Junel Fe

What is Junel Fe?

Junel Fe is a type of combined oral contraceptive containing both progesterone (a female sex hormone) and estrogen (another female sex hormone). It is a non-continuous form of oral contraceptive, meaning it allows for a bleed (known as a withdrawal bleed) every 28 days, and when taken correctly, is 99% effective in preventing pregnancy. Junel Fe is also prescribed to treat acne and irregular or painful periods and decreases the risk of ovarian cysts. 

How does Junel Fe work?

Junel Fe contains norethindrone acetate, a type of progestin (a synthetic form of the progesterone hormone), and ethinyl estradiol, a type of estrogen, which regulate the body’s natural hormone cycle. Norethindrone prevents pregnancy by  blocking  fertilisation in three ways. Primarily, it prevents ovulation (the release of an egg from the ovary) during the menstrual cycle, but it also has a thickening effect on the mucus of the cervix, making  it harder for sperm to enter the uterus, in the event that an egg is released. Finally, norethindrone alters the uterus lining to prevent implantation of a fertilized egg (adhesion of the egg to the uterine wall). Junel Fe also contains an iron supplement to prevent your  iron levels from dropping as a result of  the monthly bleeds.

How effective is Junel Fe?

When taken correctly, Junel Fe is 99% effective against pregnancy, about the same success rate as condoms used correctly (98%). It is estimated that Junel Fe remains more than 97% effective even in the event that the woman forgets to take a pill. However, you should always try to take every pill around the same time each day to ensure maximum effectiveness.

Remember that hormonal contraceptives such as Junel Fe do NOT protect against sexually transmitted infections (STIs). Condoms are the only form of protection against STIs.     

Active ingredients

The active ingredients in Junel Fe are norethindrone acetate and ethinyl estradiol at a dose of 1 mg / 20 mcg or 1.5 mg / 30 mcg (norethindrone acetate/ ethinyl estradiol).

Inactive ingredients

The inactive ingredients in Junel Fe are acacia, compressible sugar, lactose monohydrate, magnesium stearate, pregelatinized corn starch, crospovidone, ferrous fumarate, hydrogenated vegetable oil, NF type I, and microcrystalline cellulose.

Junel Fe 1 mg/ 20 mcg  includes D&C yellow no. 10 aluminium lake. Junel Fe 1.5 mg / 30 mcg contains  FD&C no. 40 aluminium lake HT.  

Junel Fe dosage

Junel Fe is available at doses of  1 mg norethindrone to 20 mcg ethinyl estradiol and  1.5 mg norethindrone to 30 mcg ethinyl estradiol. Your doctor will decide which dose is best for you, depending on your personal requirements.

How to start Junel Fe

Make sure you read the instructions on the package carefully and never start taking Junel Fe without consulting a doctor first. Junel Fe comes in a  28-day blister pack, containing 21 active tablets (containing the active hormones) and 7 inert tablets. The packs are marked with the days of the week, and when you start taking Junel Fe, you have 2 options:

• Day 1 start: Start with the first active tablet on the first day of your menstrual cycle and work your way through the pack.

• Any day start: Take the first tablet in the pack on any day of your menstrual cycle and work your way through the pack. If you choose this method, make sure you use an alternative form of contraception, such as condoms, for the first 7 days of using Junel Fe, which is how long it takes for the contraceptive effect of the pill to kick in.

How to take Junel Fe

Take 1 pill each day, at the same time each day, according to  the days of the week marked on the pack. To help you remember each day, try to make taking the medication  a part of your daily routine. For example, take your pill each morning when you brush your teeth. 

When you reach the end of the 21 active pills, continue with the inactive pills the next day. During the 7 days when you are taking the inactive pills, you will experience a withdrawal bleed, which is similar to a  natural menstrual period. This does not necessarily mean that your period will last for 7 days. When you reach the end of the calendar pack, start the next one on the very next day.

What do I do if I forget to take my pill?

If you forget to take 1 pill, you should take the missed pill as soon as you remember followed by your next pill at the usual time, even if this means taking two pills at a time. You can then continue the rest of the pack as usual and you are still protected against pregnancy.

If you miss 2 or more pills in a row, you should take the last missed pill as soon as you remember, followed by the next dose at the usual time, leaving any earlier missed pills. After this, you can continue the rest of the pack as per normal. In this case, your protection against pregnancy may be affected and you should use an alternative form of contraception (such as condoms) for 7 days after resuming the pills. 

If you have missed 2 or more pills in the first week of any pack and have had unprotected sex in the last 7 days, you may need emergency contraception to ensure prevention of pregnancy. Consult your doctor immediately if this occurs. 

Junel Fe side effects

Like all medications, Junel Fe can cause side effects in some patients. If you notice any of the following symptoms, stop taking Junel Fe and seek immediate medical help. These symptoms are rare but could be a result of serious side effects caused by Junel Fe:

• Sharp chest pain, coughing up blood, or sudden shortness of breath. This may indicate a blood clot in the lung.
• Pain in the calf, purplish or red discolouration and warmth over the calf, which may indicate a blood clot in the leg.
• Crushing chest pain or heaviness, which may be a heart attack.
• Sudden, severe headache, vomiting, dizziness or fainting, disturbances of vision or speech, weakness or numbness in an arm or a leg. These symptoms may be indicative of a stroke.
• Sudden partial or complete loss of vision, which may indicate a blood clot in the eye.
• Lump or lumps in the breast, which could indicate possible breast cancer or fibrocystic disease in the breast. Ask your doctor for advice on how to examine your breasts for lumps.
• Severe pain or tenderness in the stomach area, which may be indicative of a ruptured liver tumor.
• Weakness, lack of energy, fatigue, difficulty sleeping, or a change in mood, which could indicate depression.
• Jaundice (yellowing of the skin or whites of the eyes) accompanied by fever, fatigue, loss of appetite, dark coloured urine, or light coloured bowel movements. These symptoms could indicate liver problems.

The following side effects of Junel Fe are more common and are usually mild in nature. If these symptoms do not go away or  are troubling you, speak to your doctor for advice:

• Vaginal bleeding. Irregular bleeding or spotting is a common side effect of contraceptive pills and may vary between slight staining between periods and breakthrough bleeding resembling a period. This is more common within the first 3 months of starting the pill and often stops with continued use of the pill.
• Change in visibility or comfort while wearing contact lenses. This occurs due to the effects of the pill on tissues in the eye and the effects are usually mild. If this is interrupting your daily life, contact your doctor for advice.
• Fluid retention, which could present as swelling of the fingers or ankles, and could cause a rise in blood pressure. If you notice these signs, contact your doctor.
• Melasma, which is the appearance of dark patches on the skin, usually on the face.
• Changes in appetite
• Headache
• Nervousness
• Mood swings
• Dizziness
• Hair loss on the scalp
• Rash
• Vaginal infections

Contraindications

Do NOT take Junel Fe if:

• You are pregnant, think you may be  pregnant or are trying to get pregnant
• You have a history of heart attack or stroke
• You have previously had chest pain (angina pectoris)
• You have previously had blood clots in your  legs (thrombophlebitis or deep vein thrombosis), lungs (pulmonary embolism) or eyes
• You have a history of breast cancer, cervical cancer, or cancer of the lining of the uterus
• You have had jaundice (yellowing of the skin or whites of the eyes) during pregnancy or when using other contraceptive pills
• You have a benign or cancerous liver tumor
• You experience unexplained vaginal bleeding

Before taking Junel Fe, tell your doctor if any of the following applies to you:

• You smoke. It is advised that you do not smoke while taking the pill.
• You have breast nodules, fibrocystic disease of the breast, or have had an abnormal breast x-ray or mammogram
• You have diabetes
• You have elevated cholesterol or triglycerides
• You have high blood pressure
• You suffer from migraines, headaches, or epilepsy
• You suffer from depression
• You have gallbladder, kidney or heart problems
• You have a history of irregular menstrual periods

Drug interactions

Before you start taking Junel Fe, let your doctor know about any other medications (prescription and non-prescription), vitamin/ mineral supplements, or herbal medications you may be taking. Some of  the medications that are known to interfere with Junel Fe are:

• Rifampin
• Anticonvulsants, which include carbamazepine, phenobarbital and phenytoin

Alternatives to Junel Fe

Due to the wide variety of birth control pills on the market, it’s not uncommon for patients to try different ones before they find their perfect match. Different pills may contain different forms of progesterone and/or estrogen, and you may find that you are more sensitive to certain types than others. If you happen to be sensitive to estrogen, you could try the progesterone-only pill, also called the ‘mini pill’. This pill is continuous, meaning it does not allow a break for a monthly bleed, and can also be used by women who are breastfeeding. 

Alternatively, you could opt for hormonal contraception that doesn’t require you to take a pill every day. These include hormonal implants (Nexplanon, Implanon) and injections (Depo-Provera). If you have  any health conditions such as diabetes or hypertension, an intrauterine device (IUD) may be a better choice for you (Liletta, Kyleena, Mirena, ParaGard, and Skyla). The IUD acts locally, which may lower the risk of side effects. For more information and to help you make the best choice, speak to your doctor or healthcare provider. 

If you cannot use hormonal contraceptives, you could choose one of the barrier contraceptive methods. They include condoms (male and female) and the cervical cap (FemCap). But remember that condoms are the only contraceptive method that protects against STIs.