1 May 2026Oral drugsSource update: October 2021
Ethinylestradiol/Levonorgestrel oral
Combined oral contraceptive guidance for contraception and functional uterine bleeding, with missed-pill and thromboembolic risk precautions.
Prescription under medical supervision
This guide page is for structured reference only and does not replace a clinician, pharmacist, or emergency review. Dose choice, route choice, interactions, and safety decisions still need professional judgment.
Therapeutic action
Combined hormonal contraceptive, oestrogen-progestogen.
Indications
- Oral contraception.
- Abnormal uterine bleeding, especially functional uterine bleeding unrelated to pregnancy.
- Persistent abnormal uterine bleeding despite tranexamic acid therapy or heavy bleeding when tranexamic acid is contraindicated.
- Long-term treatment of functional uterine bleeding.
Forms and strengths
- 28-day pack: 21 active tablets of 0.03 mg (30 micrograms) ethinylestradiol plus 0.15 mg (150 micrograms) levonorgestrel and 7 inactive tablets containing ferrous salts.
Dose and duration
Oral contraception
- Adolescent and adult: one tablet daily, preferably at the same time each day, on a continuous basis, including during menstruation.
- Contraception may be started at any moment of the cycle if it is reasonably certain the woman is not pregnant, including when switching from another form of contraception.
- Contraception is effective as of the 8th tablet.
- Use condoms for the first 7 days if tablets are started more than 5 days after menstruation began, more than 28 days postpartum if not breastfeeding, or more than 7 days after an abortion.
- If one or two active tablets are missed, take one tablet as soon as possible and then continue treatment as usual. Two tablets can be taken at the same time.
- If 3 or more successive active tablets are missed, take one tablet as soon as possible, continue treatment as usual, and use condoms for the next 7 days.
- If tablets are missed during the 1st week and intercourse occurred in the preceding 5 days, use emergency contraception.
- If tablets are missed during the 3rd week, finish all active tablets and start a new pack the next day without taking inactive tablets. If this is not possible, use condoms for the next 7 days.
- Continue treatment as long as this method of contraception is desired and well tolerated.
Persistent abnormal uterine bleeding
- Adolescent and adult: one tablet 3 times daily for 7 days.
Long-term treatment of functional uterine bleeding
- Adolescent and adult: one tablet daily, as for contraception. Continue according to clinical response.
Contra-indications, adverse effects, precautions
- Do not administer to women with breast cancer, hypertension, uncontrolled or complicated diabetes, thromboembolic history, coronary insufficiency, valvular disease, stroke, severe or recent hepatic disease, migraine with neurological signs, renal impairment, hyperlipidaemia, or women smokers over age 35.
- May cause reduced menstrual flow, nausea, weight gain, breast tenderness, mood changes, acne, and headache.
- Rare severe adverse effects requiring discontinuation include hypertension, cardiovascular and thromboembolic disorders, jaundice, migraine, and visual disturbances.
- Enzyme-inducing drugs such as rifampicin, rifabutin, efavirenz, nevirapine, lopinavir, ritonavir, phenobarbital, phenytoin, carbamazepine, and griseofulvin reduce contraceptive effectiveness.
- Clinical examinations should be carried out before and during treatment, especially blood pressure and breast examination.
- Pregnancy: contraindicated.
- Breast-feeding: contraindicated before 6 weeks postpartum; not recommended between 6 weeks and 6 months except if it is the only acceptable method; no contra-indication after 6 months.
Source
MSF Essential drugs practical guidelines (January 2026)
This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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