Combined oral contraceptive (2nd-generation progestogen — first-line) Pregnancy: Not indicated in pregnancy — if the woman becomes pregnant while using this medicine, further intake must be stopped immediately. Most epidemiological studies have revealed neither an increased risk of birth defects in children born to women taking contraceptive pills before pregnancy nor teratogenic effects with unintentional intake in early pregnancy. Consider the increased risk of VTE in the postpartum period when re-starting. Use during lactation may reduce the volume of milk produced and change its composition; minute amounts of the active substances are excreted in milk and may affect the child, particularly in the first 6 weeks post-partum — breast-feeding mothers may be advised to use another method of contraception.

Ethinylestradiol with levonorgestrel

Brand names: Microgynon 30, Levest, Rigevidon, Logynon

A combined oral contraceptive of ethinylestradiol with levonorgestrel, a second-generation progestogen and one of the most widely used first-line combined pills.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1 tablet daily for 21 days (Levest 150/30 microgram coated tablets)

Route: Oral — tablets must be taken in the order directed on the blister package at about the same time every day, with some liquid if necessary

Frequency: First treatment cycle — 1 tablet daily for 21 days, starting on the first day of the menstrual cycle (contraceptive protection begins immediately). Subsequent cycles — tablet-taking from the next pack is continued after a 7-day tablet-free interval, beginning on the same day of the week as the first pack; a withdrawal bleed usually occurs during the tablet-free interval

SWITCHING — from a 21-day combined oral contraceptive: take the first tablet on the first day immediately after the end of the previous course; no additional precautions required. From a combined Every Day (28-day) pill: start after the last active tablet of the Every Day pack, taking the first tablet the next day; no additional precautions required. From a progestogen-only pill: take the first tablet on the first day of bleeding, even if a POP has already been taken that day; no additional precautions required, and discard the remaining progestogen-only pills. POST-PARTUM AND POST-ABORTUM — after pregnancy, oral contraception can be started 21 days after a vaginal delivery provided the patient is fully ambulant and there are no puerperal complications, with additional contraceptive precautions for the first 7 days of tablet taking; because the first post-partum ovulation may precede the first bleeding, another method should be used between childbirth and the first course of tablets. After a first-trimester abortion, oral contraception may be started immediately with no additional precautions. MISSED/DELAYED TABLET — a single delayed tablet should be taken as soon as possible; if within 12 hours of the correct time, contraceptive protection is maintained. With longer delays additional contraception is needed: take only the most recently delayed tablet (omit earlier missed tablets) and use additional non-hormonal contraception (not the rhythm or temperature methods) for the next 7 days while the next 7 tablets are taken. If tablet(s) were missed during the last 7 days of a pack, there should be no break before the next pack is started, and a withdrawal bleed should not be expected until the end of the second pack; some breakthrough bleeding on tablet-taking days is not clinically significant. If there is no withdrawal bleed in the tablet-free interval after the second pack, exclude pregnancy before starting the next pack. GASTRO-INTESTINAL UPSET — vomiting or diarrhoea may reduce efficacy by preventing full absorption. If it occurs within 4 hours of a tablet, continue tablet-taking from the current pack and use additional non-hormonal contraception (not rhythm or temperature methods) during the upset and for 7 days afterwards; if those 7 days overrun the end of a pack, start the next pack without a break and do not expect a withdrawal bleed until the end of the second pack (exclude pregnancy if none occurs). Consider other contraceptive methods if the gastro-intestinal disorder is likely to be prolonged. SPECIAL POPULATIONS — Children: not applicable. Elderly: not applicable.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Presence or risk of venous thromboembolism — current VTE (on anticoagulants) or history of DVT/PE; known hereditary or acquired predisposition (APC-resistance including Factor V Leiden, antithrombin-III deficiency, protein C deficiency, protein S deficiency); major surgery with prolonged immobilisation; high risk of VTE due to multiple risk factors
Presence or risk of arterial thromboembolism — current or previous ATE (e.g. myocardial infarction) or prodromal condition (e.g. angina pectoris); cerebrovascular disease (current or previous stroke, or TIA); known hereditary or acquired predisposition (hyperhomocysteinaemia, antiphospholipid antibodies); history of migraine with focal neurological symptoms; high risk of ATE due to multiple risk factors or one serious risk factor such as diabetes mellitus with vascular symptoms, severe hypertension or severe dyslipoproteinaemia
Presence or history of severe hepatic disease, e.g. active viral hepatitis and severe cirrhosis, as long as liver function values have not returned to normal
Presence or history of liver tumours (benign or malignant)
Current or history of breast cancer
Hypersensitivity to the active substance(s) or to any of the excipients
Concomitant use with medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir, glecaprevir/pibrentasvir, or sofosbuvir/velpatasvir/voxilaprevir

Side effects

Nausea and abdominal pain (common); vomiting, diarrhoea (uncommon)
Headache (common); migraine (uncommon)
Depressed mood, mood altered (common); libido decreased (uncommon), libido increased (rare)
Breast tenderness, breast pain (common); breast hypertrophy (uncommon); breast discharge, vaginal discharge (rare); reduced menstrual flow, spotting, breakthrough bleeding, missed withdrawal bleeding, post-pill amenorrhoea (post-marketing)
Weight increased (common), weight decreased (uncommon); fluid retention (common)
Venous thromboembolism (VTE) and arterial thromboembolism (ATE) — the serious adverse reactions; increased risk of arterial and venous thrombotic and thromboembolic events including myocardial infarction, stroke, transient ischaemic attack, venous thrombosis and pulmonary embolism

Interactions

Medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir, glecaprevir/pibrentasvir, or sofosbuvir/velpatasvir/voxilaprevir — concomitant use is contraindicated (stated in SPC §4.3 cross-referring to §4.5; the full §4.5 interaction section was not captured in this bundle — clinician to review it)

Clinical monograph

How it works

The combination inhibits ovulation through hypothalamic-pituitary suppression and additionally thickens cervical mucus and modifies the endometrium to impair sperm penetration and implantation.

Prescribing in practice

Although all combined pills carry VTE risk, levonorgestrel-containing preparations have one of the lowest VTE risks and are recommended first-line, but UKMEC contraindications still apply.
Assess for migraine with aura, cardiovascular risk factors and personal or family history of thrombosis before prescribing.
Advise on missed-pill rules and reduced efficacy with enzyme inducers or significant vomiting or diarrhoea.

Monitoring

Check blood pressure and reassess cardiovascular and VTE risk at initiation and at periodic review.

Counselling the patient

Take at the same time each day and follow missed-pill instructions.
The pill does not protect against sexually transmitted infections.
Seek urgent help for leg swelling, chest pain, breathlessness or sudden severe headache.

Evidence & guidelines

MHRA and UKMEC identify levonorgestrel-containing combined pills as carrying among the lowest VTE risk, supporting first-line use.

Reference: FSRH CHC guideline; UKMEC; MHRA Drug Safety Update; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways