levonorgestrel / ethinyl estradiol
Jolessa is a combined oral contraceptive (COC). It contains 2 medications: levonorgestrel (a progestin) and ethinyl estradiol (an estrogen). They prevent pregnancy by stopping ovulation and blocking implantation. Jolessa is an extended-cycle birth control that comes in a 91-day pack. Each pack contains 84 active hormone pills and 7 placebo pills. Jolessa is monophasic, meaning the hormone level is the same in each active pill (0.15 mg of levonorgestrel and 30 mcg ethinyl estradiol). Common side effects of this birth control include headache, heavy periods, and nausea.
Jolessa is the generic of the discontinued brand name Seasonale. Other generics that are like Jolessa include Setlakin and Introvale.
What is Jolessa (levonorgestrel / ethinyl estradiol)?
What is Jolessa (levonorgestrel / ethinyl estradiol) used for?
To prevent pregnancy
How Jolessa (levonorgestrel / ethinyl estradiol) works
Jolessa is a combination of two hormones, levonorgestrel (a progestin) and ethinyl estradiol (an estrogen). These two hormones work together to prevent pregnancy by:
Stopping ovulation (release of an egg from the ovary)
Thickening cervical mucus (fluid from the cervix), which makes it hard for sperm to move and fertilize an egg
Thinning the lining of the uterus (womb) so a fertilized egg can't live
Drug Facts
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What are the side effects of Jolessa (levonorgestrel / ethinyl estradiol)?
Common Side Effects
- Headache (21%)
- Heavy periods (12%)
- Nausea (8%)
- Period cramps (6%)
- Acne (5%)
Other Side Effects
- Mood swings
- Weight gain
- Migraine
- Breast tenderness
- Feeling depressed
Serious Side Effects
- Heart attack: chest pain, belly 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 or gallbladder problems: yellowing of the skin or the whites of the eyes, tiredness, pain in the right upper stomach, dark urine
Source: DailyMed
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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 of Jolessa (levonorgestrel / ethinyl estradiol)
Pros
Once-daily dosing
Taken by mouth
Period only once every 3 months
Available as a lower-cost generic medication
Cons
Doesn't protect against sexually transmitted diseases (STDs)
Can cause unpleasant side effects, like headache and period cramps
Might worsen certain medical conditions, such as chloasma and hereditary angioedema
Pharmacist tips for Jolessa (levonorgestrel / ethinyl estradiol)
Jolessa (levonorgestrel / ethinyl estradiol) can prevent pregnancy, but it can't protect you from human immunodeficiency virus (HIV) or other sexually transmitted infections (STIs). Using a condom along with Jolessa (levonorgestrel / ethinyl estradiol) can help lower your risk of a STI.
Try to take Jolessa (levonorgestrel / ethinyl estradiol) around the same time every day. Consider setting an alarm to remind yourself to take your doses at the scheduled time.
If you missed one tablet of Jolessa (levonorgestrel / ethinyl estradiol), take your missed dose as soon as possible and take your next scheduled dose at the regular time. You might need to take two tablets in one day. If you've missed more than one tablet in a blister pack, refer to the instructions that came with your pack or call your gynecologist or pharmacist for further instructions.
It's normal to have irregular bleeding (a small amount of vaginal bleeding) while using Jolessa (levonorgestrel / ethinyl estradiol). This doesn't mean that your medication isn't working. Continue to take Jolessa (levonorgestrel / ethinyl estradiol) every day as directed by your gynecologist. Speak with your gynecologist if your bleeding doesn't stop or if you missed your period.
Let your gynecologist know if you experience symptoms of depression or worsening mood while taking Jolessa (levonorgestrel / ethinyl estradiol). In cases of serious depression, your gynecologist might ask you to stop taking this medication.
Jolessa (levonorgestrel / ethinyl estradiol) can interact with many medications. Let your gynecologist or pharmacist know what medications you're taking, including over-the-counter products and supplements, before you start this medication. Talk with your gynecologist or pharmacist if you have any questions about interactions with Jolessa (levonorgestrel / ethinyl estradiol).
If you've had a skin condition that causes brownish patches on your skin, these patches can reappear or darken while taking Jolessa (levonorgestrel / ethinyl estradiol). Avoid exposing your skin to the sun or ultraviolet radiation (e.g., tanning booths, sun lamps) while you're taking this medication.
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What are the risks and warnings for Jolessa (levonorgestrel / ethinyl estradiol)?
Jolessa (levonorgestrel / ethinyl estradiol) 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.
Cigarette smoking and serious heart problems
Risk factors: Females over 35 years old who smoke cigarettes
If you smoke cigarettes, taking combined oral contraceptives (COCs) like Jolessa (levonorgestrel / ethinyl estradiol) raises your risk for serious health problems, such as stroke, heart attack, and blood clots. Females ages 35 years and older who smoke are at even higher risk for these problems. If you smoke, talk with your OB-GYN provider or healthcare professional (HCP) about safer birth control alternatives.
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 Jolessa (levonorgestrel / ethinyl estradiol) less than a month after childbirth | High blood pressure | People identified as obese | High cholesterol | Diabetes | Higher dose of estrogen
Jolessa (levonorgestrel / ethinyl estradiol) 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 healthcare team you're taking Jolessa (levonorgestrel / ethinyl estradiol). They might have you stop taking it 4 weeks before until 2 weeks after your surgery to lower your risk of blood clots.
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 Jolessa (levonorgestrel / ethinyl estradiol) and other COCs can raise your risk for breast and cervical cancer.
Don't take Jolessa (levonorgestrel / ethinyl estradiol) 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 professional. Call your HCP 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.
Liver problems
Risk factors: Liver problems or infection in the liver | Taking COCs with 50 mcg of estrogen or higher
Though rare, Jolessa (levonorgestrel / ethinyl estradiol) can cause liver problems, such as liver damage and liver tumors. These problems are linked more with earlier formulations of COCs that contained higher doses of estrogen (50 mcg or higher), and less so with Jolessa (levonorgestrel / ethinyl estradiol) since it only contains 30 mcg of estrogen. Don't take this medication if you already have liver problems. Call your HCP right away if you experience symptoms of liver problems, such as tiredness, stomach pain, or yellowing of the skin or whites of the eyes.
High blood sugar and triglycerides
Risk factors: Prediabetes or diabetes | Personal or family history of high triglycerides | High dose
COCs like Jolessa (levonorgestrel / ethinyl estradiol) might raise your blood sugar and triglyceride (fat) levels. If you have diabetes, let your HCP know if you experience any changes in your blood sugar. Make sure to go to all of your check-ups so your healthcare team can monitor any changes.
High blood pressure
Risk factors: High blood pressure | Older age | Using COCs for a long time | Kidney problems
Jolessa (levonorgestrel / ethinyl estradiol) and other COCs can raise your blood pressure. Your HCP 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 HCP. If you have uncontrolled high blood pressure, Jolessa (levonorgestrel / ethinyl estradiol) might not be the best option for you.
Headache
Headaches are a common side effect of COCs like Jolessa (levonorgestrel / ethinyl estradiol). 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 HCP so you can be checked out.
Irregular bleeding
Breakthrough bleeding and spotting are common side effects of hormonal birth control pills. This is more common during the first 3 months of taking Jolessa (levonorgestrel / ethinyl estradiol) and might get better over time. Let your HCP know if you experience any vaginal bleeding outside of your period, or if your period has stopped completely. There are other causes besides your birth control pills for irregular bleeding that your HCP will evaluate.
Depression
Risk factors: History of depression
Let your HCP know if you experience symptoms of depression or worsening depression while taking Jolessa (levonorgestrel / ethinyl estradiol). In cases of serious depression, your OB-GYN provider or HCP might have you stop taking it.
Gallbladder problems
Some studies suggest that Jolessa (levonorgestrel / ethinyl estradiol) can raise the risk of gallbladder disease since more progestin and estrogen can lead to higher chance of gallstones. Although the risk is low, talk to your gynecologist if you have a history of gallbladder disease before starting Jolessa (levonorgestrel / ethinyl estradiol).
Swelling attacks
Let your healthcare team know if you or someone in your family has a genetic condition called hereditary angioedema. Taking estrogen-containing medications can trigger swelling attacks in people who have this condition. Get medical help right away if you notice swelling in the face, arms, legs, or if you have trouble breathing.
Interactions with other medications
Certain medications can make Jolessa (levonorgestrel / ethinyl estradiol) break down faster in your body, making it less effective. And this 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 Jolessa (levonorgestrel / ethinyl estradiol) in your body, which can lead to more side effects. Make sure to tell your HCP or pharmacist all of your medications so they can make sure they don't interact with Jolessa (levonorgestrel / ethinyl estradiol).
If you're taking medications to treat hepatitis C, immediately let your HCP know that you're taking a COC. Certain hepatitis C medications can affect the level of Jolessa (levonorgestrel / ethinyl estradiol) in your body, either making it not work as well in preventing pregnancy or raising your risk of side effects. Your healthcare team can give you instructions about what to do if you're taking a hepatitis C medication that can interact with Jolessa (levonorgestrel / ethinyl estradiol).
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Jolessa (levonorgestrel / ethinyl estradiol) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 91 tablets of 0.15mg/0.03mg | 1 package | $29.62 | $29.62 |
Typical dosing for Jolessa (levonorgestrel / ethinyl estradiol)
Jolessa (and its branded generic) comes in a 91-day pack. There are 84 active tablets that contain 0.15 mg of levonorgestrel and 30 mcg ethinyl estradiol. There are 7 placebo tablets that don't contain any active medication.
The typical dose is to take 1 active tablet by mouth daily for 84 days, followed by 1 placebo tablet daily for the remaining 7 days.
Jolessa (levonorgestrel / ethinyl estradiol) contraindications
History of blood clots, stroke, or heart attack
Females over the age of 35 who smoke or have migraine headaches
Certain medical conditions like uncontrolled high blood pressure, diabetes, obesity, coronary artery disease (CAD), or atrial fibrillation (AFib)
Liver tumors or liver disease
Currently pregnant
Currently have or have had breast cancer
Abnormal vaginal bleeding that your gynecologist doesn’t know about or you haven’t gone to them about
Take certain hepatitis C medications like Viekira Pak, containing ombitasvir, paritaprevir, and ritonavir; with or without dasabuvir
What are alternatives to Jolessa (levonorgestrel / ethinyl estradiol)?
To prevent pregnancy
What is the latest news about Jolessa (levonorgestrel / ethinyl estradiol)?
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References
Best studies we foundAmerican College of Obstetricians and Gynecologists. (2023). Abnormal uterine bleeding.
Bolanca, I., et al. (2008). Chloasma--the mask of pregnancy. Collegium Antropologicum.
Cooper, D. B., et al. (2024). Oral contraceptive pills. StatPearls.
Cortés, M. E., et al. (2014). The effects of hormonal contraceptives on glycemic regulation. The Linacre Quarterly.
Etminan, M., et al. (2011). Oral contraceptives and the risk of gallbladder disease: a comparative safety study. Canadian Medical Association Journal.
Hannaford, P. C., et al. (1997). Combined oral contraceptives and liver disease. Contraception.
InformedHealth.org. (2022). Acne: Research summaries - Which birth control pills can help reduce acne? Institute for Quality and Efficiency in Health Care.
Latwal, B., et al. (2020). Authorized generics vs. branded generics: A perspective. Journal of Generic Medicines: The Business Journal for the Generic Medicines Sector.
National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Estrogens and oral contraceptives. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury.
Teva Pharmaceuticals USA, Inc. (2024). JOLESSA- levonorgestrel / ethinyl estradiol [package insert]. DailyMed.
Weerasinghe, M., et al. (2017). Overdose of oral contraceptive pills as a means of intentional self-poisoning amongst young women in Sri Lanka: Considerations for family planning. The Journal of Family Planning and Reproductive Health Care.
Xiromed, LLC. (2022). Introvale- levonorgestrel and ethinyl estradiol kit [package insert]. DailyMed.
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