Microgestin FE 1/20

When estrogen causes you side effects, consider this birth control pill

Microgestin FE 1/20 is a low-estrogen pill which minimizes estrogen-related side effects.  It’s also fortified with an iron, which is helpful if you are prone to iron deficiency anemia.

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Information

Reviewed by Dr Yasmin Aghajan, MD

Information last reviewed 07/17/19

About

What is Microgestin FE 1/20?

Microgestin FE is a type of low-estrogen birth control pill. This means that it contains progesterone and a low-dose of estrogen compared to standard combined oral contraceptive pills. The lower levels of estrogen, make Microgestin FE a good option for people who experience strong estrogen-related side effects, such as headaches, breast tenderness and nausea. In addition to the hormones, a pack of Microgestin FE also contains seven iron supplements that you take during the break between active pills when you have your period. These iron tablets are a helpful way to avoid the iron-deficiency anemia that can occur around your period. Whilst the primary use of Microgestin FE is birth control, it can also be prescribed to treat acne, endometriosis, period pains and PMS (premenstrual syndrome) amongst other conditions. 

How does Microgestin FE 1/20 work?

Microgestin FE contains both birth control pills and iron supplements. The birth control pills work to help you avoid pregnancy in the following ways:

  • They prevent ovulation, so there is no egg for sperm to fertilize.
  • They thicken the mucus around the cervix and vagina, so that sperm cannot easily pass through it to fertilize an egg if an egg was released.
  • They alter the lining of the womb/uterus (the endometrium) so that a fertilized egg would be unable to implant and would, therefore, just pass naturally out of the body without continuing into a pregnancy. 

The iron supplements work by increasing your iron levels during your period. Iron-deficiency can be caused by heavy periods, other blood loss or by not getting enough iron in your diet. The supplements help to avoid anemia by giving your iron a boost when you’ll be losing iron during your period. 

How effective is Microgestin FE?

When taken correctly, Microgestin FE is 99% effective against pregnancy, which is slightly higher than the effectiveness of condoms. In fact, it has been shown that the effectiveness of Microgestin FE remains more than 97% in the event that a single pill is missed. However, it is important to take every pill, around the same time each day, to get the maximum effect.

It is important to note that Microgestin FE does NOT offer protection against STIs, nor does any other form of hormonal contraceptive. Only barrier contraceptive methods (condoms) can provide protection against STIs when used correctly.

Microgestin FE and iron-deficiency anemia

Microgestin FE contains an iron supplement called ferrous fumarate, which helps to replenish the iron lost during your monthly bleed. These are contained in the 7 placebo pills at the end of each pack. This helps to prevent iron-deficiency anemia, which can be caused by heavy periods. They only contain small amounts of iron however, not enough to treat a diagnosed anemic condition. In this case, you’d be prescribed iron tablets from your doctor. 

Ingredients

Active ingredients

Microgestin FE birth control pills are white, but the pack also includes brown tablets, which are iron supplements. The active ingredients in the white birth control pills are 20mcg ethinyl estradiol (EE) and 1mg norethindrone. The active ingredient in the iron tablets is ferrous fumarate. 

Inactive ingredients

The birth control pills contain the following inactive ingredients:  Magnesium stearate, microcrystalline cellulose, povidone, anhydrous lactose, polacrilin potassium, alcohol. 

The inactive ingredients in the iron supplements are: Sodium starch glycolate type A corn, microcrystalline cellulose, magnesium stearate.

Dosage

Microgestin FE dosage

The usual dosage of Microgestin FE is 1 x active tablet (containing  20 mcg ethinyl estradiol and 1 mg norethindrone) each day for the first 21 days, and then 1 x inactive tablet containing an iron supplement for the following 7 days.

How to start Microgestin FE

Before starting taking Microgestin FE, make sure you read the package instructions carefully and never start taking it without first consulting a doctor. Microgestin FE comes in the form of 28-day blister packs, containing 21 active tablets (containing the active hormones) and 7 inert tablets, and marked with the days of the week. When you start taking Microgestin 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 choose this method, you will need to use an alternative form of contraception, such as condoms, for the first 7 days of your treatment.

How to take Microgestin FE

You should take 1 pill at the same time each day. 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, move onto the inactive pills the next day. During these 7 days, you will experience a withdrawal bleed, which simulates a natural period. This does not necessarily mean you will bleed for 7days. At the end of a 28 day pack, you should start a new pack the next day without leaving a break, so make sure you have your next pack ready.

What should 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.

How to stop taking Microgestin FE

You can stop taking Microgestin FE at any time without the need to consult your doctor. If you stop it midway through a pack of pills, this will disrupt your cycle, so it will be difficult to tell when your next period will be. If you are planning to switch to another pill, make sure you follow the instructions on your new pill, as you may need to finish your current pack first. After coming off the pill, your fertility will return right away, so if you are not planning on getting pregnant, you will need to use another type of contraception. 

Side Effects

Microgestin side effects

Common side effects of Microgestin FE include:

  • Irregular vaginal bleeding:

    • Spotting
    • Breakthrough bleeding
  • Difficulty wearing contact lenses
  • Swelling of:
    • Fingers
    • Ankles
    • Feet
  • Skin changes:
    • Rash
    • Darkening of the skin, especially on the face
    • Hair loss
  • Appetite changes
  • Mood changes:
    • Anxiety
    • Depression
  • Lightheadedness
  • Headaches
  • Increased likelihood of bacterial or fungal vaginal infections

You may experience other side effects not included on this list. You should always read the patient information leaflet before taking any medication to ensure that you are aware of the side effects, complications and when to go to your doctor.

In rare cases, people do experience dangerous side effects from Microgestin FE. It is possible to have an allergic reaction to Microgestin FE and it can also increase your risk of a blood clot. Blood clots can cause strokes, heart attacks and a range of other life-threatening conditions. It is important that you are aware of the symptoms below and that you seek emergency medical attention if you experience any of them.

  • Symptoms of an allergic reaction:
    • Breathing difficulties
    • Swelling of the mouth, lips, tongue, throat, face
    • Hives or rash
  • Symptoms of a blood clot:
    • Difficulty breathing
    • Fainting & dizziness
    • Pain in the chest, jaw or left arm
    • Confusion, slurred speech & lack of coordination
    • Migraine or sudden/severe headache
    • Visual changes including double vision & full or partial blindness
    • Profuse sweating

Contraindications

Do NOT take Microgestin FE if:

  • You are/might be pregnant or are trying to get pregnant
  • You have previously experienced an episode of heart attack or stroke
  • You have a history of blood clots in the legs (thrombophlebitis), lungs (pulmonary embolism), or eyes
  • You have previously had blood clots in the deep veins of your legs
  • You have a history of chest pain (angina pectoris)
  • You currently have or have ever had breast cancer, cancer of the lining of the uterus, or cervical cancer, or are already at a high risk of developing these cancers
  • You are currently experiencing unexplained vaginal bleeding
  • You have a history of jaundice (yellowing of the skin and/or whites of the eyes) during pregnancy or have experienced jaundice previously while on Microgestin FE
  • You have a history of a benign or cancerous liver tumor

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

  • You smoke. You are strongly advised not to smoke while taking the pill, as this greatly increases the risk of blood clots, stroke, and heart attacks
  • You currently have or have ever had breast nodules, fibrocystic disease of the breast, or an abnormal breast x-ray or mammogram
  • You are a diabetic
  • You have elevated levels of cholesterol or triglycerides
  • You have hypertension (elevated blood pressure)
  • You currently suffer from or have ever suffered from migraines, frequent headaches, or epilepsy
  • You are known to be suffering from depression
  • You have gallbladder, heart or kidney problems
  • You have a history of irregular menstrual periods

Drug interactions

Before taking Microgestin FE, inform your doctor if you are currently taking or have recently taken any other medications, including those purchased over the counter without a prescription. The following medications may interfere with the effectiveness of Microgestin FE:

  • Rifampin/rifampicin
  • Anticonvulsants, such as phenobarbital, phenytoin, and carbamazepine
  • Troglitazone
  • Antibiotics, in particular, antimicrobials such as ampicillin, tetracycline and griseofulvin
  • Atorvastatin
  • HCV Combination Therapy
  • Ascorbic acid (Vitamin C)
  • Acetaminophen
  • Phenylbutazone
  • Drugs for the treatment of Hepatitis C, containing ombitasvir/paritaprevir/ritonavir in combination, without or without dasabuvir

Treatment Options

Alternatives to Microgestin FE

There are many different types of hormonal birth control, and it is not uncommon to try a few forms before you find the one that is best for you. The pills differ in the form and amounts of progestogen and/or estrogen they contain and some women are sensitive to certain forms than others. Low-estrogen pills such as Microgestin FE are especially well-suited to women who are sensitive to estrogen. Another equally suited option is the progestogen-only pill or mini-pill. In contrast to Microgestin FE, the mini pill is taken in a continuous manner, which means that there is no gap for a withdrawal bleed to occur. This pill can also be used in breastfeeding mothers. 

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 injections (Depo-Provera), implants (Implanon, Nexplanon), and intrauterine devices (IUD, Skyla, ParaGard, Kyleena, Mirena, Liletta). IUDs are especially suitable for women with pre-existing conditions such as hypertension and diabetes, as these devices act directly on the reproductive system. Speak to your doctor or health worker to learn more about your options.

If you do not wish to use hormonal contraceptives at all, you may consider barrier contraceptive methods. These include the cervical cap (FemCap) and male and female condoms. When used correctly, condoms are the only form of contraception that offer protection against STIs.    

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Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.

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