Ethinylestradiol + progestin

What it is

This is a combined hormonal contraceptive: a synthetic estrogen, ethinylestradiol, with a progestin. Together they suppress the pituitary signals that trigger ovulation, thin the uterine lining and thicken cervical mucus. It is used for contraception and, because it lowers circulating androgen activity, is also prescribed for acne-prone skin.

Used for

• Contraception
• Skin

What to know while taking it

Food does not matter, but the same hour each day does, and evening is a common choice because it is easy to remember. Carbamazepine and topiramate speed the liver's clearance of these hormones and can undermine contraceptive protection; the combination also lowers lamotrigine levels, so seizure control can drift when a pack is started or a break begins. Long-term use depletes vitamin B6, folate, B12, magnesium and zinc, and can nudge ALT, triglycerides and glucose upward, which is why these are worth monitoring. Estrogen raises the risk of blood clots, and smoking multiplies that risk sharply.

When to see a doctor

Swelling or pain in one calf, sudden breathlessness or chest pain, an unusually severe headache, or any visual disturbance or aura before a headache mean seeing a doctor promptly, since migraine with aura and this drug do not go together.

Worth knowing

• Smoking sharply raises the risk
• Raises thrombosis risk
• Take at the same time every day
• Not with migraine with aura

Markers to watch

• ALT
• Triglycerides
• Glucose
• Vitamin B12
• Folate

Nutrients affected

• vitaminB6 — depleted by (Homocysteine)
• vitaminB9 — depleted by (Folate, Hemoglobin, Homocysteine)
• vitaminB12 — depleted by (Hemoglobin, Homocysteine, Mean cell volume (MCV))
• magnesium — depleted by (Glucose, HOMA-IR, Magnesium)
• zinc — depleted by (Free T3, Testosterone, TSH)