From the Guidelines
Yes, norethindrone (Nortestimate) and ethinyl estradiol triphasic birth control can potentially cause dry eyes and severe headaches as side effects. These symptoms are relatively common side effects of hormonal contraceptives, with headaches occurring in approximately 10-30% of users, as mentioned in 1. Dry eyes, although less commonly reported, are still recognized as a potential side effect. The hormonal fluctuations from the changing levels of hormones in triphasic pills can trigger these symptoms, particularly during the first few months of use as your body adjusts to the medication. If you experience severe headaches, especially with visual disturbances, sudden onset, or unusual intensity, contact your healthcare provider immediately as this could rarely indicate more serious complications, such as those associated with blood clots or migraines with aura, which are contraindications for COC use as stated in 1 and 1. For dry eyes, artificial tears may provide temporary relief. These side effects often improve after 2-3 months of continued use as your body adapts to the hormonal changes. However, if symptoms persist or significantly affect your quality of life, discuss with your healthcare provider about potentially switching to a monophasic pill or a different contraceptive method with lower hormone doses or different hormone types, considering the guidance on managing adverse effects provided in 1 and 1.
Some key points to consider:
- Common transient adverse effects of COCs include irregular bleeding, headache, and nausea, as noted in 1.
- COCs have few contraindications in healthy female adolescents, but severe and uncontrolled hypertension, ongoing hepatic dysfunction, and migraines with aura or focal neurologic symptoms are among them, as listed in 1 and 1.
- The risk of blood clots is increased with COC use, but the baseline incidence of venous thromboembolism in adolescents is relatively low, as discussed in 1 and 1.
- Counseling should include strategies to promote daily adherence and instructions on what to do if pills are missed, emphasizing the importance of consistent hormone intake to prevent ovulation, as advised in 1 and 1.
From the FDA Drug Label
The following adverse reactions have been reported in users of oral contraceptives and the association has been neither confirmed nor refuted: ... Headache ... Change in corneal curvature (steepening) Intolerance to contact lenses The onset or exacerbation of migraine or development of headache with a new pattern which is recurrent, persistent, or severe requires discontinuation of oral contraceptives and evaluation of the cause.
Possible Side Effects of Norethindrone and Ethinyl Estradiol Triphasic Birth Control:
- Headache: The drug label reports that headache is a possible side effect of oral contraceptives, including norethindrone and ethinyl estradiol triphasic birth control.
- Dry Eyes: The drug label mentions "Change in corneal curvature (steepening) Intolerance to contact lenses", which may be related to dry eyes. However, it does not directly state that dry eyes are a possible side effect. It is recommended to consult a healthcare professional for proper evaluation and guidance 2 2.
From the Research
Nortestimate Ethinyl Estradiol Triphasic Side Effects
- The combination of norethindrone (Nortestimate) and ethinyl estradiol (Ethinyl Estradiol) in triphasic birth control may cause various side effects, including dry eyes and severe headaches.
- According to a study on hormone replacement therapy and dry eye syndrome 3, estrogen use may have detrimental effects on the tear film and could influence the development of dry eye syndrome.
- Another study on combined hormonal contraceptives and migraine 4 suggests that these drugs can increase the risk of ischemic stroke in women who have migraine with aura, but this risk is not significantly increased with today's preparations containing less than 30 μg of ethinyl estradiol.
- A study on the suppression of estrogen-withdrawal headache with extended transdermal contraception 5 found that extended use of transdermal norelgestromin/ethinyl estradiol delayed menses and reduced the total incidence of mean headache days during the hormone-free interval.
- However, the studies on the effectiveness of norgestimate and ethinyl estradiol in treating moderate acne vulgaris 6 and the triphasic combination of ethinyl estradiol and gestodene 7 do not provide direct evidence on the relationship between norethindrone and ethinyl estradiol triphasic birth control and dry eyes or severe headaches.
Possible Causes of Dry Eyes and Severe Headaches
- Estrogen use, as found in hormone replacement therapy, may increase the risk of dry eye syndrome 3.
- Combined hormonal contraceptives, including those containing ethinyl estradiol, may increase the risk of migraine and severe headaches, particularly in women with a history of migraine with aura 4.
- The triphasic regimen of norgestimate and ethinyl estradiol may cause minor adverse events, including breast tension and headaches, as found in a long-term clinical trial 7.