Can You Take Oral Contraceptive Pills with Myfembree?
No, you should discontinue hormonal contraceptives before starting Myfembree (relugolix/estradiol/norethindrone acetate), as the FDA label explicitly requires excluding pregnancy and discontinuing hormonal contraceptives prior to Myfembree initiation 1.
Why This Matters
Myfembree already contains hormonal components (estradiol and norethindrone acetate) as part of its formulation for treating uterine fibroids or endometriosis. Adding combined oral contraceptive pills (OCPs) on top of this would result in:
- Duplicate hormone exposure: You'd be taking two sources of estrogen and progestin simultaneously, which is not studied and potentially increases risks
- Unpredictable drug interactions: The FDA label warns about P-gp inhibitor interactions that could increase Myfembree component levels 1
- Increased thrombotic risk: Combined hormonal contraceptives carry venous thromboembolism risk, and stacking hormonal therapies compounds this concern
What You Should Do Instead
If You Need Contraception While on Myfembree:
Use non-hormonal methods:
- Copper IUD (most effective non-hormonal option)
- Barrier methods (condoms, diaphragm)
- Fertility awareness methods
Consider progestin-only options (discuss with your provider):
- Progestin-only pills (POPs/mini-pills)
- Levonorgestrel IUD
- Etonogestrel implant
These avoid the duplicate estrogen exposure issue, though you should verify compatibility with your prescriber since Myfembree already contains norethindrone.
Before Starting Myfembree:
- Pregnancy test required: The label mandates excluding pregnancy before initiation 1
- Stop your current OCPs: Discontinue at least before your first Myfembree dose
- Plan alternative contraception: Have your non-hormonal or progestin-only method ready
Important Caveats
Timing considerations: If you're switching from OCPs to Myfembree, coordinate the transition with your provider to avoid gaps in contraceptive coverage or unexpected bleeding.
Drug interaction alert: If you must take oral P-gp inhibitors (certain antibiotics, antifungals, or other medications), take Myfembree at least 6 hours before the P-gp inhibitor 1. However, avoid combined P-gp and strong CYP3A inducers entirely, as they reduce Myfembree effectiveness 1.
Return to fertility: After stopping Myfembree, 84-98% of women resume menstruation within 27-43 days on average 1. Plan contraception accordingly if pregnancy is not desired.