Medications Similar to Loestrin
Loestrin alternatives include other combined oral contraceptives containing ethinyl estradiol with different progestins (norgestimate, desogestrel, drospirenone, levonorgestrel) or formulations with the same active ingredients (norethindrone acetate/ethinyl estradiol) under different brand names such as Estrostep Fe, Brevicon, Ortho-Novum, Norlestrin, and Norinyl. 1, 2
Direct Equivalents (Same Active Ingredients)
Loestrin contains ethinyl estradiol and norethindrone acetate. The following medications contain identical active ingredients: 3, 2
- Estrostep Fe - Contains norethindrone acetate 1 mg with triphasic ethinyl estradiol dosing (20 mcg/30 mcg/35 mcg) plus ferrous fumarate, and is FDA-approved for acne treatment 1, 4
- Norlestrin and Norinyl - Alternative brand names containing the same norethindrone acetate/ethinyl estradiol combination 2
Similar Combined Oral Contraceptives with Different Progestins
FDA-Approved Options with Antiandrogenic Effects
If seeking alternatives with beneficial effects on acne or androgenic symptoms:
- Ortho Tri-Cyclen (ethinyl estradiol/norgestimate) - Second-generation progestin with antiandrogenic properties, FDA-approved for acne treatment 1
- Yaz/Yasmin (ethinyl estradiol/drospirenone) - Contains 3 mg drospirenone with specific antiandrogenic properties, FDA-approved for acne treatment 1
- Beyaz (ethinyl estradiol/drospirenone/levomefolate) - Similar to Yaz with added folate 1
Important Cardiovascular Risk Considerations
When selecting alternatives, cardiovascular risk profile differs significantly between progestins:
- Lower VTE risk options: Norethindrone-containing pills and levonorgestrel-containing pills carry the lowest thrombotic risk among combined oral contraceptives 5
- Higher VTE risk options: Desogestrel carries approximately 50-80% higher VTE risk compared to levonorgestrel, with absolute risk of approximately 10/10,000 woman-years versus 3-9/10,000 for standard COCs 5
- Risk factors requiring caution: Women ≥35 years who smoke, those with history of VTE, thrombophilia, obesity, or hypertension should preferentially use norethindrone over third-generation progestins like desogestrel 5
Progestin-Only Alternatives
For women with contraindications to estrogen-containing contraceptives:
- Norethindrone progestin-only pills - Well-tolerated in approximately two-thirds of patients, though may cause breakthrough bleeding, pelvic discomfort, and mastalgia 6
- Etonogestrel implants (Implanon/Nexplanon) - Long-acting reversible contraception with good tolerability profile 6
Special Population Considerations
Women with Hereditary Angioedema
- Avoid estrogen-containing contraceptives: 60-80% of women with hereditary angioedema experience increased frequency and severity of attacks with estrogen-containing pills 6
- Preferred alternatives: Progestin-only pills containing norethindrone or etonogestrel implants are better tolerated 6
Postmenopausal Symptom Management
- Low-dose norethindrone acetate/ethinyl estradiol (0.5 mg/2.5 mcg) effectively reduces vasomotor symptoms while maintaining bone mineral density, though this is contraindicated in postmenopausal women per FDA labeling 3, 7
Common Pitfalls to Avoid
- Do not assume all combined oral contraceptives have equivalent VTE risk - Third-generation progestins (desogestrel, gestodene) carry significantly higher thrombotic risk than first- and second-generation options 5
- Screen for contraindications before switching: History of VTE, stroke, heart attack, active liver disease, uncontrolled hypertension, smoking in women >35 years, and migraine with aura are absolute contraindications to all combined hormonal contraceptives 1, 3
- Norethindrone acetate is pregnancy Category X - Verify pregnancy status before initiating any alternative, as there is increased risk of minor birth defects with first-trimester exposure 3