What patient teaching is recommended for a 19-year-old female patient taking Junel FE (norethindrone acetate and ethinyl estradiol) for birth control?

Patient Teaching for Junel FE in a 19-Year-Old

Teach this patient to take one pill at the same time every day without interruption, emphasizing that missing pills or taking them late significantly increases pregnancy risk and requires backup contraception. 1, 2

How to Take Junel FE Correctly

Daily Administration:

• Take one pill every single day at the exact same time, ideally within the same hour each day 1, 2
• Continue taking pills without any breaks between packs—when you finish one pack, start the next pack immediately the following day 1
• The iron pills (FE = ferrous fumarate) at the end of the pack are inactive but help maintain the daily habit 2

What to Do If Pills Are Missed

If 1 pill is missed (taken >24 hours late):

• Take the missed pill as soon as you remember, even if it means taking 2 pills in one day 2
• Continue taking remaining pills at the usual time 2
• Use backup contraception (condoms) for the next 7 days 2

If 2 consecutive pills are missed in Week 1 or Week 2:

• Take 2 pills the day you remember and 2 pills the next day 2
• Use backup contraception (condoms) for 7 days after the missed pills 2
• Consider emergency contraception if unprotected intercourse occurred in the previous 5 days 3

If 2 consecutive pills are missed in Week 3, or 3+ pills missed anytime:

• Continue taking 1 pill daily until the next Sunday (if using Sunday start) 2
• Discard the rest of the pack on Sunday and start a new pack that same day 2
• Use backup contraception for 7 days 2
• Consider emergency contraception if appropriate 3

Special Situations Requiring Backup Contraception

Vomiting or severe diarrhea within 3 hours of taking a pill:

• Take another pill as soon as possible, even if uncomfortable 3
• Continue daily pills at the usual time 3
• Use backup contraception (condoms) until 2 days after vomiting/diarrhea resolves 3
• Consider emergency contraception if unprotected intercourse occurred 3

Important Safety Information

STD Protection:

• Birth control pills do NOT protect against sexually transmitted diseases including HIV 3
• Use condoms consistently for STD protection even while on the pill 3

Warning Signs to Report Immediately (ACHES):

• Abdominal pain (severe)
• Chest pain or shortness of breath
• Headaches (severe or new pattern)
• Eye problems (vision changes, blurred vision)
• Severe leg pain or swelling

These may indicate serious complications like blood clots that require immediate medical attention.

Expected Side Effects and When to Follow Up

Common initial side effects (usually resolve within 3 months):

• Nausea (especially in first cycle) 4
• Breast tenderness
• Irregular bleeding or spotting between periods 5
• Headaches 4

Return for evaluation if:

• Side effects persist beyond 3 months
• You want to change methods
• Any concerning symptoms develop
• Otherwise, no routine follow-up visit is required unless you have other health concerns 3

Effectiveness and Continuation

Contraceptive effectiveness:

• With perfect use: >99% effective
• With typical use: 91% effective (9 out of 100 women become pregnant in the first year due to missed pills) 6
• The main reason for failure is inconsistent or incorrect pill-taking 3

Long-term considerations:

• Completely reversible—fertility returns quickly after stopping 6
• If you frequently miss pills, consider a long-acting method like an IUD or implant that doesn't depend on daily adherence 3

Practical Tips for Success

• Set a daily alarm on your phone as a reminder to take the pill
• Keep your pill pack in a visible location you see every day at the same time
• Consider keeping backup condoms available in case pills are missed
• Know where to access emergency contraception if needed 3