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Ortho Tri-Cyclen Lo for Birth Control

In general, combination birth control pills have been found to help regulate cycles, decrease painful menstrual cramps, help with menorrhagia (heavy bleeding), and lower the risk of colon, ovarian, and endometrial cancer.

Ortho Tri-Cyclen LO (28) 0.18 Mg/0.215 Mg/0.25 Mg-25 Mcg Tablet – Uses, Side Effects, and More

Do not use this medication if you smoke cigarettes/use tobacco and are over 35 years old. Smoking raises your risk of stroke, heart attack, blood clots, and high blood pressure from hormonal birth control (such as the pill, patch, ring). The risk of these serious problems increases with age and with the number of cigarettes you smoke. Do not smoke or use tobacco.

Warnings:

Do not use this medication if you smoke cigarettes/use tobacco and are over 35 years old. Smoking raises your risk of stroke, heart attack, blood clots, and high blood pressure from hormonal birth control (such as the pill, patch, ring). The risk of these serious problems increases with age and with the number of cigarettes you smoke. Do not smoke or use tobacco.

Uses

This combination hormone medication is used to prevent pregnancy. It contains 2 hormones: a progestin and an estrogen.Besides preventing pregnancy, birth control pills may make your periods more regular, decrease blood loss and painful periods, decrease your risk of ovarian cysts, and also treat acne.Using this medication does not protect you or your partner against sexually transmitted diseases (such as HIV, gonorrhea, chlamydia).

How to use Ortho Tri-Cyclen LO (28) 0.18 Mg/0.215 Mg/0.25 Mg-25 Mcg Tablet

Read the Patient Information Leaflet provided by your pharmacist before you start using this product and each time you get a refill. The leaflet contains very important information on when to take your pills and what to do if you miss a dose. If you have any questions, ask your doctor or pharmacist.

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Take this medication by mouth as directed by your doctor, usually once daily. Pick a time of day that is easy for you to remember, and take your pill at the same time each day.

If you are taking the chewable tablet, you may either swallow it whole or chew it thoroughly and swallow. Carefully follow the manufacturer’s directions for your brand.

It is very important to continue taking this medication exactly as prescribed by your doctor. With certain brands of birth control pills, the amount of estrogen and progestin in each active tablet will vary at different times in the cycle. It is very important that you follow the package instructions to find the first tablet, start with the first tablet in the pack, and take them in the correct order. Do not skip any doses. Pregnancy is more likely if you miss pills, start a new pack late, or take your pill at a different time of the day than usual.

Vomiting or diarrhea can prevent your birth control pills from working well. If you have vomiting or diarrhea, you may need to use a back-up birth control method (such as condoms, spermicide). Follow the directions in the Patient Information Leaflet and check with your doctor or pharmacist for more details.

Taking this medication after your evening meal or at bedtime may help if you have stomach upset or nausea with the medication. You may choose to take this medication at another time of day that is easier for you to remember. No matter what dosing schedule you use, it is very important that you take this medication at the same time each day, 24 hours apart. Ask your doctor or pharmacist if you have any questions.

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Your pill pack contains 21 pills with active medication. It may also contain 7 reminder pills with no medication. Take one active pill (with hormones) once daily for 21 days in a row. If you are using a product with 28 tablets, take an inactive pill once daily for 7 days in a row after you have taken the last active pill unless otherwise directed by your doctor. If you are using a product with 21 tablets, do not take any tablets for 7 days unless otherwise directed by your doctor. You should have your period during the fourth week of the cycle. After you have taken the last inactive tablet in the pack or gone 7 days without taking an active tablet, start a new pack the next day whether or not you have your period. If you do not get your period, consult your doctor.

If this is the first time you are using this medication and you are not switching from another form of hormonal birth control (such as patch, other birth control pills), take the first tablet in the pack on the first Sunday following the beginning of your menstrual period or on the first day of your period. If your period begins on a Sunday, begin taking this medication on that day. For the first cycle of use only, use an additional form of non-hormonal birth control (such as condoms, spermicide) for the first 7 days to prevent pregnancy until the medication has enough time to work. If you start on the first day of your period, you do not need to use back-up birth control the first week.

Ask your doctor or pharmacist about how to switch from other forms of hormonal birth control (such as patch, other birth control pills) to this product. If any information is unclear, consult the Patient Information Leaflet or your doctor or pharmacist.

Ortho Tri-Cyclen Lo for Birth Control

Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.

Updated on December 01, 2022

Anita Sadaty, MD, is a board-certified obstetrician-gynecologist at North Shore University Hospital and founder of Redefining Health Medical.

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Ortho Tri-Cyclen Lo was a brand of combination birth control pills. This particular brand name has been discontinued, but generic versions are available.

This is a triphasic birth control pill—this means that Ortho Tri-Cyclen Lo has three different doses of hormones during the three weeks of active pills in each pack.

Triphasic pills are different from traditional monophasic pills, which are made up of the same dose of both estrogen and progestin.

Verywell / Cindy Chung

Ortho Tri-Cyclen Lo Effectiveness

Combination birth control pills are a highly effective and convenient form of contraception. Ortho Tri-Cyclen Lo birth control pills are between 91% and 99.7% effective.

This means that with typical use, nine out of every 100 users will become pregnant during their first year on Ortho Tri-Cyclen Lo. With perfect use, less than one will become pregnant.

The type and amount of hormones in combination birth control pills don’t change how effective the pill is. All combination pills prevent pregnancy the same way.

Research confirms Ortho Tri-Cyclen Lo is still an extremely effective contraceptive method despite having lower hormone levels than some pills.

Dosage and Schedule

Each monthly pack of Ortho Tri-Cyclen Lo contains 28 pills. The active pills are made up of ethinyl estradiol and a progestin called norgestimate.

The amount of norgestimate in Ortho Tri-Cyclen Lo slowly increases over the first three weeks of the pill pack, from 0.180 milligrams (mg) to 0.215 mg and 0.250 mg. The amount of estrogen stays the same, at 0.025 mg.

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Triphasic birth control pills like this are meant to more closely mimic the hormonal changes of your natural menstrual cycle. Ortho Tri-Cyclen Lo comes with a DIALPAK Tablet Dispenser which is preset for a Sunday Start. However, you can also use it with a Day 1 Start.

Ortho Tri-Cyclen Lo Side Effects

As with any type of hormonal contraceptive, you may experience some side effects from Ortho Tri-Cyclen Lo, but they usually go away after the first 3 months. The most common reported side effects of the Ortho Tri-Cyclen Lo birth control pill are:

  • Nausea and/or vomiting
  • Spotting or irregular bleeding
  • Difficulty wearing contact lenses
  • Fluid retention
  • Weight gain and/or change in appetite
  • Spotty darkening of the skin (usually the face)
  • Elevated blood pressure
  • Breast tenderness
  • Headache and/or dizziness
  • Depression and/or nervousness
  • Hair loss

According to the U.S. National Library of Medicine, research shows that the hormone combination in Ortho Tri-Cyclen Lo tends to be well-tolerated by most users. In a study of 1,723 women using this birth control pill, only 4% (69 women) stopped using it because of side effects.

Another study, published in 2009, looked at the bleeding rates of healthy, sexually active Ortho Tri-Cyclen Lo users from across North America. The results showed that women using Ortho Tri-Cyclen Lo had less unscheduled bleeding/spotting for the first six cycles of use.

Noncontraceptive Benefits

In general, combination birth control pills have been found to help regulate cycles, decrease painful menstrual cramps, help with menorrhagia (heavy bleeding), and lower the risk of colon, ovarian, and endometrial cancer.

It is thought that Ortho Tri-Cyclen Lo can be especially helpful in decreasing disruptive spotting and breakthrough bleeding — which tends to be a typical birth control pill side effect during the first three months of use.

A nationwide study published in 2003 compared women who used Ortho Tri-Cyclen Lo for 13 cycles to women who used Loestrin Fe (a birth control pill with lower hormone levels). The participants using Ortho Tri-Cyclen Lo reported:

  • Less breakthrough bleeding per cycle
  • Less spotting/breakthrough bleeding during the first 3 months
  • Lower rate of discontinuation due to irregular bleeding

Some combination birth control pills can also help treat acne. In 1997, Ortho Tri-Cyclen (NOT Ortho Tri-Cyclen Lo) received FDA approval to help treat moderate acne in biological females who are at least 15 years old.

Ortho Tri-Cyclen Lo isn’t FDA approved to help fight acne, but research published in 2017 suggests that lower estrogen pills (like Ortho Tri-Cyclen Lo) are effective for acne treatment.

Ortho Tri-Cyclen Lo Cost

Ortho Tri-Cyclen Lo seems to be covered by over 80% of most health insurance plans. But, if you want to buy Ortho Tri-Cyclen Lo (and not its generic alternative), you are probably going to have a co-pay when buying this birth control pill brand.

What to Do When You Miss a Pill

Because the hormone levels are different in each week of an Ortho Tri-Cyclen Lo pill pack, the directions for forgetting a pill or two depend on which week it’s in.

The following is a good rule of thumb to follow   (but you should always check the pill prescribing information that comes with each monthly pack.)

One Missed Pill—Weeks 1, 2, or 3

If you missed ONE pill that was white, light blue, or dark blue:

  • Take the missed pill as soon as you remember
  • Take the next pill at your regular time
  • You may take two pills in one day
  • No backup contraception should be needed

Two Missed Pills—Weeks 1 or 2

If you missed TWO pills in a row that were white or light blue:

  • Take two pills on the day you remember
  • Take two pills the next day
  • Then resume one pill each day until you finish the pack
  • Use backup birth control for the following seven days or you could become pregnant

Two Missed Pills—Week 3

If you missed TWO pills in a row that are dark blue AND you’re a Sunday starter:

  • Continue taking one pill every day until Sunday
  • On Sunday, throw out the remainder of the pack
  • Start a new pack of pills that same day
  • You may not have a withdrawal period that month
  • Use backup birth control for the following seven days or you could become pregnant
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If you missed TWO pills in a row that are dark blue AND you’re a Day 1 starter:

  • Throw out your current Ortho Tri-Cyclen Lo pill pack
  • Begin a new pack that same day
  • You may not have a withdrawal period that month
  • Use backup birth control for the following seven days or you could become pregnant

Three Missed Pills—Weeks 1, 2, and 3

If you missed THREE or more consecutive white, light blue, or dark blue pills AND are a Sunday starter:

  • Continue taking one pill every day until Sunday
  • On Sunday, throw out the rest of the pack
  • Start a new one
  • You may not have a withdrawal period that month
  • Use backup birth control for the following seven days or you could become pregnant

If you missed THREE or more consecutive white, light blue, or dark blue pills AND are a Day 1 starter:

  • Throw out the remainder of the pill pack
  • Start a new pack that same day
  • You may not have a withdrawal period that month
  • Use backup birth control for the following seven days or you could become pregnant

Any Missed Pills—Week 4

If you missed any of the seven dark green “reminder pills”:

  • Throw away the pill(s) you missed
  • Continue taking the green pills every day until the pack is finished
  • You should not need a backup birth control method

The price of Ortho Tri-Cyclen Lo ranges between $45 and $140 for one pack of pills. A generic alternative called Tri-Lo Sprintec is available, as well. Under the Affordable Care Act, you should be able to get the generic version of these birth control pills for free.

Frequently Asked Questions

What kind of birth control is Ortho Tri-Cyclen Lo?

Ortho Tri-Cyclen is a hormonal birth control pill that combines synthetic estrogen (ethinyl estradiol) and synthetic progesterone (norgestimate). It is a triphasic contraceptive pill, meaning it provides three different levels of hormones throughout the month. Each week of tablets is a different dose and combination of ethinyl estradiol and norgestimate. The pills for the last week of the month are placebos that do not contain any hormones.

Why was Ortho Tri-Cyclen taken off the market?

In June 2018, Janssen Pharmaceuticals discontinued manufacturing Ortho Tri-Cyclen Lo after generic varieties came on the market and cut into profits.

What is the generic version of Ortho Tri-Cyclen Lo?

Ortho Tri-Cyclen Lo is available in generic versions as norgestimate and ethinyl estradiol tablets. This combination birth control pill is also sold under the names Tri-Lo Sprintec and Tri-Lo Marzia.

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. Hampton RM, Short M, Bieber E, et al. Comparison of a novel norgestimate/ethinyl estradiol oral contraceptive (Ortho Tri-Cyclen Lo) with the oral contraceptive Loestrin Fe 1/20. Contraception. 2001;63(6):289-295. doi:10.1016/s0010-7824(01)00214-1
  2. U.S. National Library of Medicine DailyMed. Ortho Tri Cyclen Lo.
  3. Hampton RM, Fisher AC, Pagano S, Laguardia KD. Scheduled and unscheduled bleeding patterns with two combined hormonal contraceptives: application of new recommendations for standardization. Fertil Steril. 2009;92(2):434-40. doi:10.1016/j.fertnstert.2008.07.010
  4. Poindexter AN, Burkman R, Fisher AC, Laguardia KD. Cycle control, tolerability, and satisfaction among women switching from 30-35 microg ethinyl estradiol-containing oral contraceptives to the triphasic norgestimate/25 microg ethinyl estradiol-containing oral contraceptive Ortho Tri-Cyclen LO. Int J Fertil Womens Med. 2003;48(4):163-72.
  5. Trivedi MK, Shinkai K, Murase JE. A Review of hormone-based therapies to treat adult acne vulgaris in women. Int J Womens Dermatol. 2017;3(1):44–52. doi:10.1016/j.ijwd.2017.02.018
  6. Trivedi MK, Shinkai K, Murase JE. A Review of hormone-based therapies to treat adult acne vulgaris in women. Int J Womens Dermatol. 2017;3(1):44-52. doi:10.1016/j.ijwd.2017.02.018

By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.

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