Alesse

By Alexandra Pellicena, MD, PA
Medically Reviewed by Becky Lynn, MD, MBA, IF, NCMP, Dipl ABOM
Last Update: January 29, 2025

What is Alesse?

Alesse is a combination birth control pill that contains ethinylestradiol and levonorgestrel, two hormones that work together to prevent pregnancy. It stops ovulation, thickens cervical mucus to block sperm, and alters the uterine lining to make implantation less likely. When taken correctly, the pill is over 99% effective in preventing pregnancy. Many users also choose this medication for its additional benefits, such as lighter periods, reduced cramps, and hormone balance.

Besides being a reliable contraceptive, the pill is sometimes prescribed to regulate menstrual cycles, help with acne, and manage hormone-related symptoms. It follows a 28-day cycle, typically including 21 active pills and 7 inactive pills, allowing for a monthly withdrawal bleed. For the best results, the pill should be taken at the same time every day. Many people prefer this pill for its affordability, effectiveness, and availability in both brand and generic forms.

FAQ

What are the uses of Alesse?

This estrogen-progestin pill is primarily used as a birth control pill to prevent pregnancy, but it also offers several other health benefits. As a combination oral contraceptive, it contains ethinylestradiol and levonorgestrel, which help regulate hormones and improve menstrual health.

Common uses of Alesse:

  • Preventing pregnancy with over 99% effectiveness when taken correctly
  • Regulating menstrual cycles, making periods more predictable
  • Reducing menstrual cramps and discomfort during periods
  • Helping with acne by lowering androgen levels and reducing oil production
  • Managing premenstrual symptoms (PMS), such as bloating and mood swings
  • Making periods lighter, which can benefit those with heavy bleeding
  • Reducing the risk of ovarian and endometrial cancer in long-term users

Many people choose this pill for both contraception and hormonal balance, making it a versatile and effective option for reproductive health.

Is it a good birth control?

Alesse is a highly effective birth control pill, with studies showing that it is over 99% effective when taken correctly. This means that fewer than 1 in 100 women using this combination birth control as directed will become pregnant in a year. In real-world use, where occasional missed pills may happen, its effectiveness is around 91-93%, according to the Centers for Disease Control and Prevention (CDC).

As a combination birth control pill, it not only prevents pregnancy but also provides additional benefits. Research shows that users often experience lighter, more regular periods, reduced menstrual cramps, and improved skin health. Long-term use is also linked to a lower risk of ovarian and endometrial cancer. Because of its proven safety and effectiveness, this pill remains a popular and trusted choice for those seeking reliable contraception.

Is Alesse a progestin-only pill?

Alesse is not a progestin-only pill; it is a combination type of birth control that contains both ethinylestradiol (estrogen) and levonorgestrel (progestin). This combination works by preventing ovulation, thickening cervical mucus to block sperm, and altering the uterine lining to reduce the chance of implantation.

Unlike progestin-only pills (also called mini-pills), this hormone-based contraceptive follows a 28-day cycle, typically with 21 active pills and 7 inactive pills, allowing for a regular withdrawal bleed. It is a highly effective contraceptive and is also used for regulating periods, reducing cramps, and managing hormonal symptoms.

What are the side effects?

This low-dose contraceptive is well tolerated by most users, but some may experience mild side effects as their body adjusts. These are usually temporary and improve within a few months. Many people also notice positive changes, such as lighter periods, fewer cramps, and improved cycle regularity. Serious side effects are rare, and research shows that the majority of users continue taking this hormone-based contraceptive without major issues.

Possible side effects of Alesse:

  • Nausea or upset stomach (5-15%), often improves after a few weeks
  • Headaches or dizziness (5-10%), usually mild and temporary
  • Breast tenderness (5-10%), fades over time
  • Spotting between periods (10-20%), more common in the first few cycles
  • Mood changes or mild mood swings (5-10%), usually stabilizes after a few months
  • Bloating or water retention (2-5%), often mild due to hormone balance
  • Decreased libido (2-5%), varies by individual
  • Increased sun sensitivity (1-3%), sunscreen is recommended
  • Melasma (dark skin patches) (Less than 2%), more likely with sun exposure
  • Severe allergic reaction (Less than 1%), includes rash, itching, or swelling

Most mild side effects improve within 2-3 months as hormone levels adjust. Taking the pill at the same time daily, staying hydrated, and maintaining a healthy routine can help minimize discomfort while the body adapts.

Is Alesse low in estrogen?

Yes, it is considered a low-estrogen birth control pill because it contains 20 mcg of ethinylestradiol, which is a lower dose compared to standard combination pills that often have 30-35 mcg. This lower estrogen level may reduce the risk of certain side effects, such as bloating, nausea, and breast tenderness, while still providing effective pregnancy prevention.

Because this cycle-regulating medication has less estrogen, it may be a good option for those who are sensitive to hormones or want a pill with a lighter hormone dose. However, lower-estrogen pills can sometimes cause more spotting between periods, especially in the first few months. Despite this, this estrogen-progestin pill remains a popular choice for those looking for a low-dose yet effective type of birth control.

Do you gain weight on this pill?

Alesse does not cause significant weight gain for most users. Studies show that over 90% of people on combination birth control pills experience no major weight changes. Research from the Cochrane Database of Systematic Reviews confirms that hormonal birth control does not lead to long-term weight gain, with most changes being temporary water retention rather than actual fat gain.

Some users may notice a slight increase of 1-2 pounds in the first few months due to water retention, but this usually balances out over time. Because this contraceptive tablet contains a low dose of estrogen (20 mcg) and levonorgestrel, it may have less impact on fluid retention than higher-dose pills. Staying active, hydrated, and maintaining a balanced diet can help keep weight stable while using this pregnancy prevention pill.

Who should not take this contraceptive?

The ethinylestradiol and levonorgestrel combination is a safe and effective birth control pill, but it may not be suitable for everyone. Certain health conditions and risk factors can make it unsafe or less effective, so it’s important to check if this contraceptive is right for you.

Below are the contraindications for Alesse:

  • Smokers over 35 – Increases the risk of blood clots, stroke, and heart attack.
  • History of blood clots or deep vein thrombosis (DVT) – Estrogen can raise the risk of serious clotting issues.
  • High blood pressure (uncontrolled hypertension) – May further increase the risk of heart-related complications.
  • Severe migraines with aura – Linked to a higher risk of stroke when using combination birth control.
  • Liver disease or liver tumors – Can affect the body’s ability to process hormones properly.
  • Certain cancers (breast or uterine cancer) – Hormonal birth control can stimulate hormone-sensitive cancers.
  • Unexplained vaginal bleeding – Needs medical evaluation before starting any hormonal contraceptive.

If any of these apply, a progestin-only pill (mini-pill) or non-hormonal birth control might be a better option.

Are there any interactions to avoid?

Alesse, like other combination birth control pills, can interact with certain medications and supplements, which may reduce its effectiveness or increase the risk of side effects. It’s important to know which substances to avoid or adjust when taking this contraceptive.

Medications and substances that may interact with this daily birth control:

  • Antibiotics – Some, like rifampin and rifabutin, can lower birth control effectiveness. Most common antibiotics do not cause issues.
  • Antiepileptic drugs – Medications such as carbamazepine, phenytoin, and topiramate can make the contraceptive less effective.
  • HIV medications – Certain treatments, including ritonavir and efavirenz, may reduce birth control protection.
  • St. John’s Wort – A common herbal supplement that can decrease hormone levels and reduce contraceptive effectiveness.
  • Some antifungal medications – Griseofulvin can interfere with birth control hormones.
  • Diabetes medications – The ovulation suppressant may slightly impact blood sugar levels, requiring adjustments in insulin or oral diabetes drugs.

If you take any of these medications, a backup contraceptive method (such as condoms) may be needed.

Do you still ovulate on Alesse?

No, you do not ovulate while taking this birth control pill correctly. This birth control pill prevents ovulation, meaning your ovaries do not release an egg each month. Without ovulation, there is no egg available for fertilization, making pregnancy very unlikely.

This medication works by keeping hormone levels steady, which stops the body from triggering ovulation. It also thickens cervical mucus, making it harder for sperm to reach an egg, and changes the uterine lining, making implantation less likely. As long as you take the pill daily and on time, ovulation remains suppressed, and the pill stays highly effective at preventing pregnancy.

Does this pill make acne worse?

Alesse does not make acne worse for most users—in fact, it often helps with acne. Studies show that combination birth control pills can reduce acne in 60-90% of users by lowering androgen levels, which decreases oil (sebum) production. The American Academy of Dermatology (AAD) recognizes birth control as an effective acne treatment, especially for hormonal breakouts.

Research has found that after three to six months of using this hormone-regulating medication, many users experience fewer breakouts, reduced skin oiliness, and overall clearer skin. While a small percentage (less than 10%) may see temporary acne flare-ups when first starting the pill, this usually improves as hormone levels balance. The tablet is commonly prescribed for those looking for both birth control and clearer skin, making it a popular choice for acne-prone individuals.

What is the generic name?

The generic name for Alesse is ethinylestradiol and levonorgestrel. This combination of hormones is used in many generic birth control pills, providing the same effectiveness and benefits as the brand-name version. Generic options, such as Alysena, Aviane, Lessina, and Lutera, contain the same active ingredients and work by preventing ovulation, thickening cervical mucus, and altering the uterine lining to reduce the risk of pregnancy.

Since generics have identical active ingredients and dosage, they offer the same level of pregnancy protection while being more affordable than brand-name period control pill. Many users choose generic versions because they provide the same benefits, including lighter periods, reduced cramps, and improved cycle regulation, at a lower cost.

What is the difference between Alesse and Alysena?

Alesse and Alysena are very similar birth control pills that contain the same active ingredients: ethinylestradiol and levonorgestrel. Both work by preventing ovulation, thickening cervical mucus to block sperm, and altering the uterine lining to reduce the chances of pregnancy. The main difference between them is that one is the brand-name version, while the other is a generic alternative that offers the same effectiveness at a lower cost.

Comparison table:

Feature Alesse Alysena
Type Brand-name birth control Generic alternative
Active Ingredients Ethinylestradiol (20 mcg) + Levonorgestrel (100 mcg) Ethinylestradiol (20 mcg) + Levonorgestrel (100 mcg)
Effectiveness Over 99% effective when taken correctly Over 99% effective when taken correctly
Cost Higher price due to brand name More affordable generic option
Availability Sold under the original brand Widely available as a lower-cost alternative
Packaging & Appearance May have a distinct look or packaging May vary in color and branding
Overall Performance Same effectiveness and benefits Same, but at a lower cost

Since Alysena is a generic, it provides the same protection and benefits as its counterpart but at a lower price, making it a budget-friendly option for those seeking an effective contraceptive.

When should I start taking these pills?

You can start taking these birth conctol pills at different times, depending on your preference and need for immediate protection. The most common options are the first-day start and the Sunday start.

  • First-day start: Take your first pill on the first day of your period. This provides immediate pregnancy protection, so no backup birth control is needed.
  • Sunday start: Take your first pill on the first Sunday after your period begins. If your period starts on a Sunday, take the pill that same day. Use backup birth control (like condoms) for the first 7 days, as pregnancy protection is not immediate.

For the best results, take the pill at the same time every day to keep hormone levels steady and maintain maximum effectiveness.

What is the price of Alesse?

As of 2025, the price of this combination oral contraceptive depends on the pharmacy, with costs typically ranging from $19 to $50 per month. Many online pharmacies offer lower prices compared to local drugstores, making it easier to find affordable options. Prices may also vary based on insurance coverage, discounts, and pharmacy promotions, so checking multiple sources can help you get the best deal.

A more affordable option is generic Alesse, which contains the same active ingredients—ethinylestradiol and levonorgestrel—and works just as effectively. The generic contraceptive is widely available at a lower cost, making it a budget-friendly choice. Purchases from trusted online pharmacies or the use of prescription discount programs can help reduce costs and provide access to reliable birth control.

About the Author

Alexandra-PellicenaDr. Alexandra Pellicena, MD, is a board-certified OB/GYN with over 20 years of experience, specializing in comprehensive women’s healthcare, including high-risk pregnancies, minimally invasive gynecologic surgery, and reproductive health. She earned her Doctor of Medicine from Case Western Reserve University School of Medicine, where she conducted research in human genetics and received prestigious fellowships, such as the Cystic Fibrosis Foundation Fellowship. Dr. Pellicena completed her residency in Obstetrics and Gynecology at Baylor College of Medicine, gaining extensive clinical training at Ben Taub General Hospital and The Women’s Hospital. A Fellow of the American College of Obstetrics and Gynecology (FACOG) since 2004, she remains dedicated to medical advancements, continually integrating the latest techniques in gynecologic surgery, prenatal care, and preventive health. Fluent in English and Spanish, she ensures personalized, patient-centered care while fostering trust and communication in diverse communities.

Disclaimer: This content is for informational purposes only and should not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for any health-related concerns. In an emergency, seek immediate assistance from local emergency services. Use of this information is solely at your own discretion and responsibility.