Elevin

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Elevin on Prescriptsy

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Elevin is a combined oral contraceptive pill (COCP) containing levonorgestrel 150 micrograms and ethinylestradiol 30 micrograms.

It is licensed in the United Kingdom as a reliable method of hormonal contraception for women of reproductive age.

As a monophasic pill, each active tablet contains the same dose of both hormones, making it straightforward to use.

Elevin belongs to the group of second-generation combined pills and contains levonorgestrel, the progestogen associated with the lowest risk of venous thromboembolism (VTE) among combined hormonal contraceptives.

Contraception is one of the most commonly accessed areas of reproductive healthcare in the UK, with approximately 3.1 million women using a combined oral contraceptive.

This page provides a comprehensive clinical overview of Elevin, including how it works, correct usage, dosing guidance, managing missed pills, side effects, safety warnings, drug interactions, and how to obtain a prescription through the NHS or an authorised online prescriber.

Important safety information about Elevin

Before reading further, note the following essential safety points about Elevin.

• Elevin is not suitable for women with a history of blood clots, uncontrolled high blood pressure, migraine with aura, known thrombophilic disorders, or active liver disease.
• Combined pills including Elevin carry a small but real increased risk of venous thromboembolism, including deep vein thrombosis and pulmonary embolism.
• Smoking while taking Elevin significantly increases the risk of cardiovascular complications. Women over 35 who smoke must not use combined oral contraceptives.
• Elevin does not protect against sexually transmitted infections. Condoms should be used if STI protection is required.

What is hormonal contraception

Hormonal contraceptives use synthetic versions of the naturally occurring sex hormones oestrogen and progesterone to prevent pregnancy.

Combined oral contraceptives such as Elevin contain both an oestrogen (ethinylestradiol) and a progestogen (levonorgestrel), while progestogen-only pills contain only a progestogen.

The choice between these methods depends on individual medical history, risk factors, lifestyle preferences, and tolerability.

NICE Clinical Knowledge Summary on contraception and FSRH guidelines provide the clinical framework for prescribers making these decisions.

Combined oral contraceptives have been available in the UK since the 1960s and remain one of the most popular reversible methods of contraception.

Their efficacy, well-characterised safety profile, and additional non-contraceptive benefits, including regulation of menstrual cycles, reduction of period pain, and management of acne, make them a first-choice option for many women.

How Elevin works: mechanism of action

Elevin prevents pregnancy through three complementary mechanisms that act at different levels of the reproductive system.

The primary mechanism is suppression of ovulation. Ethinylestradiol and levonorgestrel exert negative feedback on the hypothalamic-pituitary-gonadal axis, inhibiting the secretion of gonadotrophin-releasing hormone (GnRH) from the hypothalamus.

This in turn suppresses the pituitary release of follicle-stimulating hormone (FSH) and luteinising hormone (LH), preventing the mid-cycle LH surge that triggers ovulation.

Without ovulation, no oocyte is released and fertilisation cannot occur.

The second mechanism involves progestogenic changes to the cervical mucus.

Levonorgestrel increases the viscosity and cellularity of cervical mucus, creating a physical and biochemical barrier that impedes sperm transport through the cervical canal.

This effect contributes to contraceptive efficacy even when the primary mechanism is compromised, for example when a pill is taken late.

The third mechanism is modification of the endometrium. The combined hormonal influence renders the endometrial lining less receptive to implantation by suppressing normal proliferative and secretory development.

This provides a further safeguard, although it is considered a secondary rather than primary mechanism of action.

Levonorgestrel: the progestogen in Elevin

Levonorgestrel is a second-generation gonane progestogen with strong progestogenic activity and mild androgenic properties.

It has been used in oral contraceptives since the 1960s and has the most extensive evidence base of any progestogen in this setting.

Epidemiological data consistently show that combined pills containing levonorgestrel are associated with a lower risk of VTE compared with pills containing third-generation (desogestrel, gestodene) or fourth-generation (drospirenone) progestogens.

For this reason, NICE and FSRH guidelines recommend levonorgestrel-containing pills as a first-line combined contraceptive choice, particularly for women starting hormonal contraception for the first time.

Clinical evidence and guidelines

The combined oral contraceptive pill is one of the most extensively studied medications in the history of medicine.

Large cohort studies, including the Royal College of General Practitioners' Oral Contraception Study and the Oxford-FPA Contraceptive Study, have followed hundreds of thousands of women over several decades, establishing a comprehensive understanding of both the benefits and risks of combined oral contraceptive use.

The Faculty of Sexual and Reproductive Healthcare (FSRH) Clinical Guideline on Combined Hormonal Contraception provides evidence-based recommendations for UK practice.

NICE Clinical Knowledge Summaries on contraception align with FSRH guidance and recommend combined oral contraceptives as a safe and effective contraceptive option for most women of reproductive age who do not have contraindications.

Key evidence-based points include the following. With perfect use, the combined pill has a failure rate of less than 1% per year.

Typical-use failure rates are approximately 9% per year, largely attributable to inconsistent use and missed pills rather than method failure.

Combined pill use is associated with a reduced long-term risk of ovarian cancer, endometrial cancer, and colorectal cancer.

The small increased risk of breast cancer associated with current combined pill use declines after discontinuation and returns to baseline within approximately 10 years.

Dosage and administration

Elevin is a monophasic 21-day pill. Each blister strip contains 21 identical active tablets. The standard regimen involves taking one tablet daily for 21 consecutive days, followed by a 7-day tablet-free interval (TFI) during which a withdrawal bleed typically occurs.

Starting Elevin

The recommended time to start Elevin is day 1 of the menstrual cycle, defined as the first day of menstrual bleeding.

Starting on day 1 provides immediate contraceptive protection with no need for additional barrier methods.

If started on days 2 to 5, a 7-day run-in with condoms is advised.

Elevin can be started at any point in the cycle if pregnancy has been reasonably excluded, but barrier contraception is required for the first 7 days.

Managing missed pills

Missing pills is the most common reason for contraceptive failure with oral contraceptives. The FSRH missed pill guidance applies to all combined oral contraceptives including Elevin.

A pill is considered "missed" if it is taken more than 24 hours after the scheduled time.

If one pill is missed (24 to 48 hours late), take it immediately, continue the rest of the pack as usual, and no additional contraception is needed.

If two or more pills are missed (more than 48 hours late), take the most recently missed pill immediately, discard earlier missed pills, continue the pack, and use condoms for the next 7 days.

If pills were missed during the first 7 days of the pack and unprotected intercourse occurred during the pill-free interval or the first week, emergency contraception may be needed.

Tailored regimens

Although the traditional 21/7 regimen remains the most commonly used, FSRH guidance acknowledges that extended and flexible combined pill regimens are safe and may offer additional benefits.

These include taking three consecutive packs without a break (63/7 regimen), or continuous use with a 4-day hormone-free interval when breakthrough bleeding occurs (flexible extended use).

These approaches reduce the total number of withdrawal bleeds per year, which some women prefer for lifestyle or symptom management reasons. Discuss tailored regimens with your prescriber.

Side effects of Elevin

Common side effects

The most frequently reported side effects of combined oral contraceptives containing levonorgestrel and ethinylestradiol are headache, nausea, breast tenderness, mood changes (including irritability and low mood), and breakthrough bleeding or spotting.

These symptoms are most common during the first one to three months of use and often improve as the body adjusts to the hormonal regimen.

If side effects persist beyond three months, a review with your prescriber is appropriate to consider alternative formulations.

Uncommon side effects

Less common effects include decreased libido, migraine, fluid retention, bloating, raised blood pressure, acne or changes in skin texture, and changes in vaginal discharge.

Chloasma, a form of facial hyperpigmentation, may develop particularly with sun exposure and can be persistent.

Women who are susceptible to chloasma should use broad-spectrum sunscreen and minimise direct sun exposure.

Rare but serious side effects

The most clinically significant risk associated with combined oral contraceptives is venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism.

The absolute risk with levonorgestrel-containing pills is approximately 5 to 7 per 10,000 women per year, compared with approximately 2 per 10,000 in non-users and approximately 29 per 10,000 during pregnancy.

Risk factors for VTE include obesity (BMI over 30), immobilisation, recent surgery, a personal or family history of VTE, age over 35, smoking, and inherited thrombophilia.

Arterial thromboembolism (stroke and myocardial infarction) is extremely rare but risk is increased by smoking, hypertension, diabetes mellitus, hyperlipidaemia, obesity, and migraine with aura. The combination of multiple risk factors may render combined pill use inappropriate.

There is a small increased risk of breast cancer among current and recent users of combined oral contraceptives.

This excess risk diminishes after stopping and is no longer detectable approximately 10 years after discontinuation.

Conversely, long-term combined pill use is associated with a significant reduction in the risk of ovarian and endometrial cancer.

When to seek urgent medical advice

Contact your GP, call NHS 111, or attend A&E immediately if you experience sudden severe chest pain, unexplained breathlessness, painful swelling of one leg, sudden severe or unusual headache, loss of vision or visual disturbance, weakness or numbness affecting one side of the body, difficulty speaking, or collapse.

These symptoms may indicate a thrombotic event requiring emergency assessment. Call 999 if symptoms are severe.

Warnings and precautions

Absolute contraindications

Elevin must not be used by women with any of the following: current or past VTE or arterial thromboembolism, known hereditary or acquired thrombophilia, migraine with aura at any age, uncontrolled hypertension (systolic above 160 mmHg or diastolic above 100 mmHg), diabetes with vascular complications, active liver disease or history of liver tumours, current or suspected breast cancer, unexplained vaginal bleeding, or allergy to any component of the tablet.

Women aged over 35 who smoke 15 or more cigarettes per day must not use combined hormonal contraceptives.

Relative contraindications and cautions

Combined pills should be used with caution in women with well-controlled hypertension, BMI over 35, family history of VTE in a first-degree relative under age 45, migraine without aura, inflammatory bowel disease (which may impair absorption), and sickle cell disease.

The UKMEC (UK Medical Eligibility Criteria for Contraceptive Use), maintained by the FSRH, classifies each condition as category 1 (no restriction), 2 (advantages generally outweigh risks), 3 (risks generally outweigh advantages), or 4 (unacceptable health risk).

Elevin is UKMEC category 4 for absolute contraindications and category 3 or 2 for relative contraindications, depending on the specific condition.

Drug interactions

Enzyme-inducing drugs reduce the plasma concentration of ethinylestradiol and levonorgestrel, potentially reducing contraceptive efficacy.

These include rifampicin, rifabutin, carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone, topiramate (at doses above 200 mg daily), some antiretroviral agents (particularly protease inhibitors and NNRTIs), and the herbal remedy St John's wort (Hypericum perforatum).

Women taking short courses of enzyme-inducing drugs should use additional barrier contraception during treatment and for 28 days after stopping.

Women requiring long-term enzyme-inducing medication should consider a non-oral contraceptive method such as the copper IUD or the depot injection.

Surgery and immobilisation

Elevin should be discontinued at least 4 weeks before planned major surgery or any surgery involving prolonged immobilisation of the lower limbs, to reduce VTE risk.

An alternative contraceptive method should be used during this period. Elevin should not be restarted until at least 2 weeks after full remobilisation.

If emergency surgery is required, thromboprophylaxis (such as low-molecular-weight heparin and graduated compression stockings) should be considered.

How to get an Elevin prescription in the UK

Elevin is classified as a prescription-only medicine (POM) in the UK.

Prescriptions can be obtained from your GP, a sexual health or family planning clinic, a community pharmacy that offers the NHS Contraception Service, or an authorised online prescriber registered with the GPhC.

Before prescribing, the clinician will assess your medical history, cardiovascular risk factors, blood pressure, and BMI, and will check for contraindications using the UKMEC framework.

The standard NHS prescription charge in England is currently 9.90 pounds per item.

Prescriptions for contraceptives are free of charge when issued by sexual health clinics or through the NHS contraceptive service at pharmacies.

Prescriptions are free for all patients in Scotland, Wales, and Northern Ireland regardless of the prescribing route.

Living with hormonal contraception: practical advice

Set a daily alarm or use a pill-reminder app to take Elevin at the same time every day, which maximises its effectiveness and helps establish a consistent routine.

Keep your current blister strip in its original packaging with the patient information leaflet for reference.

Carry spare pills when travelling across time zones and adjust your pill-taking time to maintain approximately 24-hour intervals.

If you experience persistent breakthrough bleeding beyond the first three months, mood changes, or any side effects that affect your quality of life, book a review with your prescriber to discuss alternative formulations or methods.

Annual contraceptive reviews should include a blood pressure check and a discussion of any changes to your health, medications, or lifestyle.

When to seek urgent medical advice

Seek emergency help immediately by calling 999 if you experience sudden severe chest pain or tightness, sudden breathlessness, a painful swollen calf, sudden severe headache, sudden loss of vision or double vision, sudden weakness or numbness on one side of the body, or collapse.

These may be signs of a blood clot, stroke, or heart attack.

In less urgent situations, contact your GP or NHS 111 for advice about persistent headaches, mood changes, or bleeding irregularities.

Report any suspected adverse reactions to Elevin via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Sources

• Elevin 150/30, Summary of Product Characteristics (EMC)
• Levonorgestrel with ethinylestradiol, British National Formulary (BNF)
• FSRH Clinical Guideline: Combined Hormonal Contraception
• NICE NG136: Contraception
• Combined contraceptive pill, NHS
• MHRA Yellow Card Scheme