Alesse (Levonorgestrel / Ethinyl estradiol) — Patient Information

Alesse is a combined oral contraceptive pill containing two female hormones: levonorgestrel (a progestogen) and ethinyl estradiol (an oestrogen). It is used to prevent pregnancy and may also help make bleeding more regular for some people.

This guide explains how Alesse works, how to take it, what to expect, and important safety information. It is written for people in the United Kingdom and highlights practical considerations such as missed pills, interactions, and when to seek advice.

Basic product information

How Alesse works (mechanism of action)

Alesse prevents pregnancy mainly by combining several effects:

• Stops ovulation: the hormones suppress the monthly release of an egg.
• Thickens cervical mucus: this makes it harder for sperm to reach an egg.
• Alters the uterine lining: the environment becomes less suitable for implantation.

Because it works through hormonal suppression, it is most reliable when taken correctly every day. Even a short lapse or missed doses can reduce effectiveness.

Pharmacokinetics (how the body handles the hormones)

“Pharmacokinetics” describes absorption, distribution, metabolism, and excretion. While individual variation occurs, the key points for combined oral contraceptives are:

• Absorption: both hormones are absorbed through the gut after taking the tablet by mouth.
• Distribution: hormones circulate in the bloodstream and bind to carrier proteins.
• Metabolism: both levonorgestrel and ethinyl estradiol are metabolised primarily in the liver.
• Elimination: metabolites are removed from the body mostly via urine and bile/faeces.

Practical implication: certain medicines can speed up liver enzymes (especially some anticonvulsants, antibiotics like rifampicin/rifabutin, and some antivirals), which may lower contraceptive effectiveness.

Typical use and who it’s for

Alesse is used for:

• Preventing pregnancy in people who can safely use combined oral contraception.
• Regularising bleeding for some people after an initial adjustment period.

Combined pills may not be suitable for everyone. They are generally not recommended if you have certain health conditions (for example, some types of blood clot history, uncontrolled high blood pressure, or migraine with specific features).

When and how to start (timing)

Timing affects how quickly Alesse protects against pregnancy. The safest approach is to follow the instructions supplied with your pack and any advice from a healthcare professional or pharmacist. General guidance includes:

Starting options

• Start on day 1 of your period (day 1 = first day of bleeding): protection is usually immediate, and no extra contraception is required.
• Start between days 2 and 5 of your period: protection may not be immediate; consider using additional contraception for a short period (often 7 days) depending on local guidance and pack instructions.
• Start at other times: you may need backup contraception (often 7 days) and, in some cases, a pregnancy test may be advised if there is any doubt.

If you are switching from another contraceptive method, the right “start day” depends on what you used before. If you are unsure, ask a pharmacist for method-specific advice.

Dosing: how to take Alesse

Usual dose: one tablet by mouth each day, at about the same time. Many people find taking it with breakfast or at bedtime helps them remember.

21 active pills + break/placebo

Alesse packs typically follow a cycle such as: 21 days of active tablets followed by 7 days without active hormones (a break or placebo tablets, depending on the specific pack). Withdrawal bleeding usually occurs during the break.

Starting the next pack

• Start the next pack after 7 days whether bleeding has stopped or not.
• Do not extend the gap, as longer gaps can reduce contraceptive protection.

Missed doses and what to do

Missed pills are one of the most common reasons for unplanned pregnancy. Guidance depends on how many tablets are missed and where you are in the pack. Practical steps:

• Take the most recent missed tablet as soon as you remember.
• Continue the rest of the pack as normal.
• If you have missed tablets and are at risk (for example, after vomiting/diarrhoea or skipping active tablets), you may need extra contraception for a period and possibly emergency contraception.

Because recommendations vary by the number of missed active tablets and the stage of the cycle, check the patient leaflet for your exact pack, or speak to a pharmacist promptly. If you had unprotected sex in the days before missing pills, timely advice is important.

Vomiting or severe diarrhoea

If you vomit shortly after taking a tablet, it may not have been fully absorbed. As a practical rule, if vomiting occurs within a few hours of taking the pill, treat it similarly to a missed pill.

• Follow missed-pill guidance for the number of tablets potentially not absorbed.
• Use additional contraception until you have taken your tablets correctly for the recommended period.
• If diarrhoea is severe or lasts more than 24 hours, contraceptive effectiveness may be reduced—seek advice.

Food interactions

In general, Alesse can be taken with or without food. Food does not usually meaningfully affect absorption. However, if you have nausea or vomiting after taking your tablet, consistency is helpful and missed-pill rules may apply.

Alcohol and medicine interactions

Alcohol

Moderate alcohol use does not typically directly reduce contraceptive effectiveness. However, heavy drinking can indirectly increase risk by causing missed doses (for example, forgetting to take your pill).

• If alcohol makes it more likely you will miss a dose, consider setting an alarm or switching the time you take it.

Other medicines that can affect Alesse

Some medicines may reduce effectiveness by increasing the breakdown of ethinyl estradiol and/or levonorgestrel, or by affecting enterohepatic circulation. Examples include:

• Rifamycin antibiotics (e.g., rifampicin, rifabutin)
• Certain anti-seizure medicines (some enzyme-inducing antiepileptics)
• Some medicines for HIV or hepatitis C that affect liver enzymes
• St John’s wort (Hypericum perforatum)

If you start or stop any interacting medicine, ask a pharmacist about whether you need extra contraception and for how long. A common pattern is that you may require additional protection during treatment and for a short period after stopping the interacting medicine.

Medicines Alesse may interact with

Hormonal contraceptives can sometimes affect the levels of other drugs. In practice, the most relevant situation is with medicines where dose is sensitive to hormone-related changes. Always tell your pharmacist or prescriber what you take, including: herbal products, over-the-counter medicines, and supplements.

Indications (what Alesse is used for)

Alesse is indicated for:

• Contraception—to prevent pregnancy.
• Cycle control—for some users, it can lead to more predictable bleeding. This is not a substitute for treatment of underlying conditions.

Safety profile and important warnings

Like all combined oral contraceptives, Alesse can carry risks. Most people use the pill without serious complications, but it is important to be aware of warning signs and eligibility criteria.

Risk of blood clots (VTE)

Combined pills increase the risk of venous thromboembolism (VTE) compared with not using combined contraception. The absolute risk remains low in many healthy people, but it is higher in certain situations.

Seek urgent medical help if you develop signs of a clot

• Leg symptoms: swelling, pain, warmth, or redness in one leg
• Chest symptoms: sudden breathlessness, chest pain, coughing blood
• Stroke symptoms: sudden weakness or numbness on one side, trouble speaking, facial droop
• Eye symptoms: sudden vision changes

Arterial events and migraine

Combined pills may also be associated with a risk of arterial thrombotic events. Extra caution is needed if you have migraine—especially migraine with aura.

Smoking and age

If you smoke, risk may increase, particularly in older age groups. Consider discussing the safest method with a pharmacist or clinician.

Other safety considerations

• High blood pressure: may make combined pills unsuitable.
• Diabetes with complications or vascular disease: increased risk may apply.
• Severe liver disease: may be a contraindication.
• Breast cancer history: may require specialist advice.

Common side effects

Many side effects reduce after the first 2–3 months. Common effects include:

• nausea
• breast tenderness
• headache
• mood changes
• spotting or breakthrough bleeding, especially early on
• temporary changes in libido

Less common but important effects

• vaginal discharge changes
• skin changes such as melasma (dark patches), especially with sun exposure
• changes in weight can occur, though this varies by person

If you experience severe or persistent symptoms, or anything that worries you, seek advice.

Practical use tips for best effectiveness

• Choose a consistent time: set a daily alarm or link it to a routine (e.g., after brushing teeth).
• Keep track of your cycle: finishing active pills and starting the next pack on time helps maintain protection.
• Use a backup method when needed: if you miss tablets, vomit, have severe diarrhoea, or start interacting medicines.
• Store correctly: keep tablets in the original packaging, at room temperature, away from excess heat and moisture.
• Know your warning signs: blood clot symptoms and severe migraine signs should prompt urgent help.

Alternative options (if Alesse isn’t suitable or convenient)

Alesse is one option among many. Depending on your health profile, preference, and lifestyle, you may consider:

Other combined pills

• Different combined oral contraceptives with varying hormone types and dosing schedules.

Progestogen-only methods

• Progestogen-only pill (POP)
• Implant (long-acting reversible contraception)
• Injection (e.g., depot formulations, given at intervals)
• Hormonal IUD

Non-hormonal options

• Copper IUD
• Barrier methods (condoms) for additional protection against sexually transmitted infections (STIs)

If you are changing methods, ask about overlap timing and how to maintain contraceptive cover.

Market and legal context in the United Kingdom

In the UK, combined oral contraceptives are regulated medicines. Availability and supply routes can vary depending on current NHS and private services.

Contraceptive advice is widely available through the NHS, sexual health services, and community pharmacies. There are also online and telephone services that may support access pathways. Local availability can change, so the best starting point is often a pharmacist or an NHS contraceptive clinic.

Recent guidance and evolving practice (UK-relevant themes)

Guidance on combined hormonal contraception commonly emphasises:

• Individualised risk assessment (including migraine features, blood pressure, smoking, and clot risk history).
• Clear instructions for missed doses and the need for backup contraception when appropriate.
• Interaction awareness with enzyme-inducing medicines and herbal products such as St John’s wort.
• Prompt action if you miss pills or experience vomiting/diarrhoea.

If you want the most up-to-date information for your situation, speak to a pharmacist—particularly if you have new medical conditions or start a new medicine.

Delivery and availability (online pharmacy)

Availability of Alesse can vary by pack size and formulation. When ordering online in the UK, ensure:

• Correct pack: check the pack name and strength (levonorgestrel/ethinyl estradiol) before confirming.
• Expiry and storage: verify shelf-life details on receipt.
• Delivery reliability: choose a delivery option that suits your routine, so tablets are received promptly and stored correctly.

If you need urgent contraception due to a missed dose or unprotected sex, look for same-day/rapid access options through local services.

FAQ

How quickly does Alesse start working?

It depends on when you start. If you begin on the first day of your period, protection is usually immediate. If you start later in your cycle or at another time, you may need backup contraception for about 7 days. Check your pack leaflet or ask a pharmacist for guidance specific to your start date.

Will I still have a “period”?

During the break/placebo days, many people experience a withdrawal bleed that looks like a period. It may not perfectly match a natural period, and spotting can occur—especially during the first few months.

Is it safe to use Alesse for long periods?

Many people use combined pills for years. Safety depends on personal risk factors such as smoking status, blood pressure, migraine history, and clot risk. Regular check-ins with a healthcare professional (or pharmacist advice when starting/stopping) are a good idea, especially if new health changes occur.

What should I do if I miss a pill?

Take the missed tablet as soon as you remember, then continue the pack. Whether you need extra contraception depends on how many pills were missed and where you are in the cycle. Because the details differ, refer to your patient leaflet or seek prompt pharmacist advice.

Can I take Alesse if I’m breastfeeding?

Combined contraceptives are generally not the first choice while breastfeeding, especially early on, because of potential effects on milk supply and hormonal considerations. A progestogen-only method is often preferred. Seek advice from a pharmacist or NHS service.

Does Alesse protect against STIs?

No. Alesse protects against pregnancy but does not protect against sexually transmitted infections. Condoms can reduce STI risk and can also provide additional protection if you miss pills or have vomiting/diarrhoea.

Are there foods or drinks I must avoid?

There are no common food restrictions for Alesse. Alcohol itself doesn’t usually interfere directly, but heavy drinking may increase the risk of missed doses.

What if I vomit after taking Alesse?

Vomiting can reduce absorption. If you vomit shortly after taking a tablet, treat it as a missed pill and follow the leaflet’s advice. If vomiting continues or you have severe diarrhoea, use backup contraception and seek advice.

What medicines can reduce the pill’s effectiveness?

Some medicines may reduce effectiveness, especially those that increase liver enzyme activity. Examples include rifampicin/rifabutin, certain anti-seizure medicines, some HIV/hepatitis treatments, and St John’s wort. If you start any new medicine, tell your pharmacist so they can check interaction risk.

When should I stop Alesse and seek urgent help?

Seek urgent medical help if you develop symptoms suggestive of a blood clot (leg swelling/pain, sudden breathlessness, chest pain, signs of stroke). Also seek urgent advice for severe or unusual headache, especially if it is new, worsening, or associated with neurological symptoms.

Where can I get more help?

You can contact a local pharmacy, NHS sexual health service, or GP for personalised guidance. A pharmacist can be particularly helpful for missed pill questions and medicine interaction checks.