Nikki birth control: uses, side effects, and interactions

When it comes to birth control pills, the options seem endless. If you’re having trouble deciding, your best bet is to look at a few key things to decide which type is right for you. Nikki is one kind of birth control pill that can be used to prevent pregnancy, but it can also be used to treat premenstrual dysphoric disorder (PMDD) and moderate acne.

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Nikki birth control is what’s known as a combined oral contraceptive, which means that it contains both progesterone and estrogen (rather than just progesterone alone). These hormones work together to prevent pregnancy by changing your cervical mucus (which is the fluid at the entrance to your uterus) to prevent sperm from getting through and fertilizing an egg. The pills can also prevent ovulation, or the release of an egg from your ovaries in the first place (Lupin, 2020). 

While progestin alone is actually enough to prevent pregnancy, the added estrogen can help prevent breakthrough bleeding, which is when you bleed in between periods (Palacios, 2019).

Each Nikki pill pack comes with 28 tablets: 24 pink ones and four that are off-white. The pink tablets contain hormones and the off-white ones are placebo pills. 

Placebo pills don't have any medication in them and serve as a sort of a placeholder pill during your monthly period (Lupin, 2020). You don't have to take the placebo pills if you don't want to, but they can help keep you in the habit of taking your medication at the same time every day. 

Common side effects reported with Nikki include (Lupin, 2020): 

• Headache 

• Nausea or vomiting 

• Breast tenderness

• Bloating

• Weight gain 

• Mood swings

• Lower sex drive 

Nikki contains hormones that affect your menstrual cycle, so be prepared for a change in vaginal bleeding. Most commonly, this type of birth control causes shorter, lighter periods but for some people, it can cause periods that are longer than usual, or cause spotting between periods (Lupin, 2020). 

The good news is side effects usually get better with time and your cycle should become more regular. If your side effects don't improve or prevent you from taking your medication every day, follow up with a healthcare provider about alternative options (Grossman, 2010).

In rare cases, medications like Nikki that contain estrogen can have serious side effects. 

Estrogen increases the risk of heart attack, stroke, or blood clots. When a blood clot forms in one of your blood vessels, it can block blood flow to part of your body. Blood clots can be painful or you may not feel them at all, but they are dangerous and can be life-threatening (Lupin, 2020). 

Yaz, and a similar medication Yasmin, have been the subject of lawsuits regarding the risk of blood clots. While all estrogen-containing contraceptives carry this risk, some healthcare professionals suggest the risk is even higher with birth control pills containing both drospirenone (the type of progesterone in Nikki) and ethinyl estradiol. The U.S. Food and Drug Administration (FDA) looked into the issue and didn't find conclusive evidence that the risk was higher with this combined oral contraceptive than with others (FDA, 2018). 

Who should use caution or avoid taking Nikki?

Certain factors can increase your risk of blood clots if you’re taking estrogen-containing oral contraceptives, including (Lupin, 2020): 

• Smoking 

• Obesity  

• Having a history of blood clots or heart conditions 

• Uncontrolled high blood pressure

• Migraines

Your healthcare provider may recommend an alternative form of contraception if you're at a higher risk of experiencing serious side effects.

Everyone should monitor themselves for signs of a blood clot, especially right after starting the medication when the risk is the highest (Lupin, 2020). Seek medical help right away if you have persistent leg pain or severe chest pain. Other signs of a blood clot include sudden shortness of breath, blindness, or a severe headache that doesn't feel like a normal headache.

For safety reasons, do not take Nikki if you have poor kidney function, adrenal problems, liver disease, or breast cancer. Those who are breastfeeding or taking medications for hepatitis C should seek medical advice before taking Nikki (Lupin, 2020).  

Nikki birth control can also be prescribed to treat a condition called premenstrual dysphoric disorder (PMDD) as well as moderate acne.

PMDD is a severe form of premenstrual syndrome (PMS), where the physical and mood changes that happen right before your period are significant enough to disrupt your daily life (Mishra, 2020).

Hormonal birth control pills are usually the best option for treating these conditions if you’re also interested in avoiding pregnancy but aren’t usually prescribed as the first-line treatment if you’re not (Lupin, 2020). 

Nikki can be used off-label for the treatment of polycystic ovarian syndrome (PCOS)—a hormonal condition that causes problems with ovulation and leads to a hormone imbalance. While birth control isn’t the right option for everyone with PCOS, it can help people who are not looking to get pregnant immediately. PCOS can cause irregular periods, infertility, acne, excess facial hair, obesity, and increase the risk of heart conditions and diabetes. Many birth control pills are used to treat PCOS, however, some healthcare providers prefer contraceptives like Nikki which contain a form of progesterone known as drospirenone. That’s because it resembles our body's natural progesterone, allowing the medication to counteract the effects of other hormones in the body thought to contribute to PCOS (Mathur, 2008). 

Some oral contraceptives can also be used to treat acne and reduce excess facial hair growth commonly seen with PCOS (Podfigurna, 2020). A small study found that people with PCOS who took drospirenone and ethinyl estradiol tablets daily experienced better hormonal control and significant weight loss after three months of taking the medication (Li, 2020). 

When taken as directed, Nikki birth control is very effective at preventing pregnancy. However, it won’t protect against HIV and other sexually transmitted infections. In general, birth control pills are more than 99% effective at preventing pregnancy with perfect use, and 93% effective with typical use (Trussell, 2011). 

In terms of its effectiveness in the treatment of PMDD, clinical trials have shown that people who use Nikki have significant improvements in PMDD symptoms, such as negative emotions, food cravings, and bloating compared to placebo (Marr, 2011). 

For the treatment of acne, people who used Nikki once a day saw a 40% reduction in acne lesions. After six months, about 15—20% of Nikki users had clear or almost clear skin (Kolton, 2011). 

Aiming for 100% adherence is the best way to ensure Nikki works. Remembering to take your medication every day can be challenging, but there are tools that can help like smartphone apps, alarms, and leaving your pill pack somewhere you'll see it every day. 

Even with alarms and backup reminders, missed or late doses happen. If you forget to take one of your active (pink) pills, take it as soon as you remember. Then take your next pill at your regularly scheduled time. This might mean you take two pills on the same day, and that's okay. Just know you might experience more side effects when you take two doses close to each other. 

If you miss more than one pill, refer to your package insert for directions. You may need to use a backup birth control method for the next week. If you forget any of your white placebo pills, don’t worry about it. They don’t contain any active medication and missing one won’t affect your chance of becoming pregnant. Throw the ones you missed away and take your next placebo pill at your normal time (Lupin, 2020). 

There are certain drugs and supplements that can interact with birth control pills and lower their efficacy. Common interactions include certain antibiotics, St. John's wort, and certain anti-seizure medications (Lupin, 2020). 

Another type of drug interaction can lead to high potassium levels, which can be serious. Medications that can interact and raise your risk of high potassium include (NIH, 2020): 

• High blood pressure medications including ACE inhibitors and angiotensin blockers

• Certain diuretics (water pills)

• Potassium supplements 

There are many more potential drug interactions with Nikki, so make sure to talk to a healthcare provider or pharmacist about any medications or supplements you are taking before starting any new medication. 

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Current version

July 16, 2021

Written by

Hope Chang, PharmD

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.