Enjoy protection from unwanted pregnancy with the Qlaira pill

Qlaira Summary

What is Qlaira?

Qlaira is a newer type of the combined contraceptive pill. It is the first contraceptive pill to contain the ingredients estradiol valerate and dienogest which are versions of the female hormones oestrogen and progesterone. 

Qlaira is known as a ‘phasic’ pill, meaning that pills contain different levels of hormones depending on the day. Qlaira has four ‘phases’, and women who take Qlaira have shorter and less intense periods of bleeding compared with monophasic combined contraceptive pills. 

How does Qlaira work?

Qlaira works by overriding your natural menstrual cycle, releasing hormones into your bloodstream to prevent ovulation from occurring. This means that the ovaries won't release an egg each month. Qlaira also causes the mucus surrounding the cervix to thicken, stopping sperm from entering, and thins the womb lining to prevent a fertilised egg from implanting. 

How effective is Qlaira?

Qlaira is over 99% effective when used correctly. However not all women are able to take the pill perfectly, so in reality, if 100 women take the pill over the course of a year, around 9 will fall pregnant. For maximum effectiveness, ensure that you take the pill perfectly as directed, and use extra contraceptive methods if you make a mistake or experience vomiting or diarrhoea.

When does Qlaira start to work?

If you start taking Qlaira on the first day of your period it will work right away to protect against pregnancy. If you swap from a different combined hormonal contraceptive pill, or from a combined hormonal contraceptive patch or ring, Qlaira will also have an immediate effect. 

In any other circumstance, you should use a barrier method of contraception for the first 9 days of taking Qlaira as you won't be protected from pregnancy immediately. For example, starting it after the first day of your period or if you're switching from a progestogen-only form of contraception.

Qlaira for non-contraceptive purposes

Qlaira is also approved for the treatment of heavy menstrual bleeding as it typically results in lighter, shorter periods. It may also ease the symptoms of premenstrual syndrome (PMS). This pill can also be used to treat acne and for the management of endometriosis.

Switching contraceptive pill

If you wish to swap to Qlaira from a different type of combined pill, start taking Qlaira the day after taking the last active pill in your current pack. You can also start taking Qlaira the day after the removal of a vaginal ring or patch. You will be protected from pregnancy straight away.

If you are changing from a progestogen-only pill to Qlaira, you will need to use an additional method of contraception such as condoms for the first nine days of taking Qlaira.

Which ingredients can cause an allergic reaction?

Qlaira is not commonly known to cause any form of severe allergic reactions that might present as trouble breathing, dizziness, itching/swelling of the face or rashes. If you do notice these symptoms after taking the medication please seek immediate medical attention.

Active ingredients

The active ingredients contained in Qlaira are estradiol valerate and dienogest. 

Inactive ingredients

The inactive ingredients vary between the different colours of the tablet. 

Most of the tablets contain the following: lactose monohydrate, maize starch, pregelatinised maize starch, povidone K25 (E1201), magnesium stearate (E572), hypromellose type 2910 (E464), macrogol 6000, talc (E553b), titanium dioxide (E171), iron oxide yellow (E172) and/or iron oxide red (E172)
 
The white inactive tablets also contain:
lactose monohydrate, maize starch, povidone K25 (E1201), magnesium stearate(E572), hypromellose type 2910 (E464), talc (E553b), titanium dioxide (E171)
 

What should I do if I miss a pill?

If you miss a pill, what to do next depends on where you are in the pack. 

• Days 1–9: take the missed pill as soon as you remember. If you have had sex in the 7 days before the missed pill, you are at risk of pregnancy and should see a doctor right away. If you have not had sex in the 7 days before the missed pill, you are not at risk of pregnancy, and you should continue to take the rest of your pills on time and use a barrier method of contraception for the next 9 days.
• Days 10–17: take the missed pill right away and continue with the rest of the pack as usual. This may mean taking more than one pill on the same day. Use an additional barrier method of contraception for the next 9 days.
• Days 18–24: skip the missed pill and discard the rest of the pack. Begin the next pack right away. Use an additional barrier method of contraception for 9 days.
• Days 25–26: take the forgotten pill right away and continue with the rest of your pack as usual. Your contraception will not be affected.
• Days 27–28: skip the missed tablet and continue with Qlaira as usual. Your contraception will not be affected.

 If you have missed more than one pill, see a doctor or pharmacist right away. You will probably need to use additional contraception for a few days.

What should I do if I took a pill too late?

If you take your pill a little later than usual, your contraception will not be affected and you do not need to do anything. However, if a pill is taken more than 12 hours late, there is a risk that your contraception may not work as usual so it's recommended that you follow the instructions for a missed pill.

If I have vomited, will Qlaira still work?

If you vomit within 3–4 hours after taking Qlaira the pill may not be effective. You should take another pill of the same day from a new packet within 12 hours and then continue with the rest of the pack. If this isn't possible, treat it as a missed pill and follow the steps given for the corresponding day within your cycle. If you vomit after taking one of the white pills (the last two at the end of the pack) you do not need to do anything as they are placebo pills and do not contain any active ingredients.

Is it safe to take Qlaira for a long time?

Qlaira is a fairly new combined pill so there are not much long-term data on Qlaira specifically, however, it's safe to take other combined pills long-term provided you don't have any underlying health issues which can be made worse by taking the pill. 

One of the main risks of taking the combined pill, such as Qlaira, is that it increases the risk of blood clots. You should have your blood pressure checked before you start any combined hormonal contraceptive, and at least once every 12 months. 

How to start Qlaira

You should start taking Qlaira on the first day of your period. Choose the weekday sticker which states the correct day of the week on which you are starting the pill and place it on the pill strip where it reads “place weekday sticker strip here”. Tablets must be taken every day in the correct order. You will need to have your blood pressure and BMI checked prior to starting Qlaira to ensure it is safe for you.

How to take Qlaira

Qlaira is taken every day. There are 26 active pills and 2 inactive pills in each pack. Each pill should be taken at the same time each day. When you reach the end of the pack, start the next one the following day. Do not take a 7-day break like other types of the combined pill. Most users will have a withdrawal bleed around day 24–26 and you should always start your new pack on time, even if you are still bleeding. You will still be protected against pregnancy on the days you take the inactive pills.  

• The 2 dark yellow tablets contain 3mg of estradiol valerate. 
• The 5 medium red tablets contain 2mg of estradiol valerate and 2mg of dienogest. 
• The 17 light yellow tablets contain 2mg of estradiol valerate and 3mg of dienogest. 
• The 2 dark red tablets contain 1mg of estradiol valerate.
   

How to use Qlaira for period delay

To use Qlaira to delay your period, skip the last four tablets in your current pack (these are the two dark red and two white tablets) and begin with day 8 of the next pack, skipping the first 7 pills of the new pack. Tablets must be taken in the correct order. 

Qlaira side effects

Common side effects include: 

• Headaches 
• Nausea 
• Abdominal pain 
• Acne 
• No menstrual bleeding 
• Period pain 
• Irregular bleeding 
• Weight gain
• Breast pain 

 
Uncommon side effects may include: 

• Increased appetite 
• Vaginal thrush
• Depression 
• Mood changes 
• Decreased sex drive
• Sleep problems 
• Dizziness 
• Migraine 
• High blood pressure
• Hot flushes 
• Vomiting
• Diarrhoea 
• Hair loss 
• Excessive sweating 
• Itching 
• Rash
• Increased enzymes in the liver
• Muscle cramps 
• Breast swelling 
• Breast lumps
• Abnormal growth on the cervix (cervical dysplasia) 
• Spotting
• Pain during sex
• Fibrocystic breast disease 
• Heavy periods 
• Ovarian cysts 
• Pelvic pain 
• PMS
• Fatigue 
• Irritability 
• Swelling (oedema )
• Weight loss 
• Changes to blood pressure 

 
Rare side effects may include: 

• Increased susceptibility to infections e.g. herpes, fungal infections, urinary tract infections, bacterial infections of the vagina and pelvic inflammatory disease
• Fluid retention 
• Increase in triglycerides in the blood
• Aggression 
• Anxiety 
• Increased sex drive
• Nervousness 
• Nightmares 
• Restlessness 
• Poor concentration 
• Pins and needles 
• Giddiness 
• Poor tolerance of contact lenses 
• Heart attack 
• Heart palpitations 
• Low blood pressure 
• Worsening of varicose veins 
• Blood clots 
• Constipation 
• Indigestion 
• Gallbladder inflammation  
• Skin disorders 
• Excessive hair growth 
• Back or jaw pain 
• Breast cancer 
• Swollen lymph nodes 
• Asthma 
• Chest pain 
• Abnormal smear test 

Contraindications

You should not take Qlaira if you: 

• Have ever had a blood clot
• Have a condition which affects your blood clotting 
• Need to have an operation or will be off your feet for a long time 
• Have ever had a heart attack or stroke 
• Have ever had angina pectoris 
• Have severe diabetes with blood vessel damage 
• Have very high blood pressure
• Have very high levels of fat in the blood 
• Have hyperhomocysteinaemia 
• Have ever had a migraine with aura 
• Have ever had liver disease and your liver function has not yet returned to normal 
• Have ever had a liver tumour 
• Have ever had breast cancer or cancer of the genital organs 
• Have unexplained vaginal bleeding 
• Are allergic to any of the ingredients 

 
Extra care should be taken if you have: 

• A family history of breast cancer 
• Liver or gallbladder disease 
• Jaundice 
• Diabetes 
• Depression 
• Inflammatory bowel disease 
• Systemic lupus erythematosus 
• Hemolytic uraemic syndrome 
• Sickle cell anaemia 
• Hypertriglyceridaemia 
• Recently given birth 
• Superficial thrombophlebitis 
• Varicose veins 
• Epilepsy 
• A condition which first appeared during pregnancy or previous use of hormonal contraceptives 
• Ever had chloasma 
• Hereditary angioedema 
• Cardiac or renal insufficiency

Drug Interactions

Certain medications can interfere with Qlaira and cause it to be less effective. These include: 

• Epilepsy medications 
• HIV medications 
• Hepatitis C medications 
• Griseofulvin 
• Rifabutin 
• Rifampicin 
• St John's wort 

You should consult your doctor before starting Qlaira if you are taking any medications, including herbal remedies, over the counter medications, or recreational drugs as Qlaira may not be suitable for you.

Qlaira vs the mini pill

The mini-pill only contains a progestogen hormone whereas Qlaira contains both an oestrogen and a progestogen. For this reason, Qlaira is not suitable for some people, for example, those with high blood pressure, migraines, or other health risks. The mini pill is also taken every day of the month but it does not control your period in the same way as a combined pill. Some women may experience irregular periods or no periods at all with a progestogen-only pill whereas, with a combined pill, most women will experience a regular bleed. Your doctor will assess your medical history and discuss the most suitable hormonal contraception for you. 

Alternatives to Qlaira

Qlaira is the only combined pill available in the UK which contains the ingredients estradiol valerate and dienogest. This makes it slightly different to the other types of the pill available on the market. Other popular brands of the combined pill include Microgynon, Rigevidon, Ovranette and Cilest, all of which are available to order from Dr Felix. If you find it difficult to remember to take the pill every day, the vaginal ring or contraceptive patch may be a better alternative. 

The mini-pill, or progestogen-only pill, is a good option for women who are unable to take the combined pill or for those who are sensitive to oestrogen. 

Long term reversible methods of contraception are available from your GP or a family planning clinic. These include the hormonal or copper coil, the implant and injection. Condoms are the only method of contraception that also protects against STIs.

Can you use Qlaira for period delay?

Qlaira can be used for the period delay but you must ensure you take the tablets in the correct order as they contain different levels of hormones. To delay your period with Qlaira, skip the last four tablets in your current pack (the two dark red and two white pills), skip the first 7 tablets in a new pack and begin by taking the 8th tablet in the new pack. This will delay your period until you reach the end of the new pack.

When can I get pregnant after taking Qlaira?

If you stop taking the pill you can get pregnant at any time. It's recommended to wait until your natural menstrual cycle returns before trying for a baby. A family planning clinic will be able to give you the advice and support you need to ensure you have a healthy pregnancy. 

When will my period start again after I stop taking Qlaira?

Your natural menstrual cycle should return within 2–3 weeks of stopping Qlaira but it can take 1–2 months. It will depend on your own body and how long it takes to adjust.