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dolishale

Generic Lybrel
Used for Birth Control
Used for Birth Control

Amethyst is a combined hormonal birth control pill that's taken by mouth every day. It's known as a continuous cycle birth control because it doesn't contain any hormone-free pills. It can be a good option for you if you want to skip your periods. Amethyst is available as a lower-cost generic.

Last reviewed on June 22, 2022
basics-icon

What is Amethyst?

What is Amethyst used for?

  • To prevent pregnancy

How Amethyst works

Amethyst is a combined oral contraceptive (COC) that contains two hormones: ethinyl estradiol (an estrogen) and levonorgestrel (a progestin). Both hormones work together to prevent pregnancy by suppressing ovulation (release of an egg from the ovary), changing cervical mucus to block sperm movement, and creating an unfriendly environment for the fertilized egg by changing the lining in the uterus (womb).

Drug Facts

Common BrandsAmethyst, Dolishale, Lybrel (brand no longer available)
Drug ClassEstrogen / Progestin combined contraceptive
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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Avg retail price
$59.60(save 65.27%)
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$20.70
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What are the side effects of Amethyst?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Nausea
  • Vomiting
  • Stomach cramps
  • Bloating
  • Spotting
  • Breast tenderness
  • Weight changes (up or down)
  • Headache
  • Raised blood pressure
  • Depression

Other Side Effects

  • Yeast infection
  • Spotty darkening of skin
  • Change in sex drive
  • Acne
  • Change in appetite

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Heart attack: chest pain, stomach discomfort, sweating, nausea, dizziness
  • Stroke: sudden numbness or weakness in the arm, leg, or face, confusion, trouble seeing, headache, difficulty walking
  • Deep vein thrombosis (blood clot in the leg): leg cramp, swelling, pain, muscle tightness
  • Pulmonary embolism (blood clot in the lung): cough, chest pain, trouble breathing, racing heart
  • Liver problems: yellowing of the skin or the whites of the eyes, tiredness, stomach pain

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

  • Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
  • Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
  • Gallbladder problems—severe stomach pain, nausea, vomiting, fever
  • Increase in blood pressure
  • Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
  • New or worsening migraines or headaches
  • Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
  • Unusual vaginal discharge, itching, or odor
  • Worsening mood, feelings of depression

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

  • Breast pain or tenderness
  • Dark patches of skin on the face or other sun-exposed areas
  • Irregular menstrual cycles or spotting
  • Nausea
  • Weight gain
pros-and-cons

Pros and cons of Amethyst

thumbs-up

Pros

Once-daily dosing

Can have fewer periods or no period at all

Works well to prevent pregnancy (98% successful at preventing pregnancy with perfect use)

Available as a lower-cost generic

Comes as an easy-to-follow blister pack

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Cons

Not a good option for females over 35 who smoke

Can cause unpleasant side effects like nausea, vomiting, and headaches

Doesn't protect against sexually transmitted diseases (STDs)

Need to take it at the same time every day for it to work well

Not recommended during breastfeeding

pharmacist-tips

Pharmacist tips for Amethyst

pharmacist
  • Set an alarm to help you remember to take Amethyst at the same time every day. Forgetting to take your pill raises your chance of getting pregnant. If you miss a dose or start your pack late, use a back-up method of birth control any time you have sex until you can refer to the instructions that came with your prescription or call your provider.

    • It's normal to have spotting (light bleeding) or feel sick to your stomach for the first few packs of Amethyst. This should get better over time. If you experience continuous bleeding or spotting for more than 7 days in a row, contact your provider.

      • If you have vomiting or diarrhea, or take certain medications, Amethyst might not work as well for you. Always use a back-up birth control method until you're able to check with your healthcare provider.

        • Any time you vomit within 4 hours of taking Amethyst, it's considered a missed dose and you should check the instructions in your pack or call your provider to discuss what to do.

          • Don't skip pills even if you have spotting, bleeding, feel sick to your stomach, or don't have sex often. Doing so will make Amethyst work less well and can lead to pregnancy. If you have bothersome side effects or wish to change to a different birth control method, speak with your provider.

            • Make an appointment with your eye provider for an exam if you wear contact lenses and notice vision changes when wearing them or when wearing your glasses while taking Amethyst.

              • Once you finish a pack of Amethyst, continue directly to a new pack on the next day. Don't skip any days in between packs since they're meant to be taken continuously every day.

                • Since you're likely to skip periods while taking Amethyst, it can be harder to tell if you're pregnant. If you feel like you might be pregnant, call your provider. Studies haven't shown a risk of birth defects in females who've used birth control pills before pregnancy or during early pregnancy, but it's no longer necessary to take them once you're pregnant.

                  • Hormonal birth control pills like Amethyst can lower the quality and amount of breast milk you're able to produce and aren't recommended during breastfeeding. If you're breastfeeding, ask your provider about alternative birth control options.

                    • Amethyst has been prescribed specifically for you, so don't share it with anyone who wants to take birth control. Their provider should evaluate them to make sure they get a safe option.

                      faqs

                      Frequently asked questions about Amethyst

                      How should I start taking Amethyst?
                      If you're currently not taking any hormonal contraceptives, you can begin taking Amethyst on the first day of your period. If you're switching from a 21 or 28-day combined hormonal birth control pack, you can start Amethyst on the first day of your withdrawal bleed (at the latest 7 days after your last active tablet). You don't need to use a back-up method of birth control in either of these situations. If you're switching from a progestin-only pill (e.g., norethindrone (Errin)), an implant (e.g., Nexplanon (etonogestrel)), or an injection (e.g., medroxyprogesterone (Depo-Provera)), refer to the label that came with your Amethyst pack or ask your provider how you should start it. You'll likely need to use another method of birth control (e.g., condom or spermicide) for the first 7 days.
                      What does it mean that Amethyst is a continuous cycle birth control?
                      A continuous cycle birth control is a type of COC that contains all active pills, which means that every pill contains hormones. This is different from other COCs, where you typically have a few inactive (hormone-free) pills. Because Amethyst contains all active pills, you might not have any bleeding at all. Or, you might experience some breakthrough bleeding or spotting (light bleeding), but this tends to get better over time.
                      What's the difference between continuous cycle birth control and extended-cycle birth control?
                      Both continuous cycle birth control and extended-cycle birth control are COCs, which means they contain both estrogen and progesterone. Continuous cycle birth control contains all active pills. Because there aren't any hormone-free days, you might not experience any bleeding while you're taking this type of birth control. Extended-cycle birth control contains 84 days (3 months) of active pills followed by 7 days of pills with either no hormones or only estrogen. During the time you take these 7 pills, you'll likely get withdrawal bleeding , which is like a period. Discuss the best option for you with your provider.
                      Will I have bleeding or spotting while taking Amethyst?
                      It's still possible to have bleeding or spotting while you're taking Amethyst. This is normal and for many people, it should gets better over time. Studies show that after using Amethyst for 1 year, about 60% of females no longer experienced any bleeding or spotting. If you have heavy bleeding or if your bleeding lasts more than a week while you take Amethyst, let your provider know.
                      Is it safe to take Amethyst long-term?
                      Talk with your provider about the safety of taking Amethyst long-term. It has similar risks for problems such as blood clots and breast cancer as other COCs. Depending on whether or not you have other health conditions, such as high blood sugar or blood pressure, your provider might recommend other types of birth control for you.
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                      What are the risks and warnings for Amethyst?

                      Amethyst can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                      risk-warning

                      Cigarette smoking and serious heart problems

                      • Risk factors: Female over 35 years old who smoke cigarettes

                        If you smoke cigarettes, using combined oral contraceptives (COCs), like Amethyst, raises your risk for serious health problems, such as strokes, heart attacks, and blood clots. Females age 35 years and older who smoke are at even higher risk for these problems. If you smoke, talk with your provider about safer birth control alternatives.

                        risk-warning

                        Blood clots and strokes

                        • Risk factors: Females over 35 years old who smoke | Females over 40 years old who don't smoke | Recent surgery with a long period of bed rest | Starting Amethyst less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen

                          Amethyst raises your risk of blood clots. These clots can occur anywhere in your body, including your lungs (pulmonary embolism or PE), legs (deep vein thrombosis or DVT), brain (stroke), and heart (heart attack). Get emergency help right away if you have any signs of a blood clot:

                          • Brain: weakness or numbness in your arms, legs, or face on one side of the body, trouble speaking, blurred vision, dizziness, loss of balance, trouble walking, or confusion

                            • Eyes: trouble seeing, bulging eye, double vision

                              • Heart: chest pain, sweating, nausea, or dizziness

                                • Lungs: trouble breathing, chest pain, or cough

                                  • Legs: cramps, swelling, pain, or muscle tightness

                                    If you need to have surgery, tell your provider you're taking Amethyst. They might have you stop taking it 4 weeks before until 2 weeks after your surgery to lower your risk of blood clots.

                                    risk-warning

                                    Risk of breast and cervical cancer

                                    • Risk factors: History of breast cancer | Taking COCs for a long time

                                      Study results are mixed, but there's a possibility that Amethyst and other COCs can raise your risk for breast and cervical cancer.

                                      Don't use Amethyst if you have breast cancer because some types of breast cancer grow faster in the presence of estrogen, an ingredient in this birth control pill. To help with early breast cancer detection, you can do monthly breast self-checks at home and yearly breast exams with your healthcare provider. Call your healthcare provider if you notice any abnormal changes or feel lumps, pain, or swelling in your breasts.

                                      Get medical help right away if you experience abnormal vaginal bleeding, discharge, or pain during sex, since these could be signs of cervical cancer.

                                      risk-warning

                                      Liver problems

                                      • Risk factors: Liver problems or infection in the liver | Taking COCs with 50 mcg of estrogen or higher

                                        Though rare, Amethyst can cause liver problems, such as liver damage and liver tumors. These problems are linked more with earlier formulations of COCs that contained higher levels of estrogen (50 mcg or higher), and less so with Amethyst since it only contains 20 mcg of estrogen. Don't use this medication if you already have liver problems. Call your provider right away if you experience symptoms of liver problems, such as tiredness, stomach pain, or yellowing of the skin or whites of the eyes.

                                        risk-warning

                                        High blood sugar and triglycerides

                                        • Risk factors: High blood sugar

                                          Amethyst might raise your blood sugar and triglyceride (fat) levels. If you have diabetes, you might need to monitor your blood sugar more closely after you start Amethyst. Let your provider know if you experience any changes in your blood sugar.

                                          risk-warning

                                          High blood pressure

                                          • Risk factors: High blood pressure | Older age | Using COCs for a long time | Kidney problems

                                            Amethyst and other COCs can raise your blood pressure. Your provider might ask you to check your blood pressure regularly. If you notice your blood pressure is higher while you're taking this medication, contact your provider. If you have uncontrolled high blood pressure, Amethyst might not be the best option for you.

                                            risk-warning

                                            Headache

                                            Headaches are a common side effect of COCs like Amethyst. But, if you experience a new migraine, a migraine that's worse than normal, or a new headache that keeps coming back or is severe, call your provider so you can be checked out.

                                            risk-warning

                                            Irregular bleeding

                                            Breakthrough bleeding and spotting are common side effects of Amethyst. This is more common at first, but should get better over time. Let your provider know if you experience any irregular vaginal bleeding so they can help you figure out why you're bleeding.

                                            risk-warning

                                            Pregnancy outside of the womb

                                            Research suggests that females who take that COCs are at a higher risk of pregnancy occuring outside of the womb (ectopic pregnancy) if the birth control pills don't work like they're supposed to. The chance of becoming pregnant is higher when you don't take Amethyst as instructed at the same time every day. Symptoms of an ectopic pregnancy include low back pain, abnormal vaginal bleeding, and cramping. If you experience any of these symptoms, contact your provider.

                                            risk-warning

                                            Depression

                                            • Risk factors: History of depression

                                              Let your provider know if you experience symptoms of depression or changes in your mood while taking Amethyst. In cases of serious depression, your provider might have you stop taking it.

                                              risk-warning

                                              Interactions with other medications

                                              Certain medications can make Amethyst get broken down faster in your body, making it less effective and can lead to pregnancy. Some examples include carbamazepine (Tegretol) and phenytoin (Dilantin). Use a back-up method or other form of birth control for at least 28 days after stopping any of these medications. Other medications can raise the amount of Amethyst in your body, which can lead to more side effects. Make sure to tell your provider or pharmacist all of your medications so they can make sure they don't interact with Amethyst.

                                              If you have hepatitis C and need to be treated with Viekira Pak (dasabuvir / ombitasvir / paritaprevir / ritonavir), let your provider know right away that you're taking a COC. You'll need to stop Amethyst before starting Viekira Pak because taking them together can cause liver problems. You can start Amethyst again 2 weeks after you stop Viekira Pak.

                                              dosage

                                              Amethyst dosage forms

                                              The average cost for 1 package of 28 tablets of 90mcg/20mcg of Amethyst is $20.70 with a free GoodRx coupon. This is 65.27% off the average retail price of $59.60.
                                              package
                                              Package
                                              DosageQuantityPrice as low asPrice per unit
                                              28 tablets of 90mcg/20mcg1 package$20.70$20.70

                                              Typical dosing for Amethyst

                                              Your medication might look different and have slightly different directions depending on which branded generic your provider prescribes. Please take the medication as instructed by your provider. In general:

                                              Amethyst (and its branded generics) comes in a 28-day pack. All 28 tablets are active tablets and they each contains 90 mcg levonorgestrel and 20 mcg ethinyl estradiol.

                                              • The typical dose is 1 tablet by mouth at the same time every day.

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                                              How much does Amethyst cost?

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                                              contraindications-icon

                                              Amethyst contraindications

                                              Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Amethyst will not be safe for you to take.
                                              • Smoking and smoking over the age of 35

                                              • History of heart attack or stroke

                                              • Currently have or history of DVT, PE, or blood clot in your eye(s)

                                              • History of blood clotting problems

                                              • Chest pain

                                              • Currently have or have a history of breast cancer

                                              • Endometrial cancer, cervical cancer, or certain estrogen-dependent cancers

                                              • Undiagnosed abnormal vaginal bleeding

                                              • Liver tumors

                                              • Liver disease

                                              • Taking hepatitis C medication containing ombitasvir / paritaprevir / ritonavir, with or without dasabuvir

                                              • Currently have or have a history of jaundice (yellowing of the skin and whites of the eyes)

                                              • Pregnancy

                                              • Major surgery where you aren't able to walk for a long time

                                              • Certain heart valve or heart rhythm problems

                                              • Diabetes with blood vessel problems

                                              • Certain types of headaches

                                              • Uncontrolled high blood pressure

                                              alternatives

                                              What are alternatives to Amethyst?

                                              There are a number of medications that your doctor can prescribe in place of Amethyst. Compare a few possible alternatives below.
                                              Amethyst
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                                              • To prevent pregnancy

                                              $20.70 Lowest GoodRx priceView Prices
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                                              • To prevent pregnancy

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                                              $66.56 Lowest GoodRx priceView Prices

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