Basic Loette Information

• INN (International Nonproprietary Name): Levonorgestrel and Ethinyl Estradiol
• Brand Names Available In Australia: Alesse, Aviane, Altavera, Amethyst, Enpresse, Seasonique, Lutera, Lessina, Levlite, Portia, Tri-Levlen, Trivora-28, Vienva (brands listed from international registrations; local availability varies)
• ATC Code: G03AA07
• Forms & Dosages: Oral tablet; common strength 0.1 mg levonorgestrel + 0.02 mg ethinyl estradiol; pack sizes include Alesse 21 (21 active) and Alesse 28 (21 active + 7 placebo)
• Manufacturers In Australia: not specified
• Registration Status In Australia: not specified
• OTC / Rx Classification: Prescription Only (Rx)

Latest Research Highlights

What does the recent evidence say about levonorgestrel/ethinyl estradiol and safety?

Recent Australian and international work between 2022 and 2025 continued to assess low‑dose combined oral contraceptives containing levonorgestrel plus ethinyl estradiol for both efficacy and safety.

Cohort studies and pharmacovigilance analyses reaffirm contraceptive effectiveness when taken correctly, with typical‑use failure rates aligned with other low‑dose combined oral contraceptives.

Post‑market reporting to the TGA and international databases emphasises rare but serious thromboembolic events and the need for appropriate risk stratification before initiation.

Comparative safety studies indicate levonorgestrel‑based progestins carry a marginally lower venous thromboembolism risk than some newer progestins in population analyses.

Recent adolescent and obesity‑focused research looks at mood and metabolic effects and recommends individualised choice with periodic clinical review.

The formulation commonly studied and sold in many markets is 0.1 mg levonorgestrel + 0.02 mg ethinyl estradiol, often supplied in 21/28 packs and listed under ATC G03AA07.

Clinical Effectiveness In Australia

Can people in Australia expect reliable protection from pregnancy with this pill?

When taken daily as directed — one active tablet for 21 days followed by seven placebo days in 28‑day packs — levonorgestrel/ethinyl estradiol provides reliable pregnancy prevention in clinical practice.

Australian TGA adverse event reporting aggregates local signals consistent with international experience for low‑dose combined oral contraceptives.

PBS dispensing data and primary care audits help track who uses these pills and show good continuation among younger users who tolerate low oestrogen doses well.

Real‑world effectiveness is highly dependent on adherence and correct management of missed tablets.

Follow the manufacturer guidance for missed doses: one missed active tablet — take it as soon as remembered; two or more — take the most recent missed tablet ASAP and use backup contraception for seven days.

Indications & Expanded Uses

What is the pill licensed for, and how do clinicians use it off‑label?

The TGA‑approved indication for levonorgestrel plus ethinyl estradiol formulations is oral contraception.

Off‑label uses seen in Australian clinics include cycle control for dysmenorrhoea, acne management and menstrual regularisation when prescribers document counselling and obtain consent.

The product is not indicated for emergency contraception or post‑coital use.

Adolescents who have reached menarche may receive standard adult dosing, while use after menopause or in women over 50 is inappropriate.

Sexual and reproductive health services and school health programmes commonly counsel on non‑contraceptive benefits and alternative methods when appropriate.

• Approved Use: Oral contraception only.
• Common Off‑Label Uses: Dysmenorrhoea, acne, cycle regularisation (with documented counselling).

1. Prescriber Checklist: screen for VTE risk, migraine with aura, breast cancer history and pregnancy exclusion.
2. Document informed consent for off‑label indications and review periodically.

Composition & Brand Landscape

Which ingredients and brands are relevant to pharmacists and patients?

The INN is levonorgestrel combined with ethinyl estradiol and the common low‑dose strength in many markets is 0.1 mg levonorgestrel + 0.02 mg ethinyl estradiol.

Pack formats include Alesse 21 (21 active tablets) and Alesse 28 (21 active + 7 placebo tablets).

The ATC classification is G03AA07 for this fixed combination of contraceptive steroids.

Original manufacturers include Pfizer and Wyeth, and generics are supplied by companies such as Apotex, Teva and Sandoz.

There are no non‑oral forms for this INN.

Contraindications & Special Precautions

Who should not use levonorgestrel/ethinyl estradiol?

Absolute contraindications include active thromboembolic disease, history of stroke or coronary artery disease, migraines with aura, current breast or oestrogen‑dependent tumours, uncontrolled hypertension, diabetes with vascular complications, severe liver disease or tumours, and known hypersensitivity to ingredients.

Relative cautions apply to people with obesity (BMI >30), a family history of VTE, well‑controlled hypertension or diabetes, hyperlipidaemia, gallbladder disease and chronic renal impairment.

Smoking raises risk and requires caution; smoking more than 15 cigarettes per day is a recognised relative contraindication, with substantially higher risk in older smokers.

In Australian practice, culturally appropriate cardiovascular risk screening is important for Aboriginal and Torres Strait Islander clients prior to initiation.

• Absolute Contraindications: Active DVT/PE, stroke/MI history, migraines with aura, current breast cancer, uncontrolled hypertension, diabetes with vascular disease, severe liver disease, hypersensitivity.
• Relative Cautions: Obesity (BMI >30), heavy smoking, family VTE history, gallbladder disease, well‑controlled hypertension/diabetes.

Dosage Guidelines

How should patients start and manage the pill for best protection?

The standard regimen is one active tablet daily for 21 days followed by seven placebo days for 28‑day packs or a 21‑day pack followed by a tablet‑free interval.

Start options include day‑1 start, Sunday start, or quick start after a negative pregnancy test, with backup contraception advised for seven days after a quick start.

Adolescents who have reached menarche use standard adult dosing, while the pill is not indicated after menopause.

Severe hepatic impairment is a contraindication and caution is required in mild to moderate hepatic or renal disease.

There is no routine dose titration; if side effects are intolerable, choose an alternative method.

Missed‑dose Instructions (manufacturer guidance):

• One missed active tablet — take as soon as remembered, even if two tablets are taken that day; continue the pack as normal.
• Two or more active tablets missed — take the most recent missed tablet ASAP, discard other missed tablets, continue the pack and use backup contraception for seven days.

Pharmacist Dosing Checklist: confirm start date, advise backup when required, counsel on missed pill flowchart and schedule follow‑up.

Interactions Overview

Which medicines reduce contraceptive effectiveness or change side‑effects?

Drugs that induce hepatic enzymes can reduce contraceptive steroid levels and therefore decrease effectiveness.

High‑risk interacting medicines include certain anticonvulsants, rifampicin, rifabutin and some antiretrovirals.

Herbal remedies such as St John’s wort are enzyme inducers and can also reduce efficacy.

Most standard antibiotics do not reduce combined pill efficacy except for rifampicin and rifabutin.

CYP interactions may change steroid levels and the side‑effect profile but alcohol does not directly affect steroid efficacy; heavy drinking may worsen adherence.

Pharmacists should always query concurrent medicines, including OTC and herbal products, when supplying the Pill.

Cultural Perceptions & Patient Habits

How do Australians choose and use levonorgestrel/ethinyl estradiol products?

Patients commonly balance efficacy, side effects and cost when selecting a contraceptive pill.

Price‑sensitive shoppers compare national chains such as Chemist Warehouse, Priceline and TerryWhite Chemmart for generics and branded options.

Rural and remote patients often rely on telehealth and local dispensing or mail‑order services, with continuity sometimes affected by stock or courier issues.

Privacy is a major concern in small towns and pharmacists are trusted for discreet counselling and supply.

Health services provide tailored advice for Aboriginal and Torres Strait Islander peoples, with culturally safe conversations and cardiovascular risk screening where appropriate.

Availability & Pricing Patterns

Where and how can Australians get levonorgestrel/ethinyl estradiol, and what does it cost?

Availability in Australia depends on TGA registration and any PBS listings for specific brands or generics.

Generics from Teva, Sandoz and Apotex are commonly stocked by national chains and independent pharmacies when registered locally.

Prices vary between retailers and private prescriptions attract full price unless a brand is PBS‑listed.

In our online pharmacy, loette is available without a prescription, with discreet delivery to Australia in 5–14 days.

Online telehealth services issue e‑prescriptions redeemable at national chains or local pharmacies, which helps continuity for rural patients.

Storage advice for patients: keep the blister at 15–30°C, protect from moisture and heat, and keep in original packaging during travel.

Comparable Medicines And Preferences

What are the common alternatives and how do they compare?

Alternatives include other low‑dose combined oral contraceptives such as Microgynon 20/30, Marvelon, Triphasil and Levlen, which differ mainly in progestin type and dose.

Levonorgestrel‑based COCs are often selected when prescribers want a historically lower venous thromboembolism risk profile compared with some newer progestins.

Choice depends on individual risk factors, side‑effect tolerability for mood, weight and acne, cycle control needs and PBS subsidy availability.

FAQ Section — Top Questions From Australian Patients

What do people ask most about levonorgestrel/ethinyl estradiol?

• Is this pill on the PBS? It depends on current listings for each brand; check the PBS website and TGA registration for brand‑specific status.
• What if I miss two tablets? Take the most recent missed tablet as soon as possible, discard the others, continue the pack and use backup contraception for seven days.
• Can I smoke while on this pill? Smoking increases VTE risk; additional caution is needed for heavy smokers and those over 35 years, and alternatives may be advised.
• Can I use it for irregular periods? Yes, clinicians may prescribe it for cycle control but they should document counselling and monitor response.

For further guidance, patients can consult the TGA and PBS online resources or local sexual health clinics for confidential advice.

Guidelines For Proper Use — Counselling & Pharmacy Practice

How should pharmacists counsel and safely supply levonorgestrel/ethinyl estradiol?

Pharmacist counselling should cover correct start methods, missed‑pill instructions, side‑effect recognition, contraindication screening and interaction checks.

Use culturally safe approaches for Aboriginal and Torres Strait Islander clients and offer telehealth follow‑up for rural patients when needed.

Document the supply, note screening for VTE and migraine with aura, and advise on storage at 15–30°C.

Discuss PBS versus private pricing and assist with arranging repeats via e‑prescription where available.

1. Confirm contraindications and current medicines.
2. Explain start method chosen and need for backup contraception if applicable.
3. Provide missed‑pill steps and a side‑effect action plan.
4. Arrange follow‑up or referral to sexual health services when needed.

Provide a short patient handout covering starts, misses, common side effects and emergency contact details at the point of supply.

Delivery Across Australia