What to Know About Junel 1/20 21 Day Side Effects

Starting a new birth control pill often comes with questions — especially about side effects. If you've been prescribed Junel 1/20 21 Day, knowing what to expect can help you feel more prepared and less anxious about changes your body might go through.

Most side effects of Junel 1/20 21 Day are mild and tend to improve within the first two to three months. But there are some serious warning signs you should never ignore. This guide covers both, so you'll know exactly when something is normal and when it's time to call your doctor.

What Is Junel 1/20 21 Day?

Junel 1/20 21 Day is a combined oral contraceptive that contains two hormones: Norethindrone Acetate 1 mg (a progestin) and Ethinyl Estradiol 20 mcg (an estrogen). It's manufactured by Teva Pharmaceuticals and is primarily used to prevent pregnancy.

The "1/20" refers to the hormone doses, and "21 Day" means the pack contains 21 active pills — you take one daily for 21 days, then take no pills for 7 days before starting a new pack. For a complete overview, see What Is Junel 1/20 21 Day?

Common Side Effects

The following side effects are reported frequently with combined oral contraceptives like Junel 1/20 21 Day. They are generally not dangerous and often improve as your body adjusts to the hormones:

• Nausea: One of the most common early side effects. Taking your pill with food or at bedtime can help.
• Breakthrough bleeding or spotting: Light bleeding between periods is common in the first 1–3 months. It usually resolves on its own.
• Breast tenderness: Mild soreness or swelling in the breasts is normal as your body adjusts.
• Headaches: Mild headaches may occur, especially in the first few weeks.
• Bloating or fluid retention: Some women notice mild bloating, particularly around the time of their period.
• Weight changes: Small fluctuations in weight (usually 1–3 pounds from fluid retention) are possible but significant weight gain is uncommon.
• Mood changes: Some women report feeling more emotional, irritable, or anxious. These symptoms often stabilize after 2–3 months.
• Decreased libido: A reduction in sex drive is reported by some users of combined oral contraceptives.
• Acne: While some birth control pills improve acne, hormonal changes can temporarily worsen it for some users.
• Vomiting: Less common than nausea, but can occur — especially if taken on an empty stomach.

Most of these side effects are temporary. If any persist beyond three months or significantly affect your daily life, talk to your doctor about adjusting your treatment.

Serious Side Effects — When to Call Your Doctor

While rare, Junel 1/20 21 Day can cause serious side effects that require immediate medical attention. Call your doctor or go to the emergency room right away if you experience any of the following:

Blood Clots

Combined oral contraceptives increase the risk of blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Watch for:

• Sudden swelling, pain, or warmth in one leg
• Shortness of breath or difficulty breathing
• Sharp chest pain, especially with deep breaths
• Coughing up blood

Stroke

Seek emergency care if you notice:

• Sudden severe headache unlike any you've had before
• Sudden weakness or numbness on one side of the body
• Difficulty speaking or understanding speech
• Vision changes in one or both eyes

Heart Attack

Warning signs include:

• Chest pain or pressure
• Pain radiating to the arm, jaw, or back
• Shortness of breath, sweating, or nausea

Other Serious Warning Signs

• Severe abdominal pain: Could indicate liver problems or gallbladder disease
• Yellowing of the skin or eyes (jaundice): May signal liver damage
• Sudden vision changes or loss of vision: Could indicate retinal vein thrombosis
• Severe allergic reaction: Difficulty breathing, hives, swelling of face/throat

A helpful memory tool is ACHES:

• A — Abdominal pain (severe)
• C — Chest pain or shortness of breath
• H — Headache (severe, sudden, or unusual)
• E — Eye problems (blurred vision, vision loss)
• S — Severe leg pain or swelling

Important Boxed Warning: Smoking

Junel 1/20 21 Day carries an FDA boxed warning — the most serious type of safety alert — about smoking:

Cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive use. This risk increases with age and with the number of cigarettes smoked per day. Women who use oral contraceptives should be strongly advised not to smoke. Women over 35 who smoke should not use Junel 1/20 21 Day or any combined oral contraceptive.

Specific Populations

Pregnancy

Junel 1/20 21 Day is Category X — it should not be taken during pregnancy. If you think you might be pregnant, stop taking the pill and contact your doctor.

Breastfeeding

Combined oral contraceptives are generally not recommended during breastfeeding, especially in the early postpartum period. The estrogen component may reduce milk production. Talk to your doctor about progestin-only options if you're breastfeeding.

Women Over 35

The risk of serious cardiovascular side effects increases with age. Women over 35 — especially those who smoke — should discuss alternative contraceptive methods with their provider.

Teens

Junel 1/20 21 Day is safe and effective for use after menarche (first period). Adolescent medicine specialists and pediatricians commonly prescribe it for teens.

How to Manage Common Side Effects

Here are practical tips for dealing with the most common side effects:

• For nausea: Take your pill with food or right before bed. If nausea is severe, your doctor may suggest switching to a different formulation.
• For spotting: Be patient — this usually resolves within 3 months. Take your pill at the same time every day, as inconsistent timing can worsen spotting.
• For headaches: Over-the-counter pain relievers like Acetaminophen or Ibuprofen can help. If headaches become severe or are accompanied by vision changes, contact your doctor immediately.
• For bloating: Reducing sodium intake and staying hydrated can help minimize fluid retention.
• For mood changes: Track your mood for 2–3 months. If changes are significant or you experience symptoms of depression, talk to your doctor about alternative options.
• For decreased libido: This can be a frustrating side effect. If it persists, your doctor may recommend switching to a pill with a different progestin type.

If side effects are making your current pill intolerable, your doctor may suggest switching to a different brand or formulation. See our guide on alternatives to Junel 1/20 21 Day for options.

When to Talk to Your Doctor

Contact your healthcare provider if:

• Common side effects don't improve after 3 months
• You experience any ACHES warning signs
• You develop new or worsening migraines
• You need to have surgery or will be immobilized for a long period
• Side effects are significantly affecting your quality of life

Don't stop taking your birth control without talking to your doctor first — sudden discontinuation without a backup method puts you at risk of unintended pregnancy.

Final Thoughts

Junel 1/20 21 Day is a well-established birth control pill used by millions of women. Most side effects are mild and temporary, resolving within the first few months of use. The key is knowing the difference between normal adjustment symptoms and serious warning signs that need immediate attention.

If you're currently taking Junel 1/20 21 Day and having trouble finding it at your pharmacy, Medfinder can help you locate a pharmacy with it in stock near you.

For more information about this medication, explore our related guides:

• What Is Junel 1/20 21 Day?
• Junel 1/20 21 Day Drug Interactions
• How Does Junel 1/20 21 Day Work?