Altavera 28 Day Side Effects: What to Expect and When to Call Your Doctor

Starting a new birth control pill comes with questions — especially about side effects. Altavera 28 Day is a well-studied combination oral contraceptive, and most people tolerate it well. But like all medications, it can cause side effects. This guide explains what's common and usually harmless, what's serious and needs prompt attention, and when you should stop taking Altavera and call your doctor.

The Boxed Warning: Smoking and Cardiovascular Risk

Altavera carries a boxed warning — the FDA's most serious warning level. Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive use, including heart attack, blood clots, and stroke. This risk increases with age (especially in women over 35) and the number of cigarettes smoked. Altavera is contraindicated in women who are over 35 years old and smoke.

Common Side Effects (Usually Mild and Temporary)

Most side effects of Altavera occur during the first 1–3 months as your body adjusts to the hormones and often resolve on their own. Common side effects include:

Nausea or stomach upset — most common in the first few months; taking Altavera with food or at bedtime often helps

Breakthrough bleeding or spotting — light bleeding between periods; common in the first 3 months and usually resolves

Breast tenderness or mild swelling — typically goes away after the first few cycles

Headaches — mild headaches are common early on; severe or migraines with aura should prompt a call to your doctor

Bloating or water retention — the estrogen component can cause mild fluid retention in some users

Mood changes — some users experience mood swings, increased anxiety, or depression; discuss with your provider if mood changes persist

Weight changes — often related to water retention rather than body fat increase; significant weight gain should be evaluated

Vaginal discharge or itching — hormonal changes can affect vaginal discharge; if accompanied by odor or itching, rule out infection

Decreased libido — changes in sex drive are reported by some users; talk to your provider if this is bothersome

Serious Side Effects — Call Your Doctor or Seek Emergency Care

While rare, Altavera can cause serious side effects that require immediate medical attention. Seek emergency care immediately (call 911) if you experience:

Signs of blood clot (DVT or PE): leg pain, swelling, or redness; sudden shortness of breath or chest pain; coughing up blood

Signs of stroke: sudden numbness or weakness in face/arm/leg on one side; slurred speech; blurred vision; sudden severe headache

Signs of heart attack: chest pain, tightening, or pressure; sweating; nausea; dizziness

Severe abdominal pain — may indicate liver problems or other serious conditions

Yellowing of skin or eyes (jaundice) — may indicate liver dysfunction; stop Altavera and contact your doctor

Severe allergic reaction: hives, facial swelling, difficulty breathing (rare but requires emergency care)

New onset migraines with aura — migraines with visual disturbances while on COCs significantly increase stroke risk; contact your prescriber

Blood Clot Risk: What the Numbers Say

Combination oral contraceptives like Altavera do increase the relative risk of blood clots compared to non-users. The estimated incidence of deep-vein thrombosis (DVT) in users of low-dose COCs (< 50 mcg ethinyl estradiol) is up to 4 per 10,000 woman-years, compared to 0.5–3 per 10,000 for non-users. This risk is real but still quite small for most healthy, non-smoking women under 35. Your prescriber will help you assess your personal risk before starting Altavera.

Side Effects vs. Signs of Pregnancy

Some side effects of Altavera (nausea, breast tenderness, fatigue) can mimic early pregnancy symptoms. If you miss a period while taking Altavera and you have missed pills, take a pregnancy test and contact your provider. If you have taken your pills correctly, missing a period alone is not a cause for alarm.

See our related posts on Altavera drug interactions and what is Altavera 28 Day for more information.