Estral-D Tablet 21's belongs to the group of combined oral contraceptives. It is a hormonal combination that contains both female reproductive hormones oestrogen and progestin. It is used as a means of birth control in women who wish to prevent unwanted pregnancy. It is also used in the treatment of irregular menstrual cycles. It also finds use in the treatment of moderate to severe acne. A combined oral contraceptive (COCP) is nothing but a birth-control pill, colloquially referred to as the ‘’pill,’’ and it is used as a means of oral birth control by women. Menorrhagia is heavy menstrual bleeding lasting longer than seven days, whereas dysmenorrhea is painful periods. Acne vulgaris is a skin condition characterized by pimples, blackheads and whiteheads on the skin of the face.
Estral-D Tablet 21's is composed of ‘’Ethinyl estradiol and Dienogest.’’ It is essentially an ovulation inhibitor, which inhibits the release of potent eggs from the ovary, thereby preventing pregnancy. It also changes the cervical (cervix is the connection between the uterus and vagina) ambience, making cervical secretions thicker and hostile to any incoming sperm. Hence, it is a very potent contraceptive. In addition, the dienogest component inhibits gonadotropin (sex hormone) production and also suppresses the growth of uterine cells. Therefore, Estral-D Tablet 21's helps prevent pregnancy. 
In some cases, Estral-D Tablet 21's may cause certain common side effects such as nausea, breast soreness, headache and irregular periods. Most of these side effects do not require medical attention and will resolve gradually over time. However, you are advised to talk to your doctor if you experience these side effects consistently.
 If you are allergic to Estral-D Tablet 21's or any of its components, please inform the doctor before using Estral-D Tablet 21's. Keep the doctor informed if you are on treatment for any cardiovascular disease, mental health disorder, liver disease, gallbladder disease or breast/uterine/cervical cancer. Before taking Estral-D Tablet 21's, inform your doctor of your entire medical and surgical history. Please consult your doctor before taking Estral-D Tablet 21's during pregnancy or if you are breastfeeding. Do not consume Estral-D Tablet 21's with alcohol. 

Estral-D Tablet 21's is a combined oral contraceptive and birth control pill. It contains Ethinyl estradiol and Dienogest. Estral-D Tablet 21's is used to prevent pregnancy by suppressing ovulation and changing the consistency of cervical secretions. In patients suffering from menorrhagia, Estral-D Tablet 21's reduces the intensity and duration of menstrual bleeding. It also relieves pain during periods (dysmenorrhea). Estral-D Tablet 21's reduces hair and skin greasiness, providing relief to blackhead/whitehead and acne-prone skin. 

• Headache
• Nausea and vomiting
• Irregular menstrual cycles
• Cramps 
• Abdominal bloating
• Breast tenderness
• Hypertension

Estral-D Tablet 21's is not recommended for use in women over 35 who smoke. Estral-D Tablet 21's should not be used in case of any known allergy to either of the components. Estral-D Tablet 21's is not advisable for use in case of high risk or previous history of any mental health disorders, arterial or thrombotic disorders, cardiovascular health disorders, liver disease, gallbladder disease, history of breast/uterine/cervical cancer or any hormone-sensitive cancer. Women with a history of angioedema should exercise caution while taking $drug as it may worsen the angioedema. Please consult the doctor before using Estral-D Tablet 21's during pregnancy or breastfeeding. It is advisable not to consume Estral-D Tablet 21's with alcohol. Inform the doctor right away if you notice any dark urine, yellowing of the eyes/skin, severe mood changes or any sudden heavy bleeding. Women with a tendency for chloasma/melasma (skin condition commonly seen in middle-aged women) should avoid sun exposure after taking Estral-D Tablet 21's.

Drug-Drug Interactions:  Estral-D Tablet 21's is known to interact with antiepileptics (carbamazepine, phenytoin, felbamate, topiramate), antidepressant (St. John’s wort) and antibiotics (rifampicin, rifabutin), anti-fungal (griseofulvin) and anti-HIV drugs (nelfinavir, ritonavir). 

Drug-Food Interactions: Grapefruit juice may interfere with the absorption of Estral-D Tablet 21's. Proceed with caution.

Drug-Disease Interactions: Estral-D Tablet 21's may interact with blood clotting disorders, hypertension, breast disorders, cancer, depression, diabetes, angioedema, heart problems, cardiovascular disease, kidney disease, liver disease, stroke, unexplained vaginal bleeding and or thyroid issues.

• RIFAMPICIN
• CARBAMAZEPINE
• PHENYTOIN
• RIFABUTIN
• GRISEOFULVIN
• RITONAVIR
• NELFINAVIR
• FELBAMATE
• TOPIRAMATE

• As nausea and vomiting may occur with the use of Estral-D Tablet 21's, make sure to take it on light, small meals. 
• Let your doctor know if you are planning to get pregnant. 
• After starting Estral-D Tablet 21's, use another alternative non-hormonal contraceptive for at least ten days.
• Maintaining a healthy weight can go a long way in promoting healthy female reproductive health. Make sure you exercise for at least 30 minutes every day. However, do not engage in very strenuous physical exercise as this can worsen bleeding. 
• Regularly working night shifts can affect hormone production. Try to avoid night shifts. 
• Maintain good sexual hygiene and prevent any sexually transmitted diseases by practising only safe sex.
• Limit your intake of caffeine and alcohol. 
• Avoid smoking. 
• Avoid grapefruit juice while taking Estral-D Tablet 21's as this may interact with Estral-D Tablet 21's and affect its absorption. 
• Increase your intake of red vegetables, fruits, dry fruits, spinach, nuts and beans as these help in new blood formation. 
• Keeping your skin hydrated by drinking enough water can also do wonders for the overall quality of your skin. 
• Always wash your makeup before sleeping. Never go to bed with makeup on.
• Exfoliate your skin lightly but regularly. This helps wash away dry and dead cells, cleansing the skin. 
• Severe nausea or vomiting following the use of the tablet can be considered a missed dose. In this case, additional contraceptive measures are advised. 

• Do not skip tablets or delay intake by more than 12 hours. In case of a missed dose, try to catch up as early as possible. However, if the time for the second dose has come too close, revert to your original schedule. 
• Chart your menstrual cycle and take Estral-D Tablet 21's on Day 1 of your cycle, i.e. Day 1 of your period. 
• Use a condom or any non-hormonal contraceptive for the first ten days after starting Estral-D Tablet 21's.
• Please inform the doctor immediately if you notice any breast lump, dark urine, yellowing of the skin, mood changes, headache, palpitations, severe fatigue or any alarming changes in vaginal bleeding. 
• Call for the doctor right away in case of any stroke symptoms such as breathlessness, confusion, dizziness, left arm pain, jaw pain or sudden vision changes or any pulmonary embolism symptoms such as cough, leg pain and warmth, pain in calf etc.

Oral Contraception: It is birth control taken by mouth by women to prevent pregnancy. It is commonly referred to as the ‘’pill’’. Oral contraceptives contain hormonal preparations of female sex hormones for birth control. 

Menorrhagia: Severe loss of blood during a period lasting more than seven days is called menorrhagia. It is a form of dysfunctional uterine bleeding. Common signs and symptoms include having to use two pads at once, frequent spotting of clothes, blood clots the size of a coin or larger, having to change pads during the night, soakiness of pads and spillage. 

Dysmenorrhoea: Abdominal and uterine pain during periods is referred to as dysmenorrhea. This includes abdominal cramps and pelvic pain during periods. It can be caused by a variety of disorders ranging from more organic diseases such as endometriosis, fibroids and cysts, to psychological conditions such as pre-menstrual dysmorphic disorder. However, in most cases, cramps are common and are a usual symptom of pre-menstrual syndrome. 

Acne vulgaris: Acne is a skin condition in which pores get blocked or clogged, leading to the appearance of whiteheads, blackheads, pimples and greasy skin. It is caused by a bacterium called Propionibacterium acnes. In advanced stages, it can even cause a nose deformity called rhinophyma.