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What side effects may occur?
Check with your doctor as soon as possible if any of the following side effects occur:

More common—usually less common after the first 3 months of oral contraceptive use
- Changes in th uterine bleeding pattern at menses or between menses, such as decreased bleeding at menses, breakthrough bleeding or spotting between periods, prolonged bleeding at menses, complete stopping of menst rual bleeding that occurs over several months in a row, or stopping of menstrual bleeding that only occurs sometimes

Less common
- Headaches or migraines; increased blood pressure; v aginal infection with vaginal itching or irritation, or thick, white, or curd-like discharge

Special Information
If you miss one menstrual period and have taken your tablets as directed, continue taking them. However, if you miss one period and have not taken your tablets as directed or if you miss two menstrual periods and have taken the tablets as directed, call your doctor and use another method of birth control until you have a pregnancy test.

Before Using This Medicine
Breast disease (not involving cancer)—Ortho tricyclen usually protect against certain breast diseases, such as breast cysts or breast lumps; however, your doctor may want to follow your condition mor closely
- Cancer, including breast cancer (or history of or family history of)—Ortho tricyclen may worsen some cancers, especially when breast, cervical, or uterine cancers already exist. Use o Ortho tricyclen is not recommended if you have any of these conditions. If you have a family history of breast disease, Ortho tricyclen may still be a good choice but you may need to be tested more o ften
- Chorea gravidarum or
- Gallbladder disease or gallstones (or history of) or
- High blood cholesterol or

How should this medicine be used?
Take this medicine with food to help prevent nausea that might occur during the first few weeks. Nausea usually disappears with continued use or if the medicine is taken at bedtime.

When you begin to use Ortho tricyclen, your body will require at least 7 days to adjust before a pregnancy will be prevented. You will need to use an additional birth control method for at least 7 days. Some d octors recommend using an additional method of birth control for the first cycle (or 3 weeks) to ensure full protection. Follow the advice of your doctor or other health care professional.

Tr y to take the doses no more than 24 hours apart to reduce the possibility of side effects and to prevent pregnancy.

Precautions Before Using This Medicine
Pregnancy—Ortho tricyclen are not recommended for use during pregnancy and should be discontinued if you become pregnant or think you are pregnant. When Ortho tricyclen were accidently taken early in pregnancy, problems in the fetus did not occur. Women who are not breast-feeding may begin to take Ortho tricyclen two weeks after having a baby.

Breast-feeding—Ortho tricyclen pass into the breast milk and can change the content or lower the amount of breast milk. Also, they may shorten a woman's ability to breast-feed by about 1 month, especially when the mother is only partially breast -feeding.

How to Use
Ortho tricyclen come in packets of 21 or 28 tablets to take by mouth once a day. To avoid upset stomach, take Ortho tricyclen with food or milk. Take the tablet routinely at the same time every day (e .g., after dinner or at bedtime) to help you remember to take the tablet regularly. Missing doses increases your risk of becoming pregnant.

When first starting on this medicine, use an additi onal method of birth control until you have correctly taken 7 days' worth of medicine.