What medications are similar to Loestrin (Ethinyl Estradiol and Norethindrone Acetate)?

Medications Similar to Loestrin

The most directly comparable medications to Loestrin (ethinyl estradiol/norethindrone acetate) are other norethindrone acetate-containing combined oral contraceptives, including Estrostep Fe, or alternative low-dose formulations like Ortho Tri-Cyclen Lo (norgestimate/ethinyl estradiol 25 mcg) and Yaz (drospirenone/ethinyl estradiol 20 mcg), all of which are FDA-approved for both contraception and acne treatment. 1, 2, 3

Direct Alternatives with Same Progestin

• Estrostep Fe contains norethindrone acetate with ethinyl estradiol and is FDA-approved for acne treatment, making it the closest alternative with the identical progestin component 2

• Lo Loestrin Fe contains norethindrone acetate 1 mg with ethinyl estradiol 10 mcg—the lowest estrogen dose available in any FDA-approved combined oral contraceptive, though no other formulation matches this exact ultra-low estrogen dose 1

• Norethindrone acetate has unique metabolic properties, converting to ethinyl estradiol in vivo, and demonstrates moderate androgenic activity when used alone but a net antiandrogenic effect when combined with estrogen 1

Alternative Low-Dose Formulations with Different Progestins

Second-Generation Progestins

• Ortho Tri-Cyclen Lo contains norgestimate 180/215/250 mcg with ethinyl estradiol 25 mcg and is FDA-approved for acne treatment 1, 3

• Clinical trials demonstrate that women switching from 30-35 mcg ethinyl estradiol-containing oral contraceptives to Ortho Tri-Cyclen Lo experienced significantly less breakthrough bleeding/spotting (3.7-13.5%) compared to Loestrin Fe 1/20 (23.5-49.7%), with 86% reporting satisfaction at cycle 6 4

• Norgestimate-containing pills have antiandrogenic effects and produce significantly greater beneficial effects on HDL-C, HDL2, and apolipoprotein A-I compared to norethindrone acetate formulations 5

Third-Generation Progestins with Antiandrogenic Properties

• Yaz/Yasmin contains drospirenone 3 mg with ethinyl estradiol 20 mcg in a 24/4 day regimen and is FDA-approved for acne treatment 1, 2, 3

• Beyaz is similar to Yaz but includes added levomefolate 2, 3

• Drospirenone-containing pills have specific antiandrogenic properties but may carry slightly higher VTE risk compared to other combined oral contraceptives 2

Cardiovascular Risk Stratification

• Norethindrone-containing pills and levonorgestrel-containing pills carry the lowest thrombotic risk among combined oral contraceptives, with absolute VTE risk of 3-9 per 10,000 woman-years for standard COCs 1, 3

• Desogestrel carries approximately 50-80% higher VTE risk compared to levonorgestrel, with absolute risk of approximately 10/10,000 woman-years 3

• Women ≥35 years who smoke, those with history of VTE, thrombophilia, obesity, or hypertension should preferentially use norethindrone over third-generation progestins like desogestrel 3

Progestin-Only Alternatives

• Norethindrone progestin-only pills are well-tolerated in approximately two-thirds of patients, though may cause breakthrough bleeding, pelvic discomfort, and mastalgia 3

• Etonogestrel implants (Implanon/Nexplanon) provide long-acting reversible contraception with good tolerability profile 3

Important Clinical Considerations

• Lower estrogen doses (like the 10 mcg in Lo Loestrin Fe) may increase breakthrough bleeding risk but potentially reduce thrombotic risk 1

• All combined oral contraceptives share similar contraindications: history of venous thromboembolism, uncontrolled hypertension, smoking in women over 35 years, migraine with aura, active liver disease, and estrogen-sensitive cancers 1, 2, 6

• Women with hereditary angioedema should avoid estrogen-containing contraceptives, as 60-80% experience increased frequency and severity of attacks; progestin-only pills containing norethindrone or etonogestrel implants are better tolerated alternatives 3