Generic Alesse ( Levonorgestrel / Ethinyl estradiol )

Buy Generic Alesse (Levonorgestrel / Ethinyl estradiol) without prescription in Canada

In our Canadian pharmacy, you can buy Alesse (Levonorgestrel / Ethinyl Estradiol) without a prescription, with delivery across Canada within 5‑14 days. Discreet and anonymous packaging.

Alesse is a combined hormonal oral contraceptive that contains the progestin levonorgestrel and the estrogen ethinyl estradiol. It works primarily by preventing ovulation (the release of an egg from the ovary), and it also causes changes in the cervical mucus and uterine lining that make it harder for sperm to reach the uterus and for a fertilized egg to implant. The two available strengths—0.15 mg/0.03 mg and 0.25 mg/0.05 mg—provide flexible dosing options to balance contraceptive efficacy with individual tolerability, with the lower‑dose formulation often used as a starting regimen and the higher‑dose formulation reserved for women who experience breakthrough bleeding or require additional endometrial stability.

Usual adult dose: One active tablet is taken orally once daily, at approximately the same time each day, for 21 consecutive days, followed by either a 7‑day hormone‑free interval or 7 days of inert placebo tablets, during which withdrawal bleeding usually occurs. For the 0.15 mg/0.03 mg strength, each active tablet contains 0.15 mg of levonorgestrel and 0.03 mg of ethinyl estradiol; this is the lowest effective dose for most women and is recommended for initiation. For women who experience breakthrough bleeding or who require a higher estrogen dose for cycle control, the 0.25 mg/0.05 mg tablet may be used. The next 28‑day cycle is started immediately after finishing the previous pack, irrespective of whether bleeding has stopped. A backup barrier method must be used for the first 7 days of tablet‑taking unless starting on the first day of menses.

Dosage form: Oral tablets: 0.15 mg levonorgestrel / 0.03 mg ethinyl estradiol and 0.25 mg levonorgestrel / 0.05 mg ethinyl estradiol, supplied in 21‑day or 28‑day blister packs.

Onset of action: Contraceptive protection begins immediately if the first tablet is taken on the first day of menstrual bleeding (Day 1 start). If started at any other time in the cycle, a backup barrier method must be used for the first 7 days of tablet‑taking.

Duration of action: Contraceptive protection is maintained throughout the entire 28‑day cycle as long as tablets are taken correctly and without interruption. The hormone‑free interval does not reduce protection when the next pack is started on time.

Alcohol recommendation: Moderate alcohol consumption does not directly interfere with the contraceptive action of Alesse, but excessive drinking may increase the risk of vomiting or severe diarrhoea, which can impair tablet absorption. Alcohol should be limited, and a backup contraceptive method should be considered if vomiting occurs within 3‑4 hours of taking an active tablet.

Most common side effects: Irregular uterine bleeding (spotting or breakthrough bleeding, especially during the first few months), nausea, breast tenderness, headache, mood changes, and weight changes. Nausea often improves when the tablet is taken with food or at bedtime. The 0.15 mg/0.03 mg strength is associated with a lower incidence of estrogen‑related side effects, while the 0.25 mg/0.05 mg strength may provide better cycle control in some women.

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General Information about Alesse (Levonorgestrel / Ethinyl Estradiol)

• INN (International Nonproprietary Name): Levonorgestrel and Ethinyl Estradiol
• Brand names available in Canada: Alesse® is not currently marketed as a brand‑name product in Canada. The formulation containing levonorgestrel and ethinyl estradiol is available in Canada under the brand names Aviane®, Lutera®, Ovima®, Portia®, and others, typically in a 0.10 mg/0.02 mg strength. The 0.15 mg/0.03 mg and 0.25 mg/0.05 mg strengths are internationally sourced products obtained by our pharmacy through the international supply chain for personal importation.
• ATC code: G03AA07 (levonorgestrel and ethinyl estradiol; fixed combinations).
• Dosage forms and strengths: Oral tablets: 0.15 mg levonorgestrel / 0.03 mg ethinyl estradiol and 0.25 mg levonorgestrel / 0.05 mg ethinyl estradiol. Supplied in blister packs of 21 active tablets and, in some formulations, 7 additional inert placebo tablets.
• Manufacturers in Canada: The 0.15/0.03 mg and 0.25/0.05 mg strengths are not manufactured in Canada. The active ingredients are manufactured internationally by various pharmaceutical companies. The product is obtained via the international supply chain for personal importation. Canadian‑approved formulations with levonorgestrel/ethinyl estradiol are manufactured by companies such as Apotex Inc., Sandoz Canada Inc., and others, but are not available in these specific doses.
• Registration status in Canada: Not marketed in Canada in the 0.15/0.03 mg or 0.25/0.05 mg strengths. Alesse has not been issued a Notice of Compliance by Health Canada; the active combination is approved in different strengths. This product is available internationally and is imported for personal use through a valid prescription.
• OTC / Rx classification: Prescription only (Rx). Schedule I drug under the Controlled Drugs and Substances Act. A valid prescription from a licensed Canadian healthcare professional is required for personal importation.

Mechanism of Action and Pharmacology

Levonorgestrel is a synthetic progestin of the 19‑nortestosterone class, and ethinyl estradiol is a synthetic estrogen. The primary contraceptive mechanism is the suppression of the hypothalamic‑pituitary‑ovarian axis: exogenous estrogen and progestin inhibit the secretion of follicle‑stimulating hormone (FSH) and luteinizing hormone (LH), thereby preventing follicular development and ovulation. Levonorgestrel also thickens the cervical mucus, which impedes sperm penetration, and alters the endometrial lining to create a state unreceptive to implantation. Ethinyl estradiol stabilizes the endometrium, providing predictable withdrawal bleeding and reducing the likelihood of breakthrough bleeding. After oral administration, both components are rapidly absorbed, with peak plasma concentrations reached within 1‑2 hours. Levonorgestrel is extensively bound to sex‑hormone‑binding globulin (SHBG) and albumin; ethinyl estradiol is bound to albumin and induces an increase in SHBG. Both are metabolized in the liver and excreted in the urine and faeces as conjugates. The elimination half‑life of levonorgestrel is approximately 20‑30 hours, and that of ethinyl estradiol is approximately 10‑20 hours. The two strengths provided—0.15 mg/0.03 mg and 0.25 mg/0.05 mg—allow for individualization of therapy, with the lower dose minimizing estrogen‑related side effects and the higher dose providing enhanced cycle control.

Indications

• Prevention of pregnancy in women who elect to use an oral contraceptive.
• Not indicated for the treatment of acne, premenstrual dysphoric disorder, or other conditions unless specified by the prescribing physician.
• Alesse is intended for use in women of reproductive age. It is not indicated for postmenopausal women, children before menarche, or men.

Important Warnings and Precautions

At‑risk groups

• Pregnancy: Alesse is contraindicated during pregnancy. If pregnancy occurs, the medication must be discontinued immediately. There is no evidence of an increased risk of birth defects in women who inadvertently used combined oral contraceptives early in pregnancy.
• Breastfeeding: Combined hormonal contraceptives may reduce milk production and affect the composition of breast milk. Small amounts of contraceptive steroids are excreted in breast milk. Alesse is not recommended during breastfeeding; a progestin‑only contraceptive may be a safer alternative.
• Paediatrics (< menarche): Safety and efficacy have not been established in children or adolescents before menarche. Alesse is indicated only for women of reproductive age.
• Elderly: Alesse is not indicated for use in postmenopausal women and should not be used as hormone replacement therapy.
• Venous thromboembolism (VTE): Combined oral contraceptives increase the risk of deep vein thrombosis and pulmonary embolism. The risk is highest during the first year of use and in women with a personal or family history of VTE, thrombophilia, obesity, or prolonged immobilisation. The risk with levonorgestrel‑containing pills is considered slightly lower than with those containing desogestrel, gestodene, or drospirenone.
• Arterial thromboembolism: The risk of myocardial infarction and stroke is increased in users of combined oral contraceptives, particularly in women who smoke, are over 35 years of age, have hypertension, or have migraine with aura. Alesse should be discontinued at least 4 weeks before major elective surgery and during prolonged immobilisation.
• Hypertension: Alesse is contraindicated in women with uncontrolled hypertension. Blood pressure should be checked before starting therapy and monitored periodically.
• Liver disease: Alesse is contraindicated in women with active liver disease, including viral hepatitis, cirrhosis, or liver tumours (benign or malignant). Liver function must return to normal before the medication can be used.
• Migraine: Combined oral contraceptives are contraindicated in women with migraine with aura (focal neurological symptoms). In women who develop new‑onset migraine or significant worsening of migraines, the medication should be discontinued.
• Diabetes mellitus: Low‑dose combined oral contraceptives have a small effect on glucose and lipid metabolism. Women with diabetes should be monitored carefully, and their insulin or oral hypoglycaemic requirements may need adjustment.
• Breast and reproductive cancers: Long‑term use of combined oral contraceptives is associated with a slight increase in the risk of breast and cervical cancer. Alesse is contraindicated in women with known or suspected breast carcinoma or other estrogen‑ or progestin‑dependent neoplasia.
• Gallbladder disease: Combined oral contraceptives increase the risk of gallstone formation and cholecystitis.
• Depression: Women with a history of depression should be observed carefully, and the drug should be discontinued if severe depression recurs.
• Allergy: Do not take Alesse if you have a known hypersensitivity to levonorgestrel, ethinyl estradiol, or any excipient in the tablet.

Driving and alcohol

Alesse has no known influence on the ability to drive or operate machinery. Moderate alcohol consumption does not directly interfere with the contraceptive effect; however, excessive drinking can lead to vomiting or severe diarrhoea, which may reduce the absorption of the active tablets. Women who vomit within 3‑4 hours of taking an active tablet should use a backup contraceptive method. Alcohol intake should be limited to minimise the risk of gastrointestinal upset that could compromise contraceptive reliability.

Dosage Instructions

• Standard regimen: Take one tablet daily at approximately the same time each day for 21 consecutive days, followed by a 7‑day tablet‑free interval (or 7 days of inert placebo tablets if provided). Withdrawal bleeding usually begins 2‑3 days after the last active tablet. A new pack is started on the day after finishing the previous pack, regardless of bleeding.
• Strength selection: The 0.15 mg/0.03 mg tablet is generally used as the starting dose for most women, as it provides effective contraception with a favourable side‑effect profile. The 0.25 mg/0.05 mg tablet may be prescribed for women who experience breakthrough bleeding or who require a higher estrogen dose for cycle control. The choice of strength should be individualized by the prescribing physician.
• Starting Alesse:
  • Day 1 start: Take the first tablet on the first day of menstrual bleeding. Contraceptive protection begins immediately; no backup method is needed.
  • Sunday start: Take the first tablet on the first Sunday after the onset of menstrual bleeding. A backup barrier method must be used for the first 7 days.
  • Switching from another combined hormonal contraceptive: Start Alesse on the day after the last active tablet of the previous product. No backup method is required.
  • After childbirth or second‑trimester abortion: Start no earlier than 4 weeks postpartum (6 weeks if breastfeeding is being considered). If intercourse has already occurred, pregnancy must be excluded before starting.
  • After first‑trimester abortion: Alesse can be started immediately.
• Missed tablet(s):
  • If one active tablet is missed by less than 24 hours, take it as soon as remembered and continue taking the remaining tablets at the usual time. No backup method is needed.
  • If two consecutive active tablets are missed in week 1 or week 2, take two tablets on the day remembered and two tablets the next day, then continue with one tablet daily. Use a backup method for 7 days.
  • If two consecutive active tablets are missed in week 3, or three or more active tablets are missed at any time: discard the rest of the pack and start a new pack that same day. Use a backup method for 7 days.
• Gastrointestinal upset: If vomiting or severe diarrhoea occurs within 3‑4 hours of taking an active tablet, treat this as a missed tablet and follow the missed‑tablet instructions. Use a backup method for 7 days.
• Withdrawal bleeding: The absence of a withdrawal period during the tablet‑free interval may indicate pregnancy. Pregnancy should be excluded before starting the next pack if two consecutive cycles have no withdrawal bleeding.

Side Effects and Contraindications

• Common side effects (≥ 1%): Irregular uterine bleeding (spotting or breakthrough bleeding, especially in early cycles), nausea, breast tenderness, headache, mood changes (including depression and irritability), weight changes, decreased libido, and vaginal candidiasis. The 0.15 mg/0.03 mg strength is associated with fewer estrogen‑related side effects such as nausea and breast tenderness compared with the 0.25 mg/0.05 mg strength.
• Serious adverse reactions: Venous thromboembolism (deep vein thrombosis, pulmonary embolism), arterial thromboembolism (myocardial infarction, stroke, retinal thrombosis), hypertension, gallbladder disease, benign and malignant liver tumours (including hepatocellular carcinoma and hepatic adenoma), pancreatitis associated with severe hypertriglyceridemia, and chloasma (melasma) that may be permanent. An increased risk of breast and cervical cancer has been observed in long‑term users.
• Contraindications: History of or current venous thromboembolism or thrombophlebitis; known thrombophilic conditions; history of or current arterial thromboembolism (myocardial infarction, stroke, transient ischaemic attack); migraine with aura or focal neurological symptoms; diabetes mellitus with vascular involvement; uncontrolled hypertension; known or suspected estrogen‑ or progestin‑dependent neoplasia (including breast carcinoma); active liver disease or history of liver tumours (benign or malignant); undiagnosed abnormal genital bleeding; known or suspected pregnancy; hypersensitivity to any component of the product.

Drug Interactions

• Enzyme‑inducing drugs (reduce contraceptive efficacy): Rifampin, rifabutin, carbamazepine, phenobarbital, phenytoin, primidone, oxcarbazepine, topiramate, felbamate, griseofulvin, and products containing St. John's wort may increase hepatic metabolism of contraceptive hormones, leading to breakthrough bleeding or unintended pregnancy. A backup barrier method should be used while taking these inducers and for 28 days after discontinuation.
• Protease inhibitors and NNRTIs: Some HIV protease inhibitors (e.g., ritonavir, nelfinavir) and non‑nucleoside reverse transcriptase inhibitors (e.g., nevirapine, efavirenz) can alter contraceptive steroid metabolism, potentially reducing efficacy. A condom should be used in addition to Alesse.
• Antibiotics (controversial interaction): With the exception of rifampin‑like drugs, most antibiotics (e.g., ampicillin, tetracyclines) have not been consistently shown to reduce the effectiveness of oral contraceptives. No routine backup method is recommended, but women who experience breakthrough bleeding during antibiotic therapy may choose to use additional protection.
• Lamotrigine: Ethinyl estradiol may reduce plasma concentrations of lamotrigine, potentially reducing seizure control or requiring a dose adjustment.
• Cyclosporine, theophylline, and corticosteroids: Estrogen‑containing contraceptives may inhibit the metabolism of cyclosporine, increase concentrations of theophylline, and prolong the half‑life of corticosteroids (e.g., prednisolone). Appropriate dose adjustments and monitoring are advised.

Practical Advice

• Administration: Take one tablet every day at the same time, without skipping days. Tablets may be taken with or without food; taking with a meal or at bedtime may reduce nausea. If you have difficulty remembering, set a daily alarm or link tablet‑taking to a routine activity.
• Monitoring: Before starting Alesse, a complete medical history and physical examination should be performed, including a blood pressure check, breast and pelvic examination, and assessment of risk factors for thromboembolism. Blood pressure should be rechecked periodically. Women over 35 who smoke should be counselled strongly to stop smoking, as the cardiovascular risks are substantially elevated.
• Storage: Store at room temperature (15‑30 °C) in the original packaging, protected from moisture and light. Keep out of the reach and sight of children.
• Lifestyle: Alesse does not protect against HIV/AIDS or other sexually transmitted infections. A condom should be used for STI protection. If you plan to become pregnant, discontinue Alesse and wait for one spontaneous menstrual period before trying to conceive. If you are scheduled for major surgery or prolonged immobilisation, inform your surgeon that you are taking an oral contraceptive; the pill may need to be stopped 4 weeks beforehand.
• When to seek medical attention: Stop taking Alesse and contact your doctor immediately if you experience any of the following warning signs of a blood clot: sudden severe chest pain or shortness of breath, coughing up blood, unexplained swelling or pain in a leg, sudden severe headache or vomiting, dizziness or fainting, weakness or numbness of the face, arm, or leg, vision loss or double vision, or jaundice (yellowing of the skin or eyes).
• Disposal: Return unused or expired medication to a pharmacy for safe disposal. Do not flush down the toilet or discard in household waste.

Alternative Medications

• Other combined oral contraceptives (COCs): Pills containing different progestins (e.g., desogestrel, norgestimate, drospirenone) and estrogens are widely available in Canada. Low‑dose formulations of levonorgestrel/ethinyl estradiol (0.10 mg/0.02 mg) are the most commonly prescribed first‑line COCs in Canada (e.g., Aviane, Lutera, Portia). The 0.15 mg/0.03 mg and 0.25 mg/0.05 mg strengths provide alternatives for women needing different estrogen doses.
• Progestin‑only contraceptives: The “mini‑pill” (norethindrone or levonorgestrel), the depot‑medroxyprogesterone acetate injection (Depo‑Provera), the etonogestrel implant (Nexplanon), and the levonorgestrel‑releasing intrauterine system (Mirena, Kyleena, Jaydess) are alternatives for women who cannot take estrogen.
• Non‑hormonal options: Copper intrauterine devices (e.g., Nova‑T, Flexi‑T) provide long‑acting, hormone‑free contraception. Barrier methods (male and female condoms, diaphragms) offer STI protection but have higher pregnancy rates with typical use.

Clinical Efficacy

The contraceptive efficacy of levonorgestrel/ethinyl estradiol combinations is well established. With perfect use (taking every tablet correctly and on time), the Pearl Index is approximately 0.1‑0.4 pregnancies per 100 woman‑years. With typical use, including missed tablets, the Pearl Index rises to approximately 9. The 0.15 mg/0.03 mg dose provides effective ovulation inhibition with a favourable side‑effect profile, while the 0.25 mg/0.05 mg dose is effective for women who require stronger ovarian suppression or who have inadequate cycle control on the lower dose. Levonorgestrel‑containing pills are among the most widely studied and prescribed oral contraceptives worldwide, with a well‑characterized safety profile. The VTE risk with levonorgestrel is lower than with some other progestins, making it a preferred first‑line choice in many clinical guidelines.

Important:

Alesse (levonorgestrel/ethinyl estradiol) is a prescription combined hormonal contraceptive that should be used only under the supervision of a qualified healthcare professional. It is not to be used during pregnancy or while breastfeeding. Cigarette smoking, particularly in women over 35 years of age, greatly increases the risk of serious cardiovascular events, including heart attack, stroke, and blood clots. Alesse is contraindicated in women with a history of venous thromboembolism, thrombophilia, migraine with aura, uncontrolled hypertension, liver disease, or estrogen‑dependent cancers. Seek emergency medical attention immediately if you develop symptoms of a blood clot, such as sudden severe chest pain, shortness of breath, coughing up blood, unexplained leg pain or swelling, sudden severe headache or weakness on one side of the body. This information is not a substitute for professional medical advice, diagnosis, or treatment.

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