Natazia (Estradiol Valerate and Dienogest) - Oral

Warning:

Natazia carries a black box warning for women who smoke cigarettes. Do not use Natazia if you smoke cigarettes and are over 35 years old. Smoking increases your risk of severe cardiovascular side effects (heart and blood vessel problems) from birth control pills, including death from a heart attack, blood clots, or stroke. This risk increases with age and the number of cigarettes you smoke.

What Is Natazia?

Natazia (estradiol valerate and dienogest) is a 28-day oral tablet birth control regimen that can prevent pregnancy and treat heavy menstrual bleeding (menorrhagia) without a known cause. Natazia contains two female hormones: estrogen (estradiol valerate) and a progestin (dienogest). Estradiol valerate is a synthetic estrogen converted to estradiol in your body.

Natazia works to prevent ovulation and causes changes to the cervical mucus and endometrial lining, blocking sperm penetration and reducing the chance of implantation. Natazia decreases menstrual bleeding by thinning the lining of the uterus.

Drug Facts

Generic Name: Estradiol and dienogest

Brand Name(s): Natazia

Drug Availability: Prescription

Therapeutic Classification: Combination oral contraceptives (COC)

Available Generically: No

Controlled Substance: No

Administration Route: Oral

Active Ingredient: Estradiol valerate and dienogest

Dosage Form(s): Oral tablet

What Is Natazia Used For?

Natazia is a form of birth control used to prevent pregnancy and treat heavy menstrual bleeding (menorrhagia) without a known cause.

Natazia is available in packages of three blister packs. Each blister pack contains 28 film-coated tablets in the following order:

  • Two round, biconvex dark yellow film-coated tablets with embossed “DD” in a regular hexagon on one side, each containing 3 milligrams (mg) of estradiol valerate
  • Five round, biconvex medium red film-coated tablets with embossed “DJ” in a regular hexagon on one side, each containing 2 milligrams (mg) estradiol valerate and 2 milligrams (mg) dienogest
  • Seventeen round, biconvex light yellow film-coated tablets with embossed “DH” in a regular hexagon on one side, each containing 2 milligrams (mg) estradiol valerate and 3 milligrams (mg) dienogest
  • Two round, biconvex dark red film-coated tablets with embossed “DN” in a regular hexagon on one side, each containing 1 milligram (mg) of estradiol valerate
  • Two (inactive) round biconvex, white film-coated tablets with embossed “DT” in a regular hexagon on one side

How to Take Natazia

Natazia must be taken by mouth exactly as directed at the same time every day to be most effective. Here are a few things to keep in mind:

  • Take the tablets in the order directed on the blister pack.
  • You may take your medicine with food or milk to avoid stomach upset.
  • Do not skip tablets or delay taking your pill by more than 12 hours. You could get pregnant if you miss pills (including starting the pack late). The more pills you miss, the more likely you will get pregnant.
  • Do not skip any pills, even if you do not have sex often.
  • If you have trouble remembering to take Natazia, talk to your healthcare provider about how to make pill-taking easier or about using another method of birth control.
  • When starting Natazia, use a nonhormonal form of birth control such as a condom and spermicide for the first nine days.
  • You may have spotting or light bleeding when you first take Natazia. Spotting or light bleeding is normal at first.
  • You may feel sick to your stomach (nauseous), especially during the first few months that you take Natazia. If you feel sick to your stomach, do not stop taking the pill. The problem will usually go away. If your nausea doesn't go away, call your healthcare provider.
  • If you vomit or have diarrhea within four hours of taking your pill, take another pill of the same color from your extra blister pack.
  • Missing pills can also cause spotting or light bleeding, even when you take the missed pills later. On the days you take two pills to make up for missed pills, you could also feel a little sick to your stomach.

Storage

Store Natazia at room temperature, away from direct light and moisture. Keep the tablets in the blister pack until ready to take them.

Off-Label Uses

Natazia has been studied for use off-label to manage menstrually-related migraines (MRM).

How Long Does Natazia Take to Work?

When starting Natazia, you should use a nonhormonal form of birth control, such as a condom and spermicide, for the first nine days, giving it enough time to work. Your chance of getting pregnant depends on how well you follow the directions for taking your birth control pills. The better you follow the directions, the less chance you have of getting pregnant. Go to your healthcare provider or pharmacist with any questions.

What Are the Side Effects of Natazia?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects include but aren't limited to:

  • Acne
  • Weight gain
  • Nausea
  • Vomiting
  • Headache (including migraine)
  • Mood disorder
  • Breast tenderness or pain
  • Irregular uterine bleeding

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency. Serious side effects and their symptoms can include the following:

Long-Term Side Effects

Potential long-term adverse effects of combination oral contraceptives like Natazia include:

Report Side Effects

Natazia may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program online or by phone (800-332-1088).

Dosage: How Much Natazia Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

Your doctor may ask you to begin your dose on the first day of your menstrual period (called Day 1). When you begin on a certain day it is important that you follow that schedule, even if you miss a dose. Do not change your schedule on your own. If the schedule that you use is not convenient, check with your doctor about changing it.

  • For oral dosage form (tablets):
    • For contraception (to prevent pregnancy) and to treat heavy menstrual bleeding:
      • Adults and teenagers—One tablet taken at the same time each day for 28 days.
      • Children—Use and dose must be determined by your doctor.

Modifications

The following modifications (changes) should be kept in mind when using Natazia:

Pregnancy: Do not take Natazia if you know you are pregnant. There is little or no increased risk of birth defects in women who accidentally use combined oral contraceptives (COCs) during early pregnancy. Studies and meta-analyses have not found an increased risk of genital or nongenital birth defects (including cardiac anomalies and limb-reduction defects) following exposure to low-dose COCs before conception or during early pregnancy.

Pregnancy should be ruled out if you have completed two or more cycles with Natazia and have not had a period.

Breastfeeding: Those who are nursing should not use hormonal forms of birth control until they have weaned their child. Small amounts of oral contraceptive steroids and/or metabolites are present in breast milk. Estrogen-containing combined oral contraceptives (COCs) can reduce milk production. This is less likely to occur once breastfeeding is well-established; however, it can occur at any time in some people.

Adults over 65: Natazia has not been studied in postmenopausal people assigned female at birth and is not indicated in this population.

Missed Dose

If you accidentally forgot your Natazia dose, please review the appropriate section below to know exactly what to do:

If you are less than 12 hours late taking your pill:

  • Take your pill as soon as you remember.
  • Take the next pill at the usual time.
  • You do not need to use backup contraception.

If you miss ONE PILL for more than 12 hours:

Days 1–17

  • Take your missed pill immediately.
  • Take your next pill at the usual time (you may have to take two pills that day).
  • Use backup contraception for the next nine days.
  • Continue taking one pill each day for the rest of your cycle.

Days 18–24

  • Do not take any pills from your current blister pack, and throw the pack away.
  • Take the Day 1 pill from a new blister pack.
  • Use backup contraception for the next nine days.
  • Continue taking one pill from the new blister pack at the same time each day.

Days 25–28

  • Take your missed pill immediately.
  • Take your next pill at the usual time (you may have to take two pills that day).
  • No backup contraception is needed.
  • Continue taking one pill each day for the rest of your cycle.

If you miss TWO PILLS in a row:

Days 1–17
If you miss the pills for Days 17 and 18, follow the instructions for Days 17–25 instead.

  • Do not take the missed pills. Instead, take the pill for the day you first noticed you had missed pills.
  • Use backup contraception for the next nine days.
  • Continue taking one pill each day for the rest of your cycle.

Days 17–25
If you miss the pills for Days 25 and 26, follow the instructions for Days 25–28 instead.

  • Do not take any pills from your current blister pack, and throw the pack away.
  • Take the Day 3 pill from a new blister pack.
  • Use backup contraception for the next nine days.
  • Continue taking one pill from the new blister pack at the same time each day.

Days 25–28

  • Do not take any pills from your current blister pack, and throw the pack away.
  • Start a new pack on the same day or start a new pack on the day you usually start a new pack.
  • No backup contraception is needed.
  • Continue taking one pill from the new pack at the same time each day for the rest of your cycle.

Other important things to know after missing a dose:

  • Find ways to help yourself remember to keep your appointments and take your medication routinely.
  • You may already be pregnant if you forget to start a new blister pack. 
  • You may already be pregnant or could become pregnant if you had sex on the days after the pills were missed.
  • The more pills missed and the closer they are to the end of the cycle, the more likely you will get pregnant.
  • You should call your healthcare provider if you are unsure whether you are already pregnant.
  • Do not take more than two pills in one day. On the days you take two pills to make up for missed pills, you may feel a little sick to your stomach (nauseated).
  • If you start vomiting or have diarrhea within four hours of taking your pill, take another pill of the same color from your extra blister pack.
  • If you are still unsure what to do about the pills you missed, call your healthcare provider, use backup contraception (such as condoms and spermicides) anytime you have sex, and keep taking one pill each day.

Overdose: What Happens If I Take Too Much Natazia?

No serious problems have been reported from a birth control pill overdose, even when accidentally taken by children.

If you think you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

What Happens If I Overdose on Natazia?

If you think you or someone else may have overdosed on Natazia, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Natazia, call 911 immediately.

Precautions

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It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and does not cause unwanted effects. These visits will usually be every 12 months, but some doctors require them more often.

Although you are using this medicine to prevent pregnancy, you should know that using this medicine while you are pregnant could harm the unborn baby. If you suspect that you may be pregnant, stop using this medicine immediately and check with your doctor.

Vaginal bleeding of various amounts may occur between your regular menstrual periods during the first 3 months of use. This is sometimes called spotting when slight, or breakthrough bleeding when heavier.

  • If this should occur, continue with your regular dosing schedule.
  • The bleeding usually stops within 1 week. Check with your doctor if the bleeding continues for more than 1 week.
  • If bleeding continues after you have been taking hormonal contraceptives on schedule and for more than 3 months, check with your doctor.

Check with your doctor right away if you miss a menstrual period. Missed periods may occur if you skip one or more tablets and have not taken your pills exactly as directed. If you miss two periods in a row, talk to your doctor. You might need a pregnancy test.

Do not use this medicine if you smoke cigarettes or if you are over 35 years old. If you smoke while using birth control pills, you increase your risk of having a heart attack, stroke, or blood clot. Your risk is even higher if you are over age 35, if you have diabetes, high blood pressure, high cholesterol, or if you are overweight. Talk with your doctor about ways to stop smoking. Keep your diabetes under control. Ask your doctor about diet and exercise to control your weight and blood cholesterol level.

Stop using this medicine and check with your doctor right away if you have pain in the chest, groin, or legs, especially the calves, difficulty with breathing, a sudden, severe headache, slurred speech, a sudden, unexplained shortness of breath, a sudden loss of coordination, or vision changes while using this medicine.

Check with your doctor immediately if you have problems wearing contact lenses or if blurred vision, difficulty with reading, or any other change in vision occurs during or after treatment. Your eyes need to be checked by an ophthalmologist (eye doctor).

Stop using this medicine and check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.

This medicine may not work as well in women who are overweight. If you gain a lot of weight after you start taking this medicine, ask your doctor if you should change to another type of birth control pill.

Check with your doctor before refilling an old prescription, especially after a pregnancy. You will need another physical examination and your doctor may change your prescription.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or certain medical tests.

This medicine may make your skin more sensitive to sunlight. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (e.g., St. John's wort) or vitamin supplements.

What Are Reasons I Shouldn’t Take Natazia?

You should not take Natazia if you have one of the following:

If you're allergic to Natazia or any of its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

If you have a high risk of arterial or venous thrombotic diseases. Examples include women who are known to:

  • Smoke and are over age 35 (refer to the Black Box Warning)
  • Have had a heart attack or stroke
  • Have deep vein thrombosis or pulmonary embolism, now or in the past
  • Have cerebrovascular disease
  • Have coronary artery disease
  • Have thrombogenic valvular or thrombogenic rhythm diseases of the heart (for example, subacute bacterial endocarditis with valvular disease or atrial fibrillation)
  • Have inherited or acquired a blood clotting disorder (hypercoagulopathies)
  • Have uncontrolled high blood pressure (hypertension)
  • Have diabetes mellitus with vascular disease
  • Have headaches with focal neurological symptoms or have migraine headaches with or without aura if over age 35

If you have an undiagnosed abnormal uterine bleeding.

If you have a current diagnosis of, or history of, hormone-sensitive breast cancer.

If you have liver tumors, benign or malignant, or liver disease.

If you have are pregnant--there's no reason to use COCs during pregnancy.

What Other Medications Interact With Natazia?

Certain antibiotics and other drugs may cause oral contraceptives like Natazia to be less effective, and backup contraception may be necessary. Consult healthcare professionals before starting new medications.

The following list contains some drugs that tend to affect how well Natazia works:

  • CYP3A4 inducers, including Dilantin (phenytoin), barbiturates, Tegretol (carbamazepine), Tracleer (bosentan), Felbatol (felbamate), Grifulvin V (griseofulvin), Oxtellar XR or Trileptal (oxcarbazepine), Rifadin (rifampin), Topamax (topiramate), and products containing St. John’s wort.
  • Moderate or strong CYP3A4 inhibitors, including azole antifungals (for example, Nizoral (ketoconazole), Sporanox (itraconazole), Vfend (voriconazole), and Diflucan (fluconazole)), Calan (verapamil), macrolides (for instance, Biaxin (clarithromycin) or erythromycin), Cardizem (diltiazem), and grapefruit
  • Medicine to treat human immunodeficiency virus (HIV), including protease inhibitors and non-nucleoside reverse transcriptase inhibitors

This is not a complete list of medicines that interact with Natazia. 

Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Natazia.

Talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter, nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

Natazia is the only birth control available that contains the combination of estradiol valerate and dienogest at this time.

Frequently Asked Questions

  • What is Natazia used for?

    Natazia is a form of birth control used to prevent pregnancy and treat heavy menstrual bleeding (menorrhagia) without a known cause.

  • When should I take Natazia?

    Take Natazia by mouth at the same time every day.

  • Why is it important not to miss pills, when taking Natazia?

    You could get pregnant if you miss pills (including starting the pack late). The more pills you miss, the more likely you will get pregnant.

How Can I Stay Healthy While Taking Natazia?

Knowing that Natazia will not protect you from getting HIV or other sexually transmitted infections (STIs) is essential. Remember to practice safer sex techniques to reduce your risk of getting an STI if you are sexually active while taking Natazia.

It may take a few months for your body to adjust to taking Natazia daily. If you develop any side effects that you are uncomfortable with or that can lead to life-threatening issues, please notify your healthcare provider to discuss if Natazia is the proper birth control for you.

Use backup contraception (such as condoms and spermicides) anytime you have sex.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Goldenberg MM. Pharmaceutical approval updateP T. 2012;37(7):392-394.

  2. Food and Drug Administration. Natazia label.

  3. Nappi RE, Terreno E, Sances G, et al. Effect of a contraceptive pill containing estradiol valerate and dienogest (E2V/DNG) in women with menstrually-related migraine (MRM)Contraception. 2013;88(3):369-375. doi:10.1016/j.contraception.2013.02.001