Levonorgestrel - ethinyl estradiol (extended cycle) is a combination birth control pill (oral contraceptive) that contains a progestin (levonorgestrel) and estrogen (ethinyl estradiol) used to prevent pregnancy. This medication works to prevent pregnancies by inhibiting ovulation (the release of an egg from an ovary) and causing changes in the mucus of the cervix, making it difficult for sperm to penetrate and for an egg to implant.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The dose of this birth control pill is one tablet daily at the same time each day. Each pack contains 84 active tablets and 7 inactive tablets. Take 1 active tablet daily for 84 days, then take 1 inactive tablet daily for 7 days, and then begin the next pack to start the 91-day cycle again.

Talk with your doctor about the best time to start this medication. The first day of your menstrual period (bleeding) is known as Day 1. You should start taking your active tablets on the first Sunday after your period starts. If your period starts on a Sunday, take the first active tablet that day. Continue taking the active tablets for 84 consecutive days, then take 7 days of the white inactive tablets. You should have menstrual bleeding during the first 7 days after you have finished the active tablets.

The pills should be taken approximately the same time every day. You should use a second method of birth control (e.g., latex condoms or spermicides) for the first 7 days of the first cycle of pill use.

Many women have spotting or light bleeding during the first few months of taking the pill. Do not stop taking the pill even if you are having irregular bleeding. If the bleeding lasts for more than a few days, check with your doctor. Many women may also feel sick to their stomach during the first few weeks of taking the pill. If you do feel sick, do not stop taking the pill. The problem will usually go away. If it does not go away, check with your doctor.

If you experience vomiting or diarrhea, or if you take certain medications (such as antibiotics), your pills may not work as well. If you start a new medication while taking birth control pills, check with your doctor or pharmacist to make sure that it will not reduce the effectiveness of the pills. Use a backup method of birth control, such as latex condoms or spermicides, until you can check with your doctor or pharmacist.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss pills at any time, the risk of becoming pregnant increases. If you miss one pink "active" pill, take it as soon as you remember, and then take the next pill at the usual time. This may mean that you might have to take 2 pills in one day. You do not need a backup method of birth control.

If you miss 2 pink "active" pills in a row, take 2 pills on the day you remember and 2 pills the next day. Then take one pill once a day until you finish the pack. Use a second method of birth control (e.g., latex condoms or spermicides) if you have sex in the 7 days after you missed the pills.

If you miss 3 or more active pills in a row, do not take the missed pills and leave them in the pack. Keep taking one pill every day until you finish taking the rest of the pills in the pack (except for the pills that were missed). For example, if you restart taking the pill on Thursday, take the pill under "Thursday" and do not take the previous missed pills. You may experience some bleeding during the week following the missed pills. Use a second method of birth control (e.g., latex condoms or spermicides) during the first 7 days after you restart your pills. If you miss your period when you are taking the inactive pills, call your doctor as you may be pregnant.

If you miss any of the white "inactive" pills, throw away the missed pills and keep taking the scheduled pills once a day until the pack is finished. A backup method of birth control is not needed unless you missed 2 or more pink "active" pills in a row within 7 days prior to starting the white "inactive" pills.

If you are not sure what to do about the pills you have missed, use a backup method of birth control any time you have sex and keep taking one pill each day until you can consult your doctor or pharmacist.

Store this medication at room temperature, and keep it out of the reach of children and pets.

Active Tablets
Each pink, round, uncoated biconvex tablet, debossed with "473" on one side and plain on the other, contains 0.15 mg of levonorgestrel and 0.03 mg of ethinyl estradiol. Nonmedicinal ingredients: lactose monohydrate, D&C Red No. 27, FD&C Blue No. 2, FD&C Yellow No. 5, magnesium stearate, polacrilin potassium, and red iron oxide.

Inactive tablets
Each white, round, biconvex tablet debossed with "473" on one side and plain on the other side, contains no active ingredient. Nonmedicinal ingredients: lactose monohydrate, magnesium stearate, and polacrilin potassium.

Do not take levonorgestrel - ethinyl estradiol (extended cycle) if you:

• are allergic to levonorgestrel, ethinyl estradiol, or to any of the ingredients of the medication
• are or may be pregnant
• are taking a hepatitis C drug combination containing glecaprevir/pibrentasvir or sofosbuvir/velpatasvir/voxilaprevir
• have active liver disease
• have any eye lesion resulting from blood vessel disease of the eye, such as partial or complete loss of vision or defects in visual fields
• have, have had, or may have breast cancer
• have heart valve disease with complications
• have or have had a heart attack or heart disease (e.g., angina pectoris)
• have or have had benign or malignant liver tumours
• have or have had cerebrovascular disorders (e.g., stroke or "mini-stroke" [transient ischemic attacks, or TIAs])
• have or have had jaundice (yellowing of skin or whites of the eyes) during pregnancy or while on hormonal medications (e.g., birth control pills)
• have or have had migraine headaches
• have or have had thrombophlebitis or thromboembolic (blood clotting) disorders
• have or may have an endometrium (lining of the uterus) tumour, or other suspected or diagnosed estrogen-dependent tumours
• have risk factors for developing blood clots, including:
• diabetes with complications
• heavy smoking (more than 15 cigarettes per day) and over the age of 35
• high blood cholesterol or triglyceride levels
• known abnormalities of the blood clotting system that increases the risk for developing blood clots
• prolonged bed rest
• recent or scheduled major surgery
• severe high blood pressure
• have undiagnosed abnormal vaginal bleeding

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• bleeding or spotting between menstrual periods
• breast tenderness
• contact lens discomfort
• diarrhea
• fatigue
• gas
• nausea
• vomiting
• weight gain

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• amenorrhea (lack of a period)
• breast lumps
• darkening of the skin (particularly on the face)
• dizziness
• fever
• flu-like symptoms
• fluid retention (unusual swelling of extremities)
• headache (severe)
• loss of scalp hair
• nervousness
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• symptoms of a urinary tract infection (e.g. pain when urinating, urinating more often than usual, low back or flank pain)
• trouble sleeping
• upper respiratory tract infections (e.g., colds, bronchitis, runny or stuffy nose, sore throat)
• vaginal infections

Stop taking the medication and seek immediate medical attention if any of the following occur:

• severe pain in the stomach area
• signs of a blood clot in blood vessels (e.g., sudden loss of vision or change in vision; pain in the chest, groin, or leg [especially with swelling in the calf of the leg]; sudden or unexplained shortness of breath)
• signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
• significant increases in blood pressure
• signs of an allergic reaction (e.g., shortness of breath or difficulty breathing; hives; swelling of the eyes, mouth, lips, or throat)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of a stroke (e.g., headache, loss of coordination, slurred speech, weakness, numbness, or unexplained pain in the arm or leg)
• sudden partial or complete loss of vision

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood clots: Blood clots are the most common serious side effects of birth control pills. Developing blood clots is especially high during the first year a woman ever uses a hormonal contraceptive. Clots can occur in many parts of the body (brain, eyes, heart, legs, or lungs). If you notice any of the following signs or symptoms that may suggest a potential clot, notify your doctor immediately.

• crushing chest pain or heaviness may indicate a possible heart attack
• pain or swelling in the calf may suggest a possible blood clot in the leg
• sharp pain in the chest, coughing blood, or sudden shortness of breath may indicate a possible blood clot in the lung
• sudden partial or complete loss of vision may indicate a blood clot in the eye
• sudden severe or worsening headache, vomiting, dizziness or fainting, disturbances of vision or speech, or weakness or numbness in an arm or leg may suggest a stroke

People with a blood clot or history of blood clot should not use this medication (See "Who should NOT take this medication?").

Blood pressure: If you have high blood pressure, discuss with your doctor how this medication may affect your medical condition, and whether any special monitoring is needed. People with severe or uncontrolled high blood pressure should not use this medication.

Breast cancer: The chance of having breast cancer diagnosed may be slightly higher in women who use birth control pills, especially if you started using them at a younger age. You should have regular breast examinations by your doctor and examine your own breasts regularly. Women who currently have or have had breast cancer should not use birth control pills because the hormones in the pills may stimulate the cancer to grow. People who have or have had breast cancer should not use this medication (See "Who should NOT take this medication?").

Cervical cancer: Some studies have found that women who use birth control pills have an increased risk of cancer of the cervix. This finding may be related to other factors other than the use of birth control pills. However, there is insufficient evidence to rule out the possibility that birth control pills may cause such cancers.

Cholesterol: Blood cholesterol or triglyceride levels may increase while taking this medication. If you have cholesterol problems, discuss with your doctor how this medication may affect your medical condition, and whether any special monitoring is needed.

Cigarette smoking: Cigarette smoking increases the risk of serious heart disease and death. Birth control pills increase this risk, especially with increasing age (over 35 years of age). All women are urged not to smoke while taking this medication.

Diabetes: Birth control pills can affect blood sugar. If you have diabetes or a family history of diabetes, discuss with your doctor how this medication may affect your medical condition, and whether any special monitoring is needed.

Emotional problems: Women with a history of emotional problems, especially depression, may be more likely to have a recurrence of their condition while taking birth control pills. If you notice your condition worsen while on this medication, consult your doctor.

Eye problems: Women who are taking birth control pills may experience fluid buildup in the cornea of the eye, which can lead to visual disturbances and changes in tolerance to contact lenses, especially the rigid type. Disturbances usually do not occur with soft contact lenses. If you experience visual changes or difficulty wearing your contact lenses, consult your doctor.

Fibroids: This medication may worsen fibroids, causing sudden enlargement, pain, or tenderness. If you notice these effects, contact your doctor.

Gallbladder disease: Women who use birth control pills have a greater risk of developing gallbladder disease. If you notice severe pain in the abdomen (stomach area), fever, or yellowing of skin or eyes (jaundice), contact your doctor immediately.

Heart diseases: If you are at high risk for heart disease such as diabetes, high blood pressure, abnormal cholesterol levels, or a family history of these conditions, discuss with your doctor how this medication may affect your medical condition, and whether any special monitoring is needed.

Liver disease: Though rare, birth control pills can cause liver problems. If you develop yellowing of the eyes or skin, fever, fatigue, loss of appetite, dark urine, or light-coloured stools, stop taking the medication and contact your doctor.

Taking certain medications to treat hepatitis C when you are taking levonorgestrel – ethinyl estradiol can increase the risk of developing liver problems. If you need to take medication to treat hepatitis C, talk to your doctor about whether you should continue taking this medication.

Liver tumours: The short- and long-term use of birth control pills has been linked to the growth of liver tumours. Stop taking the medication and contact your doctor immediately if you notice yellowing of your skin or whites of your eyes, fever, fatigue, loss of appetite, dark urine, or pale stools. People who have or have had liver tumours should not use birth control pills (See "Who should NOT take this medication?").

Migraine and headaches: The onset or worsening of a migraine or the development of new types of recurrent, persistent, or severe headaches should be reported to your doctor.

Regular checkups: Physical examinations and follow-up visits with your doctor should be done 3 months after starting this medication and then yearly thereafter.

Return to fertility: After stopping birth control therapy, you should delay getting pregnant until at least one normal spontaneous menstrual cycle has occurred in order to date the pregnancy. An alternative birth control method should be used during this time. If you do not menstruate for 6 months or more after stopping birth control pills, notify your doctor.

Sexually transmitted infections (STIs): Birth control pills do not protect against STIs, including HIV/AIDS. For protection against these diseases, use latex condoms in combination with birth control pills.

Pregnancy: Do not take birth control pills if you are pregnant. If you become pregnant while taking birth control pills, contact your doctor immediately.

Breast-feeding: The hormonal components of this medication pass into breast milk and may reduce the quantity and quality of breast milk. The use of this medication is not recommended for breast-feeding women.

Children and adolescents: The safety and effectiveness of using this medication have not been established for children and adolescents under 18 years of age. The use of this medication is not recommended before menarche (first menstrual period).

Seniors: The use of birth control pills is not recommended for postmenopausal women.

There may be an interaction between levonorgestrel - ethinyl estradiol (extended cycle) and any of the following:

• acetaminophen
• acetylsalicylic acid (ASA)
• anastrozole
• antacids (aluminum hydroxide, calcium carbonate, magnesium hydroxide) – use 2 hours before or after taking levonorgestrel – ethinyl estradiol
• antibiotics (e.g., ampicillin, chloramphenicol, metronidazole, neomycin, nitrofurantoin, penicillin, rifampin, sulfonamides, tetracyclines)
• anticoagulants (e.g., apixaban, dabigatran, dalteparin, enoxaparin, fondaparinux, heparin, edoxaban, rivaroxaban, warfarin)
• aprepitant
• "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
• benzodiazepines (e.g., diazepam, lorazepam, oxazepam)
• bosentan
• celecoxib
• chloral hydrate
• cholesterol-lowering medications (e.g., cholestyramine, colesevelam, colestipol, clofibrate)
• clomipramine
• clonidine
• clozapine
• cobicistat
• conivaptan
• corticosteroids (e.g., dexamethasone, prednisone, hydrocortisone)
• cyclosporine
• dantrolene
• deferasirox
• dehydroepiandrosterone
• diabetes medications (e.g., canagliflozin, glyburide, insulin, metformin, linagliptin, lixisenatide, saxagliptin, rosiglitazone)
• diltiazem
• elagolix
• elvitegravir
• exemestane
• folic acid
• grapefruit juice
• hepatitis C antivirals (e.g., glecaprevir, pibrentasvir, sofosbuvir, velpatasvir, voxilaprevir)
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• lenalidomide
• lomitapide
• lumacaftor and ivacaftor
• medications that are used to treat high blood pressure
• mifepristone
• mitotane
• modafinil
• mycophenolate
• octreotide
• pomalidomide
• rifabutin
• rifampin
• ropinirole
• St. John's wort
• sarilumab
• seizure medications (e.g., carbamazepine, clobazam, ethosuximide, levetiracetam, phenobarbital, phenytoin, primidone, topiramate, valproic acid, zonisamide)
• selegiline
• siltuximab
• somatropin
• theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
• thyroid replacements (e.g., desiccated thyroid, levothyroxine)
• tizanidine
• tobacco (smoked)
• tocilizumab
• tranexamic acid
• ursodiol
• vitamin B12
• vitamin C

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.