Norgestimate & Ethinyl Estradiol (Ortho Tri-Cyclen) 101: How it Works, Side Effects and Interactions

    Commonly sold under the brand name Ortho Tri-Cyclen, norgestimate and ethinyl estradiol is a widely used birth control pill.

    Norgestimate and ethinyl estradiol is a combined oral contraceptive, meaning it combines two different hormones to stop you from becoming pregnant. Used correctly, it’s highly effective at preventing pregnancy.

    Birth control pills that contain norgestimate and ethinyl estradiol can also be used to treat and prevent acne. In fact, norgestimate and ethinyl estradiol is one of three birth control pill types approved by the FDA as a hormonal acne treatment.

    We’ve covered the other two, drospirenone and ethinyl estradiol (Yaz) and norethindrone and ethinyl estradiol (Estrostep) in separate guides. 

    As well as Ortho Tri-Cyclen, norgestimate and ethinyl estradiol birth control pills are commonly sold under the brand names Tri-Lo-Sprintec, Sprintec and TriNessa.

    As a form of birth control, norgestimate and ethinyl estradiol works by changing your hormone levels, affecting your body’s ability to release eggs as normal. It also changes the amount of androgens (male hormones) in your body to make acne outbreaks less common.

    As complicated as this sounds, the basic mechanism behind norgestimate and ethinyl estradiol is actually pretty simple. Below, we’ve covered how norgestimate and ethinyl estradiol (Ortho Tri-Cyclen) work, as well as the key side effects and interactions you should be aware of.

    How Do Norgestimate/Ethinyl Estradiol Birth Control Pills Work?

    Like other combined birth control pills, norgestimate and ethinyl estradiol birth control pills work by releasing a combination of two hormones into your body.

    Because norgestimate and ethinyl estradiol birth control pills contain more than one hormone, they’re known as combined oral contraceptives, or “COCP” birth control pills. 

    These two hormones are a progestin (norgestimate) and an estrogen (ethinyl estradiol). Used in combination, these hormones can change your body’s production of hormones to reduce your risk of becoming pregnant.

    Sound complicated? By adjusting your levels of norgestimate and ethinyl estradiol, birth control pills like Ortho Tri-Cyclen do two things:

    • First, your ovaries stop releasing eggs. By stopping the ovulation process, birth control pills that contain norgestimate and ethinyl estradiol reduce your risk of pregnancy if you use them correctly.

    • Second, the hormones inside norgestimate and ethinyl estradiol birth control pills make your cervix produce more mucus, making it more difficult for sperm to make its way into your uterus.

    You can think of norgestimate and ethinyl estradiol birth control as a two-pronged approach to preventing pregnancy: Not only do your ovaries stop releasing eggs (making it more difficult for an egg to become fertilized), but they also physically block sperm using cervical mucus.

    Like other birth control pills, however, norgestimate and ethinyl estradiol are only effective if you use them according to the instructions.

    Used perfectly at the same time every day with no missed tablets, birth control pills containing norgestimate and ethinyl estradiol are more than 99 percent effective at preventing pregnancy. This means that less than 1 percent of users will become pregnant every year, on average.

    However, most norgestimate and ethinyl estradiol birth control users aren’t perfect. Missing a dose, taking a pill later than usual and other mistakes contribute to a “real life” success rate of about 91 percent for norgestimate and ethinyl estradiol birth control.

    Like other multi-hormone birth control pills, norgestimate and ethinyl estradiol birth control pills come in a pack of 28 tablets. Twenty-one of these tablets are “active” tablets that contain the two main hormones, while seven are placebo pills that do not contain any active ingredients.

    Unlike other birth control pills, the “active” tablets of norgestimate and ethinyl estradiol contain different doses of norgestimate (starting from .180 mg in week one and ramping up to .250 mg in week three). 

    This is known as a triphasic approach to birth control. By gradually increasing the amount of norgestimate with each week of the birth control cycle, birth control pills like Ortho Tri-Cyclen are designed to more closely mimic the natural hormonal fluctuations of your body. 

    Because of this gradual increase in norgestimate, it’s essential that you take your norgestimate and ethinyl estradiol birth control pills in the correct order, without missing any tablets.

    Norgestimate & Ethinyl Estradiol for Acne

    Norgestimate and ethinyl estradiol is one of three combined birth control formulates approved by the FDA for treating acne.

    The other two FDA-approved birth control formulas are drospirenone and ethinyl estradiol (Yaz) and norethindrone and ethinyl estradiol (Estrostep). We’ve explained both of these birth control pills in their own guides. 

    Norgestimate and ethinyl estradiol for acne treatment work by lowering your body’s production of androgen hormones like testosterone. Studies show that norgestimate and ethinyl estradiol birth control pills are about as effective at treating acne as benzoyl peroxide. 

    Acne breakouts occur as a result of several different factors. The first factor is sebum — a type of natural oil your body secretes to keep your skin hydrated, protected and healthy. The second is your skin cell turnover cycle — the speed at which your body produces new skin cells.

    The final factor is bacteria — a factor that’s usually treated through the use of an antibiotic along with other medication.

    Androgens such as testosterone play a major role in the production of sebum. When you have high testosterone levels, your sebaceous glands secrete more sebum, making your skin oilier and more prone to acne. 

    This sebum can become trapped inside your pores, causing blockages which in turn result in whiteheads, blackheads and other acne nodules. When these blockages become infected, it can lead to painful cystic acne outbreaks. 

    Our guide to hormonal acne goes into more detail on the major role sebum and hormones play in acne outbreaks, as well as how factors like your menstrual cycle, use of birth control and age can all affect your risk of experiencing hormonal acne. 

    Because they reduce your body’s testosterone production, norgestimate and ethinyl estradiol for acne is a very effective treatment. Less sebum equals less oily skin, which in turn can reduce the severity of your acne.

    On the whole, norgestimate and ethinyl estradiol birth control works as a treatment for acne. For optimal results, most dermatologists recommend using birth control along with other acne medications, such as tretinoin (Retin-A) and topical antibiotics like clindamycin

    What are the Benefits of Norgestimate & Ethinyl Estradiol Birth Control?

    As you’d expect, the biggest benefit of norgestimate and ethinyl estradiol birth control is that it significantly reduces your risk of becoming pregnant.

    Used perfectly, norgestimate and ethinyl estradiol birth control pills like Ortho Tri-Cyclen have a more than 99 percent success rate. Even in “real life” conditions, norgestimate and ethinyl estradiol is about 91 percent effective as a form of birth control.

    Beyond the obvious, norgestimate and ethinyl estradiol birth control pills can have several other benefits:

    • Used consistently, birth control pills containing norgestimate and ethinyl estradiol can help to regulate your menstrual cycle, resulting in a more predictable period that starts when you expect it to.

    • Many women experience shorter, lighter and easier periods while using norgestimate and ethinyl estradiol birth control pills. As well as being easier, a lighter period means less iron loss and a lower risk of developing anemia during your period.

    • Compared to other birth control pills, norgestimate and ethinyl estradiol pills are usually less likely to cause common side effects like spotting.

    • As we’ve mentioned above, norgestimate and ethinyl estradiol birth control pills can be highly effective as a treatment for hormonal acne.

    • There’s also some evidence that norgestimate and ethinyl estradiol birth control lowers your risk of acute pelvic inflammatory disease, ovarian cancer, uterine cancer, ectopic pregnancy and breast cysts. 

    How to Use Norgestimate/Ethinyl Estradiol Birth Control

    Like other combined birth control pills, norgestimate and ethinyl estradiol birth control is easy to use. 

    All norgestimate and ethinyl estradiol birth control pills come in packs of 28 tablets. The tablets are designed for once-per-day consumption, meaning you’ll need to take one tablet per day at the same time, every day.

    Taking tablets at inconsistent times or missing a tablet can reduce the effectiveness of norgestimate and ethinyl estradiol birth control. To avoid missing a tablet, set a daily schedule for your birth control pill and make sure you follow it.

    Your doctor will normally recommend a Sunday start protocol for your norgestimate and ethinyl estradiol birth control. 

    For a Sunday start protocol, start by taking the first tablet on the first Sunday after the beginning of your period. Take one active tablet daily for the remaining 20 days, then use an inactive tablet daily until you reach the end of the packet.

    Once you reach the end of the packet, start a new packet of norgestimate and ethinyl estradiol birth control pills from the beginning. 

    If your doctor recommends a day one start, start by taking the first active tablet on the first day of your period. Take one active tablet per day for the next 20 days, until you reach the end of the white and/or blue tablets.

    Once you’ve finished the active tablets, take one inactive tablet per day for seven days until you reach the end of the pack. Then, start the next pack the next day (which will be the same day as the day you began using the medication). 

    Many brands of norgestimate and ethinyl estradiol birth control include a rotating day dial, which makes tracking the right day to use your medication easy if you follow a day one start. 

    Regardless of the specific protocol your doctor recommends, it’s important to take each tablet at the same time daily. The easiest way to do this is to make taking your pill a part of your morning routine, or set an alarm each day to remind you it’s time to take your birth control.  

    Most brands of norgestimate and ethinyl estradiol birth control, including Ortho Tri-Cyclen, use a color scheme to show each tablet’s ingredients:

    • For Ortho Tri-Cyclen, day one to seven active tablets are white, day eight to 14 tablets are light blue, and day 15 to 21 tablets are blue. Inactive tablets are dark green.

    • For Ortho-Cyclen, day one to 21 active tablets are blue. Inactive tablets are dark green.

    The color schemes used for norgestimate and ethinyl estradiol birth control can vary depending on the brand of medication you use. Check your medication’s instructions to make sure you use the correct tablets from the beginning of your cycle. 

    Norgestimate and ethinyl estradiol birth control takes about one week to become effective. Keep yourself protected from pregnancy by using a secondary form of birth control, such as condoms, during the first seven days of your medication cycle. 

    If you forget to take an active tablet during weeks one, two or three, take the tablet you missed as soon as you remember. Keep taking one tablet per day until you finish the packet, then start using the next packet as normal.

    If you miss two active tablets during weeks one or two, take the two active tablets you missed as soon as you remember, then take two active tablets the next day, Keep taking one tablet per day until you finish the packet.

    You’ll need to use a secondary form of birth control, such as condoms, for at least seven days after missing two or more tablets in a row.

    If you miss two active tablets during week three on a Sunday start protocol, continue taking one tablet per day until Sunday. On Sunday, throw away the remaining tablets and start from the first active pill of a new pack. 

    You’ll need to use a secondary form of birth control, such as condoms, for at least seven days after starting the new pack of medication. 

    It’s also important to use a secondary form of birth control for at least seven days if you vomit or experience diarrhea after taking your birth control pill. This can affect your body’s absorption of the medication and increase your risk of becoming pregnant. 

    Norgestimate & Ethinyl Estradiol Birth Control Side Effects

    Like all forms of hormonal birth control, norgestimate and ethinyl estradiol birth control pills can have some side effects. Most of these side effects are the same as other combined birth control pills. Common side effects of norgestimate and ethinyl estradiol birth control include: 

    • Weight gain. Ortho Tri-Cyclen and other brands of norgestimate and ethinyl estradiol birth control can cause your body to retain more water than normal, resulting in weight gain.

      Weight gain from birth control pills usually happens during the first two months. Since most weight gain caused by birth control is due to water retention, it’s typically easy to lose if/when you decide to stop using oral contraceptives for birth control.
    • Vaginal bleeding/spotting. Although norgestimate and ethinyl estradiol birth control pills have a lower rate of spotting than other birth control pills, there’s still some risk of you experiencing minor bleeding outside your period.
    • Breast tenderness. Norgestimate and ethinyl estradiol can result in sensitivity in your breast tissue. Some women report minor soreness and tenderness in their breasts from norgestimate and ethinyl estradiol birth control.
    • Increased breast size. Norgestimate and ethinyl estradiol can cause an increase in your breast size, although this doesn’t affect everyone. This increase is usually minor and driven by the hormone combination used in the tablets.
    • Nausea and vomiting. Some women report nausea, discomfort and vomiting after they start using norgestimate and ethinyl estradiol birth control. This is usually temporary and is most commonly reported during the first one to three months of use.
    • Mood changes, irritability and headache. Birth control pills containing norgestimate and ethinyl estradiol can potentially affect your mood, causing you to feel more easily irritated, anxious or worried than normal.

    These side effects don’t affect every woman that uses norgestimate and ethinyl estradiol birth control pills, and if/when they do occur they’re typically fairly minor. Many of these side effects occur during the first few months of use, then gradually disappear as you continue using hormonal birth control.

    Less Common, Serious Side Effects

    Most side effects from norgestimate and ethinyl estradiol birth control pills are minor. However, there are also some rare, significantly more serious side effects that can occur from using birth control pills. These side effects include:

    • Blood clots, stroke and other cardiovascular events. Although rare, birth control pills that contain norgestimate and ethinyl estradiol can increase your risk of experiencing a range of serious cardiovascular events, including blood clots, heart attacks and stroke.

      If you have any existing cardiovascular issues, or your family has a genetic history of heart disease, it’s important to disclose this information to your doctor before you use any hormonal birth control pills.

      If you experience any warning signs of cardiovascular issues — a rapid-onset and severe headache, sudden numbness or weakness in one side of the body, severe chest pains or loss of vision — seek emergency medical help immediately.
    • High blood pressure. All combined oral contraceptives can potentially increase your blood pressure, making it important to speak to your doctor about safe birth control if your blood pressure is already higher than the optimal range.
    • Jaundice and liver damage. Most birth control pills are relatively mild on the liver and rarely produce liver-related issues. However, it’s possible for birth control pills to affect your liver and cause issues such as jaundice and liver damage.

      If you notice any signs of liver damage, such as yellowing of the eyes and skin, dark urine, clay-colored stools or tiredness, contact your doctor as soon as possible.
    • Sleep problems, fatigue and tiredness. Although rare, the hormones in birth control pills like Ortho Tri-Cyclen can make you feel fatigued and tired, particularly during the first one to three months of use. 

    Norgestimate/Ethinyl Estradiol Birth Control and Smoking

    Your risk of experiencing a stroke, heart attack or blood clot while using norgestimate and ethinyl estradiol birth control is significantly higher if you are a cigarette smoker. 

    If you smoke, it’s essential that you disclose this information to your doctor before discussing birth control options. This is particularly important if you’re 35 or older, as women in this group have the highest risk of experiencing cardiovascular side effects from oral birth control.

    Your doctor may be able to recommend a safe form of birth control for you based on your needs and lifestyle. 

    Norgestimate/Ethinyl Estradiol Birth Control Interactions

    Norgestimate/ethinyl estradiol birth control has 47 major interactions and almost 400 moderate drug interactions, making it important that you let your doctor know about any other medications you use before starting birth control pills.

    Drugs.com has a complete list of interactions for norgestimate and ethinyl estradiol birth control, which features everything from major to mild interactions. There are also 21 disease interactions that you should be aware of before using norgestimate and ethinyl estradiol birth control. 

    To avoid the risk of norgestimate and ethinyl estradiol interacting with other medications, make sure you let your know doctor about any other drugs you take before you discuss birth control options. 

    Learn More About Birth Control Medication

    As one of three birth control pills approved by the FDA as both contraceptives and treatments for acne, norgestimate and ethinyl estradiol birth control pills like Ortho Tri-Cyclen are used by millions of women around the world.

    Other birth controls with similar formulas and effects include drospirenone and ethinyl estradiol (Yaz) and norethindrone and ethinyl estradiol (Estrostep), both of which are also used to treat hormonal acne.

    Our guide to birth control medication and acne also covers how you can use birth control pills to clear up your skin, avoid blocked pores and prevent acne outbreaks. 



    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.