Qlaira
Is It Right for You?
A complete guide to Qlaira — what it treats, how it works, dosages, side effects, and when a clinician may prescribe it following an online consultation.
What Is Qlaira?
Qlaira is a combined oral contraceptive pill (COCP) with a distinctively different hormonal composition from most other combined pills. Rather than containing a synthetic progestogen paired with ethinylestradiol (the artificial oestrogen used in virtually all other combined pills), Qlaira contains estradiol valerate — a naturally identical form of oestrogen — combined with dienogest, a selective synthetic progestogen with strong anti-androgenic properties.
Qlaira uses a unique four-phase dosing schedule across a 28-tablet strip — 26 active tablets containing varying doses of the two hormones across different phases, followed by 2 hormone-free placebo tablets. This quadriphasic design mimics the natural hormonal fluctuations of the menstrual cycle more closely than conventional fixed-dose combined pills, and is designed to reduce total oestrogen exposure while maintaining reliable contraceptive efficacy.
It is the only combined oral contraceptive licensed in the UK for a dual indication: contraception and the treatment of heavy menstrual bleeding (menorrhagia) in women who choose oral contraception. Its oestradiol valerate component is better tolerated by some women who experience side effects on ethinylestradiol-containing pills, and its distinct progestogen (dienogest) contributes additional therapeutic benefits for those with dysmenorrhoea or endometriosis-related symptoms.
Qlaira is a prescription-only medication in the UK. A licensed clinician must assess your medical history and risk factors before it can be prescribed.
What Conditions Is Qlaira Used For?
Qlaira is indicated for:
prevention of pregnancy in women who choose an oral hormonal contraceptive method
in women without an identified organic cause who wish to use oral contraception; Qlaira is specifically licensed for this indication
Missed Tablets Affect Contraceptive Reliability. Unlike many 21-day pills, Qlaira contains 28 tablets that must all be taken in order, every day, without a break. The varying hormonal doses across the four phases mean the rules for missed tablets differ depending on which phase tablet has been missed. Always consult the patient information leaflet or your clinician if you miss a tablet.
How Does Qlaira Work?
Qlaira works through the combined actions of estradiol valerate and dienogest to prevent pregnancy via the same primary mechanisms as other combined oral contraceptives.
Ovulation suppression is the principal contraceptive mechanism. Estradiol valerate and dienogest together suppress the release of follicle-stimulating hormone (FSH) and luteinising hormone (LH) from the pituitary gland via negative feedback on the hypothalamic-pituitary axis, preventing the development of a dominant follicle and the LH surge required to trigger ovulation.
Cervical mucus thickening — dienogest's progestogenic effect causes the cervical mucus to become viscous and hostile to sperm penetration, providing a secondary barrier to fertilisation.
Endometrial suppression — the combined hormonal action produces an atrophic endometrial lining, reducing receptivity to any fertilised egg and contributing to the reduction in menstrual blood loss that makes Qlaira effective for heavy menstrual bleeding.
The estradiol valerate component is cleaved to release 17β-oestradiol — structurally identical to the body's own endogenous oestrogen — which is thought to have a more favourable cardiovascular and metabolic profile than the synthetic ethinylestradiol used in most other combined pills, including a lesser effect on hepatic protein synthesis and haemostasis markers
Dosages & Administration
The correct dose depends on the type and severity of infection, age, weight, and kidney function. Always follow your clinician's instructions. The table below is for general reference only.
Administration Tips
Take one tablet daily at the same time each day, working through the strip in order from tablet 1 to tablet 28 without any breaks between strips.
Start on the first day of your period for immediate contraceptive protection. If starting on any other day, use additional barrier contraception for the first 9 days.
Do not skip the placebo tablets — continue taking tablets without interruption; this maintains the 28-day rhythm critical to Qlaira's quadriphasic design.
Missed tablet rules for Qlaira are complex and phase-dependent. If you miss a tablet, refer to the package leaflet carefully for guidance based on which phase tablet was missed, or contact your clinician or pharmacist promptly.
Vomiting or severe diarrhoea within 3–4 hours of taking a tablet may prevent full absorption — treat as a missed tablet for the purposes of contraceptive reliability.
Side Effects of Qlaira
The side effect profile of Qlaira is broadly similar to other combined oral contraceptives, though its natural oestrogen component may be better tolerated by some women.
- Headache / migraine
- Nausea
- Breast tenderness or pain
- Irregular bleeding or spotting — particularly in the first 3–6 months of use
- Mood changes, including low mood or mood swings
- Decreased libido
- Weight changes
- Acne (though dienogest has anti-androgenic properties that may improve acne in some women)
- Venous thromboembolism (VTE) — deep vein thrombosis (DVT) or pulmonary embolism (PE); leg pain and swelling, sudden breathlessness, chest pain, coughing blood
- Arterial thrombosis — stroke, transient ischaemic attack (TIA), myocardial infarction; sudden severe headache, facial droop, arm weakness, speech disturbance, severe chest pain
- Severe liver disease or liver tumour — jaundice, severe abdominal pain, upper abdominal mass
- Severe hypertension — seek medical review if blood pressure becomes significantly elevated during treatment
- Severe allergic reaction
All combined oral contraceptives increase the risk of VTE compared to non-use. The absolute risk remains low in healthy young women, but rises with additional risk factors including obesity, immobility (e.g. long-haul travel), smoking, personal or family history of blood clots, and thrombophilia. Seek immediate medical attention if you develop calf pain, leg swelling, sudden breathlessness, or chest pain.
Drug Interactions
Qlaira may interact with strong CYP3A4 inducers (e.g. rifampicin, carbamazepine, phenytoin, St John's Wort) which dramatically reduce contraceptive hormone levels, risking contraceptive failure. Additional or alternative contraception is required during use and for 28 days after stopping the inducing agent. Broad-spectrum antibiotics have a theoretical risk of reduced contraceptive efficacy through gut flora disruption, though current UK guidance does not recommend routine additional contraception. Oestrogen-containing contraceptives reduce lamotrigine plasma levels, potentially reducing seizure control. Consult your clinician for specific guidance regarding HIV antiretrovirals and other medications.
Dramatically reduce contraceptive hormone levels, risking contraceptive failure. Additional or alternative contraception is required during use and for 28 days after stopping the inducing agent.
The theoretical risk of reduced contraceptive efficacy through gut flora disruption has not been confirmed in clinical trials for most antibiotics. Current UK guidance does not recommend routine additional contraception, though patients should be informed of the theoretical concern.
Oestrogen-containing contraceptives reduce lamotrigine plasma levels, potentially reducing seizure control. Dose adjustment of lamotrigine may be required when starting or stopping Qlaira.
Many significantly affect oestrogen/progestogen metabolism; consult your clinician or HIV pharmacist for specific guidance.
Important Warnings
Combined oral contraceptives including Qlaira increase the risk of both venous thromboembolism and — in women with additional risk factors — arterial thrombosis (stroke, MI). Seek immediate emergency care if symptoms of DVT, PE, stroke, or heart attack develop during use.
Qlaira and all combined oral contraceptives are contraindicated in women who experience migraines with aura (neurological symptoms preceding headache). This significantly increases the risk of ischaemic stroke. Women who develop new migraine with aura while taking Qlaira must stop immediately and consult their clinician.
Smoking significantly increases the risk of serious cardiovascular events in women using combined oral contraceptives. This risk escalates substantially with age and the number of cigarettes smoked. Women over 35 who smoke must not use combined oral contraceptives.
Blood pressure should be measured before starting Qlaira and monitored periodically throughout treatment. Qlaira should be discontinued if a significant sustained rise in blood pressure is detected.
Speak to a Clinician About Treatment
Getting advice no longer means sitting in a waiting room. Through The GP Service, you can consult with a licensed clinician in minutes — from home, on your lunch break, or wherever works for you. If treatment is clinically appropriate, your clinician can issue a prescription during the consultation. A consultation does not guarantee a prescription.
The treatment you need, when you need it.
Qlaira FAQs
Most combined pills use synthetic ethinylestradiol as the oestrogen component. Qlaira uses estradiol valerate — a naturally identical oestrogen — which may be better tolerated by some women. Qlaira also uses a unique quadriphasic dosing pattern across 28 days, making it the most complex combined pill in terms of structure, and it is the only combined pill additionally licensed for heavy menstrual bleeding.
Yes — Qlaira is specifically licensed for the treatment of heavy menstrual bleeding (menorrhagia) in women without an identified organic cause who also wish to use oral contraception. Clinical trials demonstrated meaningful reductions in menstrual blood loss in the majority of users.
The rules for missed tablets with Qlaira are more complex than for fixed-dose pills because the hormonal content varies across the four phases. The correct action depends on which phase tablet was missed. Always refer to the package leaflet carefully or contact your clinician or pharmacist.
Irregular bleeding and spotting — particularly in the first 3–6 cycles — is common and is related to the quadriphasic hormone pattern and adjustment of the endometrial lining. It usually settles with continued use. If it persists beyond 6 months, discuss with your clinician.
No. Unlike monophasic pills (which can be taken back-to-back to delay withdrawal bleeds), Qlaira's quadriphasic design makes this approach unsuitable. If you need to delay a period for a specific event, speak to your clinician about an appropriate strategy.