###  1\. Use of Oral Contraceptives Before or During Early Pregnancy

Because regular monthly bleeding does not occur on levonorgestrel and ethinyl estradiol, an unexpected pregnancy may be difficult to recognize. If you suspect you may be pregnant, or if you have symptoms of pregnancy such as nausea/vomiting or unusual breast tenderness, a pregnancy test should be performed and you should contact your health care professional. Stop taking levonorgestrel and ethinyl estradiol if you are pregnant. Pregnancy is unlikely if the pill is taken as directed.

There is no conclusive evidence that oral contraceptive use is associated with an increase in birth defects, when taken inadvertently during early pregnancy. Previously, a few studies had reported that oral contraceptives might be associated with birth defects, but these studies have not been confirmed. Nevertheless, oral contraceptives should not be used during pregnancy. You should check with your health care professional about risks to your unborn child of any medication taken during pregnancy.

###  2\. While Breastfeeding

If you are breastfeeding, consult your health care professional before starting oral contraceptives. Some of the drug will be passed on to the child in the milk. A few adverse effects on the child have been reported, including yellowing of the skin (jaundice) and breast enlargement. In addition, oral contraceptives may decrease the amount and quality of your milk. If possible, do not use oral contraceptives while breastfeeding. You should use another method of contraception since breastfeeding provides only partial protection from becoming pregnant and this partial protection decreases significantly as you breastfeed for longer periods of time. You should consider starting oral contraceptives only after you have weaned your child completely.

###  3\. Laboratory Tests

If you are scheduled for any laboratory tests, tell your health care professional you are taking birth-control pills. Certain blood tests may be affected by birth-control pills.

###  4\. Drug Interactions

Certain drugs may interact with birth-control pills to make them less effective in preventing pregnancy or cause an increase in unscheduled bleeding. Such drugs include rifampin, drugs used for epilepsy such as barbiturates (for example, phenobarbital) and phenytoin (Dilantin® is one brand of this drug), primidone (Mysoline®), topiramate (Topamax®), carbamazepine (Tegretol® is one brand of this drug), phenylbutazone (Butazolidin® is one brand), some drugs used for HIV or AIDS such as ritonavir (Norvir®), modafinil (Provigil®) and possibly certain antibiotics (such as ampicillin and other penicillins, and tetracyclines), and herbal products containing St. John's Wort (Hypericum perforatum). You may also need to use a nonhormonal method of contraception during any pill pack in which you take drugs that can make oral contraceptives less effective.

You may be at higher risk for a specific type of liver dysfunction if you take troleandomycin and oral contraceptives at the same time.

You should inform your health care professional about all medicines you are taking, including nonprescription products.

###  5\. Sexually Transmitted Diseases

This product (like all oral contraceptives) is intended to prevent pregnancy. It does not protect against transmission of HIV (AIDS) and other sexually transmitted diseases such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, and syphilis.

###  What You Should Know About Your Menstrual Cycle When You Use levonorgestrel and ethinyl estradiol

You are likely to have unscheduled or unplanned bleeding or spotting when you start to use levonorgestrel and ethinyl estradiol. The number of days each month with bleeding or spotting usually decreases over time in the majority of women. In a study of levonorgestrel and ethinyl estradiol, about 5 out of 10 women had 7 or more days of bleeding or spotting while using their third 28-day pill pack of levonorgestrel and ethinyl estradiol. The number of women with 7 or more days of bleeding or spotting decreased to 3 out of 10 women during the use of their seventh pill pack. Among women who continued to use levonorgestrel and ethinyl estradiol for one year, about 6 out of 10 women had no bleeding or spotting during their last month of use.

Do not stop taking levonorgestrel and ethinyl estradiol because of bleeding or spotting as this will increase your chance of getting pregnant. If the spotting or bleeding continues for more than 7 consecutive days or if the bleeding is heavy, call your health care provider.

###  Can I Get Pregnant While Taking levonorgestrel and ethinyl estradiol?

You are not likely to get pregnant if you take levonorgestrel and ethinyl estradiol at the same time everyday as directed by your health care provider. Because regular monthly bleeding does not occur on levonorgestrel and ethinyl estradiol, it may be difficult to recognize if you get pregnant. If you suspect that you may be pregnant, or if you have symptoms of pregnancy such as nausea/vomiting or unusual breast tenderness, you should have a pregnancy test and you should contact your health care professional. Stop taking levonorgestrel and ethinyl estradiol if you are pregnant.