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Combined oral contraceptive (quadriphasic, estradiol-based)

Dienogest with estradiol valerate

Brand names: Qlaira

A combined oral contraceptive pairing the progestogen dienogest with the natural oestrogen estradiol valerate, used for contraception and, in some countries, for managing heavy menstrual bleeding.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Suppresses ovulation through inhibition of gonadotrophin release, while dienogest also exerts an antiandrogenic effect and thins the endometrium; estradiol valerate provides cycle control.

Prescribing in practice

  • Avoid in women with a personal history of venous or arterial thromboembolism, known thrombogenic mutations, or other UKMEC category 4 conditions for combined hormonal contraception.
  • Assess cardiovascular risk factors (smoking, age, BMI, blood pressure, migraine with aura) before starting and at review.
  • Enzyme-inducing drugs and some antiretrovirals reduce contraceptive efficacy; check interactions before co-prescribing.

Monitoring

Review blood pressure and reassess thrombotic and cardiovascular risk factors at follow-up and periodically thereafter.

Counselling the patient

  • Seek urgent advice for calf swelling, chest pain, breathlessness, severe headache or sudden visual or speech disturbance.
  • Take tablets in the correct order following the supplied schedule, and use the missed-pill instructions if a dose is delayed.
  • This method does not protect against sexually transmitted infections.

Evidence & guidelines

Combined hormonal contraceptives are addressed by FSRH and MHRA guidance, which sets out the recognised venous thromboembolism and cardiovascular risk considerations.

Reference: FSRH CHC guideline; UKMEC; NICE NG88 HMB; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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