Loette (Ethinyl Estradiol + Levonorgestrel)
Also sold as: Loette, Ovral-L, Triquilar, Femilon, Lady, Mala-N
Pregnancy
Cat X
Lactation
Avoid
Schedule
H
Forms
Tablet: EE 20 mcg + LNG 100 mcg (low-dose, e.g., Loette) +2
Indications
- Contraception (most reliable reversible method when taken correctly — >99% typical use)
- Dysmenorrhoea (primary — reduces pain significantly)
- Menorrhagia (reduces menstrual blood loss)
- Endometriosis (symptom management)
- Polycystic ovary syndrome (PCOS) — cycle regulation, acne, hirsutism
- Premenstrual dysphoric disorder (PMDD)
Adult Dosing
Contraception / cycle control
1 tablet PO once daily for 21 days, then 7-day pill-free break (or 28-day pack with 7 placebo tablets)
Start Day 1 of period (immediate protection) or Day 1–5 (use backup contraception for 7 days if starting > Day 1). If pill missed: see counselling.
Pediatric Dosing
Same dosing as adults; bone health and breast development considerations in young adolescents — discuss with specialist
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Mild-moderate CKD | Assess cardiovascular risk — oestrogen-containing pills increase clotting risk; progestogen-only pill or non-hormonal method preferred in significant CKD |
Hepatic Adjustment
AVOID in acute or chronic liver disease, liver tumour, or if LFTs abnormal. Contraindicated.
Pregnancy & Lactation
Pregnancy: Category X
CONTRAINDICATED during pregnancy. Does not cause harm if inadvertently taken in early pregnancy (Cochrane review — no teratogenicity confirmed). Stop immediately if pregnancy detected.
Lactation: Avoid
Combined pill (containing oestrogen) suppresses lactation — avoid in breastfeeding especially < 6 months postpartum. Progestogen-only pill (POP — e.g., norethindrone, desogestrel) is compatible with breastfeeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Rifampicin, rifabutin | CYP3A4 induction — dramatically reduces contraceptive efficacy. Use additional contraception during and for 4 weeks after rifampicin. | Major |
| Enzyme-inducing anti-epileptics (carbamazepine, phenytoin, phenobarbital, primidone, topiramate > 200 mg) | Reduce contraceptive efficacy — use higher-dose pill or non-hormonal method | Major |
| St John's Wort (Hypericum perforatum) | Reduces contraceptive efficacy — avoid | Major |
| Warfarin | COCPs may increase or decrease INR — monitor INR when starting/stopping | Moderate |
| Lamotrigine | COCPs reduce lamotrigine levels by ~50% — may worsen seizure control; lamotrigine dose may need to increase during pill use | Major |
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Side Effects
Common
- Nausea (especially first 3 months)
- Breast tenderness
- Headache
- Mood changes (low libido, depression — especially levonorgestrel-containing pills)
- Breakthrough bleeding (spotting in first months)
- Weight gain (usually < 2 kg)
- Reduced menstrual flow (usually beneficial)
Serious / Discontinue If
- Venous thromboembolism — DVT, pulmonary embolism (absolute risk is small but 3–4× baseline; levonorgestrel pill has lowest VTE risk among COCPs)
- Arterial thrombosis — stroke, MI (especially with smoking, hypertension, migraine with aura)
- Hypertension (monitor BP)
- Breast cancer (marginally increased relative risk — absolute risk very small; reverses after stopping)
- Cervical cancer (small increase — likely confounding)
- Liver tumours (rare)
Contraindications
- Current or past VTE/DVT/PE
- Thrombophilias (Factor V Leiden, antiphospholipid syndrome)
- Migraine with aura (high stroke risk)
- Ischaemic heart disease, stroke
- Breast cancer (current or recent)
- Liver disease (active)
- Smoking + age > 35 years (absolute contraindication)
- Uncontrolled hypertension
- Pregnancy
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Loette (EE 20 + LNG 100) | Wyeth/Pfizer | 21 tab ₹95 |
| Ovral-L (EE 30 + LNG 150) | Wyeth/Pfizer | 21 tab ₹95 |
| Femilon (EE 20 + Desogestrel 150) | Organon | 21 tab ₹120 |
| Mala-N (EE 30 + Norethindrone) | HLL | 28 tab ₹5 (govt) |
Monitoring Required
- Blood pressure (before starting and at 3–6 months)
- Weight
- Migraine history (rule out aura)
- Breast examination (annually)
- Pap smear (as per age-appropriate schedule)
- Contraceptive efficacy (missed pills)
Patient Counseling Points
- Take at the same time every day — set an alarm if needed
- If you miss 1 pill: take it as soon as you remember, take next at usual time (can take 2 in one day), continue pack, no extra contraception needed
- If you miss 2+ pills early in pack or in last week: use condoms for 7 days; emergency contraception if unprotected sex in previous 5 days
- ⚠️ SMOKING + pill after age 35 is extremely dangerous — greatly increases stroke and heart attack risk. Quit smoking or switch method.
- ⚠️ Seek emergency help for severe headache, sudden vision loss, chest pain, severe leg pain or swelling, breathlessness — possible clot
- Start pill on Day 1 of period for immediate protection, or on Day 2–5 with 7-day backup
- Rifampicin (TB drug) and some epilepsy drugs reduce pill effectiveness — tell your doctor
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EasyClinic auto-flags Loette interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Anitha Krishnamurti, DGO, DNB (Obstetrics & Gynaecology), Senior Consultant
Last reviewed: 2026-04-01
References
- WHO Medical Eligibility Criteria for Contraceptive Use (MEC) 5th edition
- FOGSI Guidelines on Contraception
- BNF — Combined Oral Contraceptives
- FSRH UK Guidance 2023