What are the effects of Linessa (levonorgestrel and ethinyl estradiol)?

From the Guidelines

Linessa, a combination oral contraceptive pill containing levonorgestrel and ethinyl estradiol, is effective in preventing pregnancy, but it may increase the risk of blood clots and has common side effects such as irregular bleeding, headache, and nausea, as noted in the 2014 study on contraception for adolescents 1. The effects of Linessa can be understood by looking at its components and the way it works.

• Linessa contains 30 to 35 μg of ethinyl estradiol and a progestin such as levonorgestrel, which are common components of combined oral contraceptive pills (COCs) 1.
• COCs work by preventing ovulation, thickening cervical mucus to block sperm, and thinning the uterine lining to prevent implantation.
• The typical regimen involves taking active hormone pills for 21 days followed by 7 days of placebo pills, during which withdrawal bleeding occurs.
• For immediate use, start on the first day of your menstrual period or on the first Sunday after your period begins, and use backup contraception like condoms for the first 7 days if starting mid-cycle 1.
• The most serious adverse event associated with COC use, including Linessa, is the increased risk of blood clots, which increases from 1 per 10,000 to 3 to 4 per 10,000 woman-years during COC use 1.
• Common side effects of Linessa may include nausea, breast tenderness, headaches, and spotting between periods, which typically improve after 2-3 months of use.
• It is essential to counsel patients on strategies to promote daily adherence, such as cell phone alarms and support from a family member or partner, and to instruct them on what to do if pills are missed 1.
• Patients should be informed that Linessa does not protect against sexually transmitted infections, and they should use condoms or other barrier methods to prevent STIs 1.

From the FDA Drug Label

ADVERSE REACTIONS An increased risk of the following serious adverse reactions has been associated with the use of oral contraceptives (see WARNINGS section): Thrombophlebitis and venous thrombosis with or without embolism Arterial thromboembolism Pulmonary embolism Myocardial infarction Cerebral hemorrhage Cerebral thrombosis Hypertension Gallbladder disease Hepatic adenomas or benign liver tumors The following adverse reactions have been reported in users of oral contraceptives and the association has been neither confirmed nor refuted: Pre-menstrual syndrome Cataracts Changes in appetite Cystitis-like syndrome Headache Nervousness Dizziness Hirsutism Loss of scalp hair Erythema multiforme Erythema nodosum Hemorrhagic eruption Vaginitis Porphyria Impaired renal function Hemolytic uremic syndrome Acne Changes in libido Colitis Budd-Chiari syndrome

The effects of Linessa (levonorgestrel and ethinyl estradiol) include:

• Increased risk of serious adverse reactions such as thrombophlebitis, venous thrombosis, arterial thromboembolism, pulmonary embolism, myocardial infarction, cerebral hemorrhage, and hypertension
• Common adverse reactions such as change in weight, change in cervical erosion and secretion, diminution in lactation, cholestatic jaundice, migraine, rash, mental depression, reduced tolerance to carbohydrates, vaginal candidiasis, and change in corneal curvature
• Potential adverse reactions with an uncertain association, including pre-menstrual syndrome, cataracts, changes in appetite, cystitis-like syndrome, headache, nervousness, dizziness, hirsutism, loss of scalp hair, erythema multiforme, erythema nodosum, hemorrhagic eruption, vaginitis, porphyria, impaired renal function, hemolytic uremic syndrome, acne, changes in libido, colitis, and Budd-Chiari syndrome 2

From the Research

Effects of Linessa (Levonorgestrel and Ethinyl Estradiol)

The effects of Linessa, a combined oral contraceptive pill containing levonorgestrel and ethinyl estradiol, can be understood by examining the properties and impacts of its components.

• Contraceptive Effectiveness: Linessa is effective in preventing pregnancy, with pregnancy rates of women using oral contraceptives like Linessa ranging from 4% to 7% per year 3.
• Hormonal Regulation: The combination of levonorgestrel (a progestin) and ethinyl estradiol (an estrogen) in Linessa works by suppressing ovulation, thereby preventing pregnancy 4.
• Non-Contraceptive Benefits: Combined hormonal contraceptives like Linessa can offer non-contraceptive benefits, including regulated menses, decreased dysmenorrhea, and diminished premenstrual dysphoric disorder 5, 6.
• Risks and Side Effects: The use of estrogen-containing methods like Linessa can increase the risk of venous thrombosis 3, 5. Progestin-only and nonhormonal methods are associated with rare serious risks.
• Contraindications: Contraceptives containing estrogen, such as Linessa, should be avoided in women with a history of venous thromboembolism, stroke, cardiovascular disease, or peripheral vascular disease 5.
• Extended or Continuous Use: Extended or continuous use of combined hormonal contraceptives like Linessa may offer advantages, including improved compliance, greater satisfaction, fewer menstrual symptoms, and less menstruation-related absenteeism from work or school 7.

Considerations for Use

When considering the use of Linessa, it is essential to weigh the benefits against the potential risks and side effects.

• Patient Preferences: The choice of contraceptive method should incorporate patient values and preferences, including tolerance for risk of pregnancy, menstrual bleeding changes, and other risks 3.
• Medical History: Effective contraceptive counseling requires an understanding of a woman's medical history, as well as the risks, benefits, adverse effects, and contraindications of each method 5.
• Dosing Regimens: The dosing regimen for Linessa, whether cyclic or extended/continuous, can impact user experience, with some women preferring extended regimens for fewer or no inactive pills 6, 7.