: Consider Therapy Modification
Repotrectinib: May decrease serum concentration of Hormonal Contraceptives. Risk X: Avoid
Retinoic Acid Derivatives: May decrease therapeutic effects of Progestins (Contraceptive). Retinoic Acid Derivatives may decrease serum concentration of Progestins (Contraceptive). Management: Two forms of effective contraception should be used in patients receiving retinoic acid derivatives. Microdosed progesterone-only preparations (ie, minipills that do not contain estrogen) are considered an inadequate method of contraception. Risk D: Consider Therapy Modification
Sugammadex: May decrease therapeutic effects of Hormonal Contraceptives. Management: Patients receiving any hormonal contraceptive (oral or non-oral) should use an additional, nonhormonal contraceptive method during and for 7 days following sugammadex treatment. Risk D: Consider Therapy Modification
Suzetrigine: May decrease serum concentration of Hormonal Contraceptives. Management: Patients should use a nonhormonal contraceptive, an intrauterine system, or ethinyl estradiol and norethindrone or levonorgestrel for the duration of treatment with suzetrigine and for 28 days after stopping suzetrigine. Risk D: Consider Therapy Modification
Taurursodiol: May decrease serum concentration of CYP3A4 Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk X: Avoid
Tazemetostat: May decrease serum concentration of Hormonal Contraceptives. Management: Individuals of childbearing potential should use a non-hormonal contraceptive method during treatment with tazemetostat and for 6 months after. Males with partners of childbearing potential should use contraception during treatment and for 3 months after. Risk D: Consider Therapy Modification
Tetrahydrocannabinol and Cannabidiol: May decrease serum concentration of Hormonal Contraceptives. Management: Product labeling recommends that patients taking hormonal contraceptives should use an additional, non-hormonal contraceptive or reliable barrier method during treatment with THC/CBD buccal spray. Other forms of THC and CBD do not contain this warning. Risk D: Consider Therapy Modification
Thalidomide: Hormonal Contraceptives may increase thrombogenic effects of Thalidomide. Risk C: Monitor
Tirzepatide: May decrease serum concentration of Hormonal Contraceptives. Management: Patients using oral hormonal contraceptives should switch to a non-oral contraceptive method, or add a barrier method of contraception, for 4 weeks after initiation of tirzepatide and for 4 weeks after each dose escalation of tirzepatide. Risk D: Consider Therapy Modification
Topiramate: May decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing topiramate to ensure contraceptive reliability. Risk D: Consider Therapy Modification
Tovorafenib: May decrease serum concentration of Hormonal Contraceptives. Management: Avoid concurrent use when possible. If combined use is unavoidable, use of an additional nonhormonal method of contraception is recommended during combined use and for 28 days after stopping tovorafenib. Risk D: Consider Therapy Modification
Tranexamic Acid: Hormonal Contraceptives may increase thrombogenic effects of Tranexamic Acid. Risk X: Avoid
Ulipristal: May decrease therapeutic effects of Progestins. Progestins may decrease therapeutic effects of Ulipristal. Risk X: Avoid
Ustekinumab: May decrease serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor
Vaborbactam: May decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing meropenem/vaborbactam to ensure contraceptive reliability. Risk D: Consider Therapy Modification
Vedolizumab: May decrease serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inducers). Risk C: Monitor
Vitamin K Antagonists: Hormonal Contraceptives may increase serum concentration of Vitamin K Antagonists. Hormonal Contraceptives may decrease serum concentration of Vitamin K Antagonists. Risk C: Monitor
Vorasidenib: May decrease serum concentration of Hormonal Contraceptives. Management: Avoid combined use when possible, but if this combination cannot be avoided, use of an alternative, nonhormonal means of contraception is recommended during treatment with vorasidenib and for 3 months after the last dose. Risk D: Consider Therapy Modification
Voriconazole: Hormonal Contraceptives may increase serum concentration of Voriconazole. Voriconazole may increase serum concentration of Hormonal Contraceptives. Risk C: Monitor
When used for self-medication (OTC labeling), the manufacturer recommends taking a pregnancy test or contacting a health care provider if a menstrual period is late after missing any tablets during the month, if there are no menstrual periods for 2 months, or anytime a pregnancy is suspected.
Use a condom or other barrier method of contraception for the first 2 days (48 hours) after the first dose, if a tablet is missed or taken more than 3 hours late, or if severe nausea or vomiting occur after a dose.
This product is not for use as emergency contraception; it does not prevent pregnancy if used after unprotected sex.
Progestin-only contraceptives may be started immediately postpartum (CDC [Curtis 2016a]; CDC [Curtis 2016b]). A rapid return to fertility is expected if norgestrel is discontinued.
All available forms of contraception can be considered for patients on gender affirming testosterone therapy after evaluating patient preferences and medical conditions (eg, risk for venous thromboembolism) (Bonnington 2020; Krempasky 2020).
When used for self-medication (OTC labeling), norgestrel is used to prevent pregnancy; norgestrel should not be used in people who are pregnant or think they may be pregnant. When used for self-medication (OTC labeling), patients should discontinue norgestrel and contact health care provider if pregnancy occurs.
Progestins are present in breast milk.
When used for self-medication (OTC labeling), norgestrel is acceptable for use in people who wish to breastfeed. Available guidelines state progestin-only contraceptives may be started at any time postpartum in breastfeeding patients (CDC [Curtis 2016a]; CDC [Curtis 2016b]).
Self-medication (OTC labeling): Instruct patients to discontinue norgestrel and/or contact a health care provider immediately if the following occur: pain in lower belly (mostly on one side), yellowing of skin or whites of eyes, fever, tiredness, loss of appetite, dark colored urine, late menstrual period after missing any tablets during the month, no menstrual period for 2 months, or any time a pregnancy is suspected.
Progestin-only contraceptive tablets prevent pregnancy through several mechanisms: Thickening of cervical mucus, which inhibits sperm passage through the uterus; inhibition of sperm survival; alteration of the endometrium. Inhibition of ovulation may also occur in some patients (McCann 1994).
Time to peak: 2 hours (Warren 1974).
