Lucette

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Lucette on Prescriptsy

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Lucette is a combined oral contraceptive (COC) pill containing drospirenone 3 mg and ethinylestradiol 0.03 mg.

It is a generic equivalent of Yasmin, manufactured to identical pharmaceutical standards and containing the same active ingredients in the same doses.

Lucette is taken once daily for 21 consecutive days, followed by a 7-day tablet-free interval during which a withdrawal bleed occurs.

When used correctly and consistently, combined oral contraceptives are more than 99% effective at preventing pregnancy.

Combined oral contraceptives remain one of the most popular methods of reversible contraception in the United Kingdom, used by millions of women.

Drospirenone, the progestogen component of Lucette, is a fourth-generation progestogen with a unique pharmacological profile that includes anti-androgenic and anti-mineralocorticoid activity.

These properties can offer additional benefits beyond contraception, including improvement of hormonal acne and reduced water retention compared with older progestogen formulations.

This page provides a comprehensive clinical overview of Lucette, including how it works, dosing guidance, what to do if you miss a pill, side effects, safety warnings including blood clot risk, and how to obtain a prescription in the UK.

Important safety information about Lucette

Before reading further, note the following key safety points about Lucette.

• All combined oral contraceptives carry a small increased risk of blood clots (venous thromboembolism). Drospirenone-containing pills carry a slightly higher risk compared with levonorgestrel-containing pills. Seek immediate medical attention if you develop sudden chest pain, sudden leg pain or swelling, sudden breathlessness, or sudden severe headache.
• Do not take Lucette if you have migraine with aura, as this significantly increases the risk of stroke.
• Smoking while taking combined oral contraceptives greatly increases the risk of serious cardiovascular events. Women aged over 35 who smoke should not use combined hormonal contraception.
• Lucette does not protect against sexually transmitted infections. Use condoms for STI protection.

What is combined hormonal contraception

Combined hormonal contraception uses two types of hormone, an oestrogen and a progestogen, to prevent pregnancy.

These hormones work synergistically through three mechanisms: suppression of ovulation (the release of an egg from the ovary), thickening of the cervical mucus (making it difficult for sperm to reach the egg), and thinning of the endometrial lining (making it less receptive to implantation of a fertilised egg).

The oestrogen component, ethinylestradiol, is the most commonly used synthetic oestrogen in oral contraceptives and is responsible for cycle control and suppression of follicular development through negative feedback on pituitary FSH secretion.

The progestogen component varies between different pill brands and generations. First-generation progestogens include norethisterone, second-generation includes levonorgestrel, third-generation includes desogestrel and gestodene, and fourth-generation includes drospirenone.

Each progestogen has a slightly different balance of progestogenic, androgenic, anti-androgenic, and mineralocorticoid activity, which accounts for the varying side effect profiles and additional properties of different pills.

When taken correctly, combined oral contraceptives have a failure rate of less than 1% per year (perfect use).

With typical use (accounting for missed pills, late starts, and human error), the failure rate rises to approximately 9% per year.

Consistent daily use at the same time is the most important factor in maintaining contraceptive efficacy.

How Lucette works: mechanism of action

Ethinylestradiol (oestrogen component)

Ethinylestradiol is a potent synthetic oestrogen that provides the oestrogenic component of the combined pill.

Its primary contraceptive action is the suppression of follicle-stimulating hormone (FSH) secretion from the anterior pituitary gland via negative feedback on the hypothalamic-pituitary-gonadal axis.

Without adequate FSH stimulation, ovarian follicles do not mature, and ovulation does not occur.

Ethinylestradiol also provides cycle control by stabilising the endometrium and reducing breakthrough bleeding, which is particularly important during the first few months of pill use.

It is rapidly absorbed from the gastrointestinal tract, undergoes extensive first-pass hepatic metabolism, and has a half-life of approximately 13 to 27 hours.

Drospirenone (progestogen component)

Drospirenone is a synthetic progestogen derived from 17-alpha-spironolactone. It has a pharmacological profile that is closer to natural progesterone than most other synthetic progestogens, with three clinically relevant properties: progestogenic activity, anti-androgenic activity, and anti-mineralocorticoid activity.

The progestogenic activity of drospirenone suppresses the mid-cycle surge of luteinising hormone (LH), providing a secondary mechanism for ovulation suppression.

It also thickens the cervical mucus, creating a physical and biochemical barrier to sperm transport, and renders the endometrial lining thin and atrophic, reducing the likelihood of implantation.

The anti-androgenic activity of drospirenone means that it counteracts the effects of androgens on the skin and hair follicles.

This is clinically relevant because some women taking oral contraceptives experience androgen-mediated side effects such as acne, oily skin, and hirsutism.

Drospirenone can improve these symptoms, making Lucette a suitable choice for women who experience hormonal acne.

The anti-mineralocorticoid activity of drospirenone is unique among progestogens used in oral contraceptives.

Ethinylestradiol stimulates the hepatic production of angiotensinogen, which activates the renin-angiotensin-aldosterone system, leading to sodium and water retention.

Many of the common side effects of combined pills, including bloating, breast tenderness, and weight gain, are attributable to this fluid retention.

Drospirenone, with its structural similarity to spironolactone, antagonises the mineralocorticoid receptor, counteracting aldosterone-mediated sodium and water retention.

This is why drospirenone-containing pills such as Lucette are associated with less bloating and less fluid-related weight change compared with pills containing older progestogens.

Clinical evidence and national guidelines

The combination of drospirenone and ethinylestradiol has been extensively studied in large clinical trials.

These trials have demonstrated high contraceptive efficacy (Pearl Index of approximately 0.5 to 1.0 per 100 woman-years with perfect use), good cycle control with low rates of breakthrough bleeding, and improvements in acne and premenstrual symptoms in many women.

The FSRH (Faculty of Sexual and Reproductive Healthcare) Clinical Guideline on Combined Hormonal Contraception provides the current UK framework for prescribing combined pills.

It states that all combined oral contraceptives are effective contraceptives and that the choice of pill should be based on the individual woman's medical history, risk factors, preferences, and tolerance of side effects.

The guideline notes that drospirenone-containing pills carry a slightly higher risk of venous thromboembolism compared with levonorgestrel-containing pills, and this should be discussed as part of informed consent.

NICE Guideline NG88 (Heavy menstrual bleeding: assessment and management) and NICE CKS on Contraception also provide relevant guidance.

Combined oral contraceptives, including those containing drospirenone, can reduce menstrual blood loss and may be used for the management of heavy periods as well as contraception.

The MHRA has issued safety communications regarding the VTE risk associated with different combined oral contraceptives.

The current position is that the benefits of combined hormonal contraception outweigh the risks for most women, but prescribers should discuss the VTE risk and help women choose the most appropriate method based on their individual risk profile.

Women with known risk factors for VTE (obesity, family history, immobility, recent surgery) should be considered for alternative contraceptive methods.

Dosage and administration

Lucette is taken as one tablet daily for 21 consecutive days, followed by a 7-day tablet-free interval.

A withdrawal bleed usually occurs during the 7-day break, typically starting 2 to 3 days after the last tablet.

Start the next pack after the 7-day break, even if bleeding has not stopped.

Contraceptive protection is maintained during the 7-day break provided the previous pack was taken correctly and the next pack is started on time.

Starting for the first time

If you have not used hormonal contraception in the preceding month, start Lucette on the first day of your menstrual period. Contraceptive protection is immediate.

If you start on days 2 to 5 of your cycle, use additional barrier contraception (such as condoms) for the first 7 days.

After pregnancy, Lucette can be started 21 days postpartum if you are not breastfeeding.

If starting later than 21 days, use additional contraception for the first 7 days and ensure you are not pregnant.

Switching from another pill

If switching from another combined oral contraceptive, start Lucette the day after taking the last active tablet of the previous pack, or at the latest on the day after the usual tablet-free or placebo period.

No additional contraception is needed. If switching from a progestogen-only pill, start Lucette on any day and use additional barrier contraception for 7 days.

If switching from an injectable, implant, or intrauterine system, start Lucette on the day the next injection would be due, on the day of implant removal, or on the day of IUS removal, and use additional barrier contraception for 7 days.

Missed pill guidance

Missing pills is the most common reason for contraceptive failure with combined oral contraceptives.

The critical window is 12 hours: if you take a pill less than 12 hours late, contraceptive protection is maintained.

If you are 12 hours or more late, protection may be reduced. The advice below follows FSRH guidance.

If one pill is missed (12 or more hours late), take the missed pill as soon as you remember, even if this means taking two pills on the same day.

Continue the rest of the pack as normal.

No additional contraception is needed unless the missed pill was in week 1 and you had unprotected sex in the previous 7 days, in which case consider emergency contraception.

If two or more pills are missed, take the most recently missed pill as soon as you remember and discard any earlier missed pills.

Continue the rest of the pack as normal and use barrier contraception for the next 7 days.

If pills were missed in week 3, finish the current pack and start the next pack immediately without a 7-day break.

If pills were missed in week 1 and unprotected sex occurred, consider emergency contraception.

Vomiting and diarrhoea

If you vomit within 3 to 4 hours of taking a Lucette tablet, or if you have severe diarrhoea, absorption may be incomplete.

Take another tablet from a spare pack as soon as possible.

If the illness continues for more than 24 hours, follow the missed pill rules and use additional barrier contraception until you have taken pills correctly for 7 consecutive days.

Side effects of Lucette

Common side effects

The most frequently reported side effects of drospirenone/ethinylestradiol pills include headache, breast tenderness, mood changes (including low mood and mood swings), nausea, and unscheduled bleeding or spotting.

These effects are most common during the first 2 to 3 cycles and often improve with continued use.

Other common side effects include abdominal pain, bloating, and changes in weight.

Effect on mood and mental health

Mood changes, including depressed mood, anxiety, and irritability, are recognised side effects of combined oral contraceptives.

The MHRA issued a Drug Safety Update reminding prescribers and patients that hormonal contraceptives can affect mood and that women should be advised to seek medical advice if they experience significant mood changes.

If you notice a new or worsening pattern of low mood, anxiety, or emotional changes after starting Lucette, discuss this with your GP, as an alternative contraceptive method may be more suitable.

Venous thromboembolism risk

All combined oral contraceptives increase the risk of venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE).

The baseline risk of VTE in healthy non-pregnant women who are not using hormonal contraception is approximately 2 per 10,000 per year.

With levonorgestrel-containing combined pills, the risk increases to approximately 5 to 7 per 10,000 per year.

With drospirenone-containing pills such as Lucette, the risk is approximately 9 to 12 per 10,000 per year.

For context, the risk of VTE during pregnancy is approximately 29 per 10,000 pregnancies.

The risk is highest during the first year of use and when restarting after a break of 4 weeks or more.

Risk factors for VTE include obesity (BMI above 30), smoking, a personal or family history of VTE, prolonged immobility (such as long-haul travel or bed rest after surgery), and inherited thrombophilias (such as factor V Leiden).

If you have one or more of these risk factors, your prescriber may recommend a pill containing levonorgestrel (such as Rigevidon or Microgynon), a progestogen-only pill, or a non-hormonal contraceptive method.

The decision should be made collaboratively after discussing the risks and benefits.

Arterial thrombotic events

Combined oral contraceptives also carry a very small increased risk of arterial thrombotic events, including myocardial infarction (heart attack) and ischaemic stroke.

This risk is increased in women who smoke (particularly those over 35), have hypertension, diabetes, dyslipidaemia, or migraine with aura.

Women with migraine with aura must not use combined hormonal contraception, as this combination substantially increases stroke risk.

Reporting side effects

Report any suspected adverse reactions to your prescriber or directly via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Warnings and precautions

Absolute contraindications

Lucette must not be used by women with current or past VTE or arterial thrombosis, known thrombophilia, migraine with aura, uncontrolled hypertension (persistently above 160/100 mmHg), diabetes with vascular complications, severe hepatic disease or liver tumours, known or suspected breast cancer, undiagnosed vaginal bleeding, or hypersensitivity to drospirenone, ethinylestradiol, or any excipient.

Relative contraindications and risk factors

Lucette should be used with caution, and the risk-benefit balance carefully considered, in women with a BMI above 30, a family history of VTE in a first-degree relative under 45 years, migraine without aura, controlled hypertension, diabetes without vascular complications, or inflammatory bowel disease (Crohn disease, ulcerative colitis).

In these situations, a pill with a lower VTE risk or a non-oestrogen-containing method may be preferred.

Potassium-sparing effect of drospirenone

Drospirenone has mild anti-mineralocorticoid activity equivalent to approximately 25 mg of spironolactone. In most women, this has no clinically significant effect on serum potassium.

However, in women with renal insufficiency, hepatic impairment, or adrenal insufficiency, or in those taking potassium-sparing drugs (ACE inhibitors, ARBs, spironolactone, amiloride, potassium supplements, or NSAIDs), there is a theoretical risk of hyperkalaemia.

Serum potassium should be checked during the first treatment cycle in these women.

Surgery and immobility

Combined oral contraceptives should be discontinued 4 weeks before elective major surgery or any surgery involving prolonged immobilisation of the lower limbs, to reduce the VTE risk.

They can be restarted 2 weeks after full mobilisation.

If emergency surgery is required while taking Lucette, inform your surgeon and anaesthetist, and thromboprophylaxis (such as compression stockings and low-molecular-weight heparin) should be considered.

Drug interactions

Enzyme-inducing drugs can reduce the effectiveness of Lucette by increasing the hepatic metabolism of ethinylestradiol and drospirenone.

These include certain anti-epileptics (carbamazepine, phenytoin, phenobarbital, primidone, topiramate, oxcarbazepine, eslicarbazepine), rifampicin, rifabutin, certain antiretrovirals, and St John's wort.

Women taking enzyme-inducing medications should use an alternative, non-interacting contraceptive method.

Broad-spectrum antibiotics (other than rifampicin) are no longer considered to reduce pill efficacy based on current evidence, but the FSRH advises additional precautions if severe vomiting or diarrhoea occurs during antibiotic use.

Breastfeeding

Lucette is not recommended during breastfeeding, as the oestrogen component may reduce breast milk production.

A progestogen-only pill, the contraceptive implant, the hormonal or copper intrauterine device, or barrier methods are preferred during breastfeeding.

Discuss your options with your midwife, health visitor, or GP.

How to get a Lucette prescription in the UK

Lucette is a prescription-only medicine (POM) in the UK.

It can be prescribed by your GP, a sexual health or family planning clinic, or an authorised online prescriber registered with the GPhC.

Some community pharmacies now offer a patient group direction (PGD) service allowing pharmacists to supply combined oral contraceptives directly after a consultation, without the need for a GP appointment.

Before prescribing, your clinician will assess your medical history, family history, blood pressure, and BMI to ensure there are no contraindications.

A full assessment of VTE and cardiovascular risk factors is required. You will be invited for a follow-up consultation 3 months after starting Lucette and then annually.

At each visit, your blood pressure, weight, and any new risk factors will be reviewed.

Contraceptive prescriptions are free of charge when issued by NHS sexual health services or through a GP contraceptive consultation.

The standard NHS prescription charge in England (9.90 pounds per item) may apply when prescriptions are issued through other routes.

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

Choosing the right contraceptive

Lucette is one of many contraceptive options available in the UK.

The FSRH and NHS encourage women to discuss the full range of methods with their clinician to find the most suitable option based on their health, lifestyle, and preferences.

Long-acting reversible contraceptives (LARCs) such as the intrauterine device (IUD), the intrauterine system (IUS), the contraceptive implant, and the injection are highly effective and require less daily adherence than oral pills.

Progestogen-only pills are an alternative for women who cannot take oestrogen. Barrier methods (condoms, diaphragm) and natural family planning are non-hormonal options.

Emergency contraception is available from pharmacies and sexual health clinics for use after unprotected sex or contraceptive failure.

When to seek urgent medical advice

Seek immediate medical attention (call 999 or attend A&E) if you develop sudden severe chest pain or tightness, sudden unexplained breathlessness, sudden severe or unusual headache, sudden partial or complete loss of vision, sudden leg pain or swelling (especially in one calf), sudden weakness or numbness of the face, arm, or leg (especially on one side), difficulty speaking, or sudden collapse.

These symptoms may indicate a blood clot or arterial event and require emergency investigation.

Contact your GP or sexual health clinic if you experience significant mood changes, persistent breakthrough bleeding after the first 3 months, new or worsening migraines, or any other symptoms that concern you.

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

Sources

• Lucette 0.03 mg/3 mg film-coated tablets, Summary of Product Characteristics (EMC)
• Drospirenone with ethinylestradiol, British National Formulary (BNF)
• FSRH Clinical Guideline: Combined Hormonal Contraception
• Combined contraceptive pill, NHS
• MHRA Drug Safety Update: Combined hormonal contraceptives
• MHRA Yellow Card Scheme