Junel FE

What is Junel FE?

Junel FE is a type of combined oral contraceptive containing both a progestogen  and an estrogen hormone. It is a non-continuous form of oral contraceptive, meaning it allows for a withdrawal bleed in each 28 day cycle, 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 developing ovarian cysts. 

How does Junel FE work?

Junel FE contains Norethindrone, a type of progestin, and Ethinyl Estradiol, a type of estrogen, which regulate the body’s natural hormone cycle. Norethindrone acts as a progestogen supplement and provides a threefold barrier to fertilisation. Primarily, it prevents ovulation (the release of an egg from the ovaries) during the menstrual cycle, but also has a thickening effect on the mucus of the cervix, which makes 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 fertilised egg. Junel FE also contains an iron supplement to prevent women’s iron levels dropping during their monthly bleed.

How effective is Junel Fe?

When taken correctly, Junel FE is 99% effective against pregnancy, about the same success rate as condoms. It is estimated that Junel FE remains more than 97% effective in the event that women forget to take a pill.

Remember, Junel FE does NOT offer protection against STIs, nor does any other form of hormonal contraceptive. The only form of contraceptive to offer some protection against STIs is condoms.  

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.

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 1/20 also includes D&C yellow no. 10 aluminium lake. Junel FE 1.5/30 also includes FD&C no. 40 aluminium lake HT.  

Junel FE dosage

Junel FE is available at a dosage of 1 mg Norethindrone to 20 mcg Ethinyl Estradiol, or 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 package instructions carefully and never start taking Junel FE without first consulting a doctor. Junel FE comes in the form of 28-day blister packs, 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 labeled with the day of the week on which your period starts (day 1 of your menstrual cycle).

• Sunday Start: Take the first tablet in the pack, an active tablet marked as ‘Sunday’, on the first Sunday after the start of your period. If you chose this method, make sure you use an alternative form of contraception, such as condoms, while you wait to begin Junel FE.

How to take Junel FE

Take 1 pill each day, at the same time each day, following the days of the week marked on the pack. To help you remember, try and make this 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 simulates a natural 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 next day.

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

If you forget to take your pill, you should take it as soon as you remember and then continue with your next dose at the usual time. If you miss 2 pills in a row, take both at the same time, as soon as you remember, and another 2 the following day. In this case, you will need to use an additional means of birth control, such as condoms, to ensure that you are fully protected from pregnancy. Missed pills may result in spotting or breakthrough bleeding, but this is normal and nothing to worry about.

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 indicative of severe health problems to which oral contraceptives may contribute:

• 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 on the skin of the calf, which may indicate a blood clot in the leg.

• Crushing chest pain or heaviness, which may indicate a heart attack.

• Sudden, severe headache, vomiting, dizziness or fainting, disturbances of vision or speech, weakness or numbness in an arm or a leg. This 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.

• Sever 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. This could indicate liver problems.

 

The following side effects of Junel FE are more common and usually mild. If they are troubling you, you can 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 time.

• Change in visibility or comfort while wearing contact lenses. If this is interrupting your daily life, contact your doctor for advice.

• Fluid retention. This may include swelling of the fingers or ankles, and could cause a rise in blood pressure. If you notice these signs, contact your doctor.

• Melasma, characterised by a spotted darkening of the skin, usually on the face.

• Changes in appetite

• Headache

• Nervousness

• Depression

• Dizziness

• Hair loss on the scalp

• Rash

• Vaginal infections

Contraindications

Do NOT take Junel FE if:

• You are pregnant, think you might be pregnant, or are trying to get pregnant

• You have a history of heart attack or stroke

• You have blood clots in the legs (thrombophlebitis), lungs (pulmonary embolism) or eyes

• You have a history of blood clots in the deep veins of your legs

• You have chest pain (angina pectoris)

• You are known to have or are suspected of having breast cancer, cancer of the lining of the uterus, or cervical cancer

• You have unexplained vaginal bleeding

• You have had jaundice (yellowing of the skin or whites of the eyes) during pregnancy or during previous use of the pill

• You have a benign or cancerous liver tumor

 

Before taking Junel FE, inform your doctor and take particular care if:

• You smoke. You are strongly advised not to smoke while taking the pill.

• You have breast nodules, fibrocystic disease of the breast, and abnormal breast x-ray or mammogram

• You have diabetes

• You have elevated cholesterol or triglycerides

• You have high blood pressure

• You suffer from migraines, other headaches, or epilepsy

• You suffer from depression

• You have gallbladder, heart or kidney problems

• You have a history of irregular menstrual periods

Drug interactions

Before taking Junel FE, inform your doctor if you are taking or have recently taken any other medications, including those purchased without a prescription. The following medications may interfere with Junel FE:

• Rifampin

• Anticonvulsants, such as phenobarbital, phenytoin, and carbamazepine

• Troglitazone

• Antibiotics, in particular antimicrobials such as ampicillin, tetracycline and griseofulvin

• Atorvastatin

• HCV Combination Therapy

• Ascorbic acid

• Acetaminophen

• Phenylbutazone

• Hepatitis C drug combination containing ombitasvir/paritaprevir/ritonavir, without or without dasabuvir

Alternatives to Junel FE

There are many different types of hormonal birth control, and it is not unusual to try a few different ones before finding one that works for you; different pills may contain different forms of progestogen and/or estrogen, and some patients find that they are more sensitive to some types than others. If find that you are sensitive to estrogen, the progestogen-only pill, or ‘mini pill’, may be better suited to you. 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 may wish to try a form of hormonal contraception that is not taken orally and does not need to be administered on a daily basis. These include the implant (Implanon, Nexplanon), the shot (Depo-Provera), and the intrauterine device (IUD, Mirena, ParaGard, Skyla, Liletta, Kyleena). In particular, the IUD may be appropriate for women with contradictory health conditions, such as diabetes or hypertension, as it works locally to the reproductive system. Speak to your doctor or health worker for information and advice about these types of contraception.

If you do not wish to use hormonal contraceptives, you may choose to rely on barrier contraceptive methods. These include the cervical cap (FemCap) and Male and Female Condoms. It is worth noting that male condoms are the only form of contraception to offer protection against STIs.