Norethindrone-Ethinyl Estradiol

Junel is a combined oral contraceptive of estrogen and progesterone that is used to prevent pregnancy. Pills are contained in a monthly blister card of 3 weeks of active pills and 1 week of placebo pills.  

By clicking the “I Agree” button below, you certify under penalty of perjury that the following statements are true and correct and understand that a medical provider will rely on the truthfulness of your statements when determining whether a prescription is warranted and appropriate. 

I agree that I: 

• am 18 years or older 
• have not had a hypersensitivity reaction to any component of the formulation 
• am not pregnant, have given birth in the past 4 weeks, or have had an abortion or miscarriage in the past 4 weeks 
• am using this medication for the purpose of contraception 
• understand the use of this medication and cigarette smoking increases the risk of serious cardiovascular events 
• am not over the age of 35 years old and smoke cigarettes 
• understand this medication increases the risk of endometrial cancer and breast cancer 
• understand taking medication with estrogen alone and with progestin therapy increases the risk of cardiac events including heart attack, stroke, pulmonary embolism, and deep vein thrombosis 
• understand taking medication with estrogen alone and with progestin therapy increases the risk of dementia 
• do not have a history of liver (hepatic) impairment, hepatic tumors, or severe kidney (renal) impairment 
• do not have current or history of breast cancer, endometrial cancer, or other estrogen or progestin-sensitive cancers 
• do not have abnormal genital and uterine bleeding 
• do not have a benign or malignant tumor
• do not have systemic lupus erythematosus (SLE) 
• do not have current or history of cholestatic jaundice 
• am not taking hepatitis C drugs containing ombitasvir, paritaprevir, ritonavir, and dasabuvir 
• understand this medication should not be used as daily or regular birth control 
• understand to take a pregnancy test if regular menstruation is delayed for more than 7 days 
• have not gone through menopause 
• understand this medication may interact with medications being metabolized similarly, including phenobarbital, phenytoin, rifampin, and St. John’s Wort 
• do have a current or history of blood clots (e.g. venous thromboembolism (VTE) or deep vein thrombosis (DVT)) 
• do have a history of or at high risk of arterial or venous thromboembolic disease (e.g. cerebrovascular disease, coronary artery disease, uncontrolled high blood pressure, high blood pressure with vascular disease) 
• have not had diabetes for more than 20 years, diabetes over the age of 35 years old, or diabetes with high blood pressure, vascular disease, or end organ damage 
• do not have headache with neurological symptoms 
• do not have migraine with aura or am over the age of 35 with migraine 
• do not have an inherited or acquired abnormal blood clotting disease (hypercoagulopathy) 
• do not have a heart disease involving the heart valves or heart rhythm 
• have not had bariatric surgery or solid organ transplantation 
• will discontinue the medication if any of the following occur: migraine, vision loss, or other visual disturbances 
• understand this medication may increase the risk of or worsen other disease states (e.g. breast cancer, cervical cancer, liver cancer, cholestasis, gallbladder disease, cardiovascular disease, depression, diabetes, kidney dysfunction, asthma, epilepsy) 
• understand oral contraceptives do not protect against HIV and other sexually transmitted diseases 
• understand this is not a comprehensive list of precautions, risks, side effects, or details about taking this medication 
• understand that only major drug interactions are listed and have not been reviewed against the other medications, supplements, or herbal products I may be taking unless also filled by TelyRx