Is it safe to take Lo Loestrin Fe (ethinyl estradiol and norethindrone acetate) and one pill of norethindrone together?

Taking Lo Loestrin Fe and Norethindrone Together: Safety Assessment

Taking Lo Loestrin Fe (a combined hormonal contraceptive) together with an additional norethindrone pill is not recommended and provides no clinical benefit while potentially increasing progestin-related side effects without improving contraceptive efficacy or safety.

Why This Combination Is Problematic

Lo Loestrin Fe already contains norethindrone acetate (a prodrug of norethindrone) as its progestin component, combined with ethinyl estradiol 1. Adding a separate norethindrone pill creates unnecessary duplication of the progestin component without any evidence-based rationale.

Key Clinical Concerns

Lack of Therapeutic Benefit:

• Combined hormonal contraceptives like Lo Loestrin Fe are already optimized for contraceptive efficacy with their specific hormone ratios 1
• Adding extra progestin does not enhance contraceptive protection, as ovulation suppression is already achieved by the combined formulation 1
• No guidelines support supplementing combined oral contraceptives with additional progestin-only pills for contraceptive purposes 1

Potential for Increased Side Effects:

• Higher progestin exposure may increase breakthrough bleeding, mood changes, and other progestin-related adverse effects 1
• The carefully balanced estrogen-progestin ratio in combined contraceptives would be disrupted 2
• Norethindrone-related side effects (headache, breast tenderness, nausea) may be amplified 1

Clinical Context: When Norethindrone Is Used Separately

Norethindrone as a standalone medication has distinct indications:

• Progestin-only pills (norethindrone 0.35 mg) are used as an alternative contraceptive for women who cannot take estrogen 1
• Higher doses (1 mg daily continuous) are used for endometrial protection in hormone replacement therapy, not contraception 3
• Doses of 5-10 mg are used for treating endometriosis or abnormal uterine bleeding, not as contraceptive supplementation 3

None of these indications apply when already taking a combined oral contraceptive 1.

Appropriate Management Strategies

If contraceptive efficacy is a concern:

• Ensure proper timing of pill administration (same time daily) 1
• Use backup contraception for 7 days if pills are missed or started >5 days after menstrual bleeding 1
• Consider switching to a different contraceptive method if adherence is problematic 1

If breakthrough bleeding is occurring:

• This is common with low-dose formulations and typically improves over 3-6 cycles 4, 5
• Adding extra progestin is not the evidence-based solution 1
• Consider switching to a different combined oral contraceptive formulation if bleeding persists 4

Important Safety Considerations

Before taking any hormonal contraceptive, verify absence of contraindications:

• Active or history of venous thromboembolism, stroke, or myocardial infarction 1
• Breast cancer or other estrogen-sensitive malignancies 1
• Uncontrolled hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg) 1
• Pregnancy (Category X) 1, 3
• Active liver disease or hepatic tumors 1

Blood pressure monitoring is essential for all combined hormonal contraceptive users at baseline and follow-up visits 1.

Bottom Line

Continue Lo Loestrin Fe as prescribed without adding norethindrone. If there are specific concerns about contraceptive efficacy, bleeding patterns, or other symptoms, consult with a healthcare provider to determine if a different contraceptive formulation or method would be more appropriate 1, 2. The combination of these two medications serves no evidence-based purpose and may cause unnecessary side effects.