Combined oral contraceptives (COC), second generation
ATC code: G03AA07 (Levonorgestrel and estrogen)
Suppresses ovulation by lowering pituitary FSH and LH. Ethinylestradiol is a synthetic estrogen; levonorgestrel is a second-generation progestin with mild androgenic activity. Thickens cervical mucus and thins endometrium, reducing implantation. Pearl Index 0.3 perfect-use, 7 typical-use. Levonorgestrel is cheaper and has the lowest VTE risk among progestins (5-7 per 10,000 woman-years vs 9-12 with drospirenone).
First line
Regular contraception for women of reproductive age. Per MEC 2015 and SEGO 2023, the preferred COC without VTE risk factors (smoking after 35, migraine with aura, thrombophilia, BMI ≥35, uncontrolled hypertension). One tablet at the same time daily for 21 days, then 7-day break with withdrawal bleed. Efficacy – Pearl Index 0.3 perfect-use. A missed dose >24 h reduces protection – use backup barrier for 7 days.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Ethinylestradiol + Levonorgestrel during breastfeeding. MEC 2015 and SEGO 2023 classify combined COCs with estrogen as category 4 (contraindicated) in the first 6 weeks postpartum due to elevated VTE risk. From week 6 to 24 with established lactation – category 2 (acceptable). Estrogen lowers milk supply, especially before lactation stabilizes. Alternatives are progestin-only methods (Cerazette, desogestrel or levonorgestrel mini-pills, implant, LNG-IUS) from day 1 postpartum. If breastfeeding matters and you have a choice, consider a second opinion.
Not recommended
Blogs and forums advise pausing COCs for 3-6 months so «the body rests from hormones». Committee Opinion 2017 and SEGO 2023 do not support this. Ethinylestradiol and Levonorgestrel clear within days. Ovulation returns in 1-3 cycles in most women. A break does not improve fertility and raises unintended pregnancy risk. When planning pregnancy, stop the COC and start trying immediately – no «detox» needed. If a clinician recommends a mandatory break without medical reason, consider a second opinion.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Contraindicated in pregnancy. Accidental use in early pregnancy is not linked to birth defects – continuing pregnancy is safe. Once pregnancy is confirmed, stop the COC immediately.
Ethinylestradiol reduces milk supply. WHO MEC 2015: first 6 weeks postpartum – category 4 (contraindicated); weeks 6-24 with stable lactation – category 2 (acceptable). Levonorgestrel transfers to milk in small amounts (RID about 1-2%) and is considered compatible per Hale L2. The estrogen is the main issue. If breastfeeding matters, progestin-only methods are preferred.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Ethinylestradiol + Levonorgestrel is evaluated for the following indications with varying evidence strength: Contraception (evidence tier A), Contraception during breastfeeding (evidence tier D), Pill-free interval for «detox» (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Ethinylestradiol + Levonorgestrel (≥ 1 in 100): Nausea, Breast tenderness, Breakthrough bleeding in first 1-3 months, Headache, Mood changes, Decreased libido. See the Safety section for uncommon and serious reactions.
FDA category X. Contraindicated in pregnancy. Accidental use in early pregnancy is not linked to birth defects – continuing pregnancy is safe. Once pregnancy is confirmed, stop the COC immediately.
Ethinylestradiol reduces milk supply. WHO MEC 2015: first 6 weeks postpartum – category 4 (contraindicated); weeks 6-24 with stable lactation – category 2 (acceptable). Levonorgestrel transfers to milk in small amounts (RID about 1-2%) and is considered compatible per Hale L2. The estrogen is the main issue. If breastfeeding matters, progestin-only methods are preferred.
Ethinylestradiol + Levonorgestrel is contraindicated in: History or current venous thromboembolism; Known thrombophilia (Leiden, prothrombin G20210A); Smoking after 35 (≥15 cigarettes/day); Migraine with aura; Uncontrolled hypertension (≥160/100). Full list in the Safety section.