Contraindicated in:

• Hypersensitivity;

• Women >35 yr who smoke

  ;

• Current or history of deep vein thrombosis or pulmonary embolism

  ;

• Cerebrovascular disease, cardiovascular disease, or peripheral vascular disease

  ;

• Subacute bacterial endocarditis with valvular disease or atrial fibrillation

  ;

• Inherited or acquired hypercoagulopathies

  ;

• Uncontrolled hypertension

  ;

• Headaches with focal neurological symptoms or migraine headaches with aura if >35 yr

  ;
• Osteoporosis;
• Current or history of breast cancer or other hormone-sensitive malignancy;
• ↑risk for hormone-sensitive malignancy;
• Hepatic impairment;
• Undiagnosed abnormal uterine bleeding;
• OB: Pregnancy.

Use Cautiously in:

• Underlying cardiovascular disease;
• Obesity;
• History of low trauma fracture or risk factors for osteoporosis or bone loss, including taking medications that may ↓ bone mineral density;
• History of suicidal ideation, depression, or anxiety;
• Submucosal uterine fibroids (↑ risk of prolapse or expulsion);
• Prediabetes or diabetes;
• Hypertriglyceridemia;
• Hypothyroidism or hypoadrenalism (may need to ↑ doses of thyroid hormone or cortisol replacement therapy);
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
• Rep: Women of reproductive potential;
• Pedi: Safety and effectiveness not established in children.