How do I transition from Levlen (ethinyl estradiol and levonorgestrel) 30 to Nexstellis (estradiol and segesterone acetate)?

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Transitioning from Levlen 30 to Nexstellis

To transition from Levlen (ethinyl estradiol and levonorgestrel) 30 to Nexstellis (estetrol and drospirenone), start taking Nexstellis on the day you would have started your next pack of Levlen, without any gap between the two contraceptives. 1

Transition Protocol

When to Start Nexstellis

  1. Switching from Levlen (combined oral contraceptive):
    • Start Nexstellis on the day you would have started your next pack of Levlen
    • No need for a hormone-free interval between the two medications
    • No need for backup contraception if you start on the scheduled day 1

Administration Instructions

  • Take one Nexstellis tablet at the same time every day
  • Follow the 24 pink active tablets followed by 4 white inactive tablets regimen
  • Take with or without food 1

Special Considerations

Missed Dose Management

If you miss Nexstellis tablets:

  • One pink active tablet missed: Take the missed tablet as soon as possible and take the next tablet at the scheduled time (even if this means taking two tablets in one day)
  • Two or more pink active tablets missed in Week 1 or 2: Take one missed tablet immediately, take the current day's tablet, use backup contraception for 7 days
  • Two pink active tablets missed in Week 3: Take one missed tablet immediately, take the current day's tablet, finish the active tablets, discard the inactive tablets, and start a new pack the next day 1

Potential Side Effects During Transition

  • You may experience breakthrough bleeding during the first few months after switching
  • This is normal and typically decreases over time
  • Contact your healthcare provider if breakthrough bleeding persists beyond a few months 1

Important Warnings

  • Nexstellis may be less effective in women with BMI ≥30 kg/m²
  • If you experience vomiting or diarrhea within 3-4 hours after taking an active tablet, take a new active tablet as soon as possible
  • Use backup contraception if you take certain medications, including some antibiotics and herbal products like St. John's Wort 1

Differences Between Levlen and Nexstellis

  • Levlen contains ethinyl estradiol and levonorgestrel, while Nexstellis contains estetrol and drospirenone
  • Nexstellis contains estetrol, which is a natural estrogen with potentially fewer side effects than the synthetic ethinyl estradiol in Levlen
  • Both medications are effective at preventing pregnancy when taken correctly 2

Follow-up Recommendations

  • Schedule a follow-up appointment 3 months after starting Nexstellis to assess tolerance and address any concerns
  • Report any unusual symptoms such as severe headaches, chest pain, severe leg pain, or vision changes immediately 2

Remember that consistent, daily use at approximately the same time each day is essential for maintaining contraceptive effectiveness during and after the transition.

References

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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