Natazia (estradiol valerate and estradiol valerate/dienogest)

Do’s

• Take Natazia exactly as prescribed by your healthcare provider, usually once daily at the same time each day.
• If you have trouble remembering, choose a time that works best for you, like after dinner or before bed.
• If you experience nausea, taking Natazia with food may help.
• Start the first pill in the pack on the first day of your period.
• Take all pills in the correct order, following the instructions on the pack. Don't skip any doses.
• Use a backup form of birth control (like condoms) for the first 9 days of your first cycle.

Don'ts

• Don't take more Natazia than prescribed.
• Don't skip doses or stop taking Natazia without talking to your healthcare provider.
• Don't take Natazia if you are pregnant or breastfeeding.
• Don't take Natazia if you have a history of blood clots, stroke, liver problems, or uncontrolled high blood pressure.

Common side effects:

• Light vaginal bleeding or spotting
• Nausea (especially during the first few months of taking this medicine), vomiting
• Breast pain or tenderness
• Weight gain
• Problems with contact lenses

Serious side effects that may require immediate medical attention include:

• A lump in the breast
• Unusual changes in vaginal bleeding (such as continuous spotting, sudden heavy bleeding)
• Mental/mood changes (such as new/worsening depression)
• Dark urine
• Yellowing of the eyes/skin
• Severe stomach/abdominal/pelvic pain
• Unusual tiredness
• Heart attack symptoms: chest pain or pressure, pain spreading to the jaw or shoulder, nausea, sweating
• Liver problems: severe stomach pain, fever, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes)
• Sudden and severe pelvic pain
• Change in the pattern or severity of migraine headaches
• Swelling in the hands, ankles, or feet
• Symptoms of depression: sleep problems, weakness, tired feeling, mood changes

This is not an exhaustive list, and other side effects may occur. If you experience any unusual or severe side effects while taking Natazia,  contact your healthcare provider for medical advice.

Disclose any allergies to estradiol, dienogest, other estrogens, progestins, or other medication ingredients.

Inform your healthcare provider about your medical history, especially if you have or have had any of the following:

• Blood clots
• Blood clotting disorders
• High blood pressure
• Abnormal breast exam or cancer (especially endometrial or breast cancer)
• High cholesterol or triglycerides
• Depression
• Diabetes
• Family history of angioedema
• Gallbladder problems
• Severe headaches/migraines
• Heart problems (valve disease, irregular heartbeat, heart attack)
• Jaundice during pregnancy or hormonal birth control use
• Kidney disease
• Liver disease (including tumors)
• Obesity
• Stroke
• Swelling (edema)
• Thyroid problems
• Unexplained vaginal bleeding

Natazia may affect blood sugar levels. Monitor blood sugar regularly and report changes to your healthcare provider.

Inform your healthcare provider about upcoming surgery or prolonged bed rest, as these increase blood clot risk. You may need to stop Natazia temporarily.

Natazia may cause skin darkening. Limit sun exposure, use sunscreen, and wear protective clothing. Contact your eye healthcare provider if you experience vision problems or difficulty wearing contact lenses.

Natazia must not be used during pregnancy. If you become pregnant, stop using Natazia and consult your healthcare provider immediately. It may decrease breast milk production and pass into breast milk. Consult with your healthcare provider before breastfeeding.

Do not use Natazia if you smoke and are over 35. Smoking increases health risks associated with hormonal birth control.

Track all medications you take (prescription, non-prescription, and herbal products). Share the drug Interactions list with your healthcare provider. This allows them to identify potential interactions with Natazia.

Avoid medication adjustments without consulting your healthcare provider. Never start, stop, or change the dosage of any medications on your own.

Some medications can interact with Natazia and reduce its effectiveness, potentially increasing pregnancy risk. Examples include:

• Aromatase inhibitors
• Fezolinetant
• Ospemifene
• Tamoxifen
• Tranexamic acid
• Griseofulvin
• Modafinil
• Rifamycins
• Ritonavir
• St. John's wort
• Seizure medications (like barbiturates, carbamazepine)
• HIV medications (like nelfinavir, nevirapine)

Inform your healthcare provider when you start any new medication and discuss the need for backup birth control. Report any new spotting or breakthrough bleeding, as these may indicate reduced birth control effectiveness.

Natazia may affect certain lab tests. Inform laboratory personnel and all your healthcare provider that you use this medication