Estarylla dosage, forms, and strengths

Estarylla is a prescription birth control pill combining ethinyl estradiol, an estrogen, and norgestimate, a progestin. Each blister pack contains 21 active pills and seven inactive pills. Take one pill daily by following the blister pack order. 

Estarylla forms and strengths

Estarylla comes in only one dosage form, but some pills are active tablets and some are inactive tablets.

• Tablets: 21 active tablets containing 0.25 mg norgestimate and 0.035 mg ethinyl estradiol; seven inactive tablets

Estarylla dosage for adults

To prevent pregnancy, women take one Estarylla tablet daily in a cycle matching the menstrual cycle. In the first three weeks—starting on the first day of a period—women take one active tablet with estradiol and norgestimate daily for 21 days. Seven placebo tablets are reserved for the last week of the cycle. 

Estarylla is not safe for every woman. The list of contraindications is long, so consult the FAQ “Who should not take Estarylla?” below.

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Estarylla dosage for pregnancy prevention

About 1 in 4 women currently on birth control take it as a pill. Estarylla is an estrogen-progesterone birth control pill. Combination oral contraceptives like Estarylla are the most common type of birth control pill used. 

Estarylla is a monocyclic therapy, meaning that all of the active pills in the pack have the same active ingredients and dosage strength. They are taken on a 28-day cycle. One active tablet is taken daily for 21 days. For seven days, women take placebo pills containing no active ingredients.

The progesterone in the tablets prevents pregnancy primarily by blocking ovulation. It also prevents the uterine wall from thickening, making it too thin for a fertilized egg to implant, and alters the cervical lining, making it hard for sperm to pass through and fertilize an egg.

The estrogen in the pill prevents the maturation of an ovarian follicle into an egg that’s able to be fertilized. 

The inactive pills start the “withdrawal bleed,” in which the thin uterine lining breaks down and bleeds out, similar to a menstrual period. 

• Standard Estarylla dosage for pregnancy prevention: Take one active pill daily for 21 days starting on the first day of a period or the Sunday after the first day of a period, followed by one inactive pill daily for seven days

Estarylla dosage for children

Estarylla is FDA-approved for use by adolescents who have had their first period. Dosing is the same for adults and adolescents.

Estarylla dosage restrictions

No dosage modifications are necessary for women with liver or kidney problems. However, healthcare professionals will carefully monitor women with liver impairment. Estarylla may need to be discontinued if liver problems worsen.

How to take Estarylla

The most important thing to do when taking Estarylla is not to miss doses. Forgetting to take doses increases the risk of pregnancy. This drug works best when following the directions:

• Read and follow the Instructions for Use included in the carton.

• Take one tablet each day. Do not miss a dose.

  • There are 21 blue tablets containing active ingredients and seven inert white tablets. Take all tablets in the blister pack, including the inert tablets.

  • Take the first tablet (number 1) on the day your period starts or the first Sunday after your period starts.

  • Take tablets at the same time each day.

  • Estarylla tablets can be taken with or without food. 

  • Swallow the tablet whole with a drink of water. Do not crush, break, or chew it.

  • Each tablet has a number assigned to it on the blister pack. Take each tablet in order.

  • When the last pill is taken, you will start a new blister pack the next day by taking the first blue pill in that pack.

  • The first pill should be taken on the same day of the week each cycle.

• Ask the prescriber for special instructions if you’re switching from another birth control pill or contraceptive method. These instructions are also printed in the Instructions for Use sheet.

• If you vomit or have diarrhea three to four hours after taking an Estarylla tablet, take a blue pill from an extra blister pack.

  • If you don’t have an extra blister pack, take the next blue pill in the blister pack. Continue through the rest of the blister pack in order.

• If you vomit for several days in a row after taking Estarylla, contact the doctor. Use additional birth control measures.

• Store Estarylla at room temperature in the original carton.

Estarylla dosage FAQs

How long does it take Estarylla to work?

When started as instructed, Estarylla provides effective birth control from the very first day. If Estarylla is not started as instructed, it’s possible to get pregnant for the first seven days that tablets are taken. Use backup birth control for those first seven days.

How long does Estarylla stay in your system?

Norgestimate, the progesterone in Estarylla, is converted by the body into the two active ingredients that prevent pregnancy. These active versions of norgestimate have somewhat long half-lives from nearly one to two days. This means it can take the body about a week to completely eliminate all of the active ingredients from an Estarylla pill.

What happens if I miss a dose of Estarylla?

Missed doses increase the risk of pregnancy. Managing a missed dose depends on the circumstances:

• If a blue active pill is missed:

  • Take the missed dose when remembered. Take the next dose at its regular time even if it means taking two doses in a single day.

  • You don’t need to use backup birth control.

• If you miss two active blue pills in a row in the first two weeks:

  • Take two doses on the day you remember and two doses the next day.

  • Two consecutive missed doses increase the risk of pregnancy. Use backup birth control for the next seven days.

• If you miss two active blue pills in a row in the third week: 

  • Start over with a new Estarylla blister pack. 

  • When you start with the first pill from the new blister pack depends on when you first started the cycle. See the Instructions for Use for guidance.

  • Use backup birth control during the first seven days of the new blister pack.

• If you miss three or more active blue pills in a row in any week:

  • Start over with a new Estarylla blister pack. 

  • The day you start a new blister pack depends on when you first started the cycle. See the Instructions for Use for guidance.

  • Use backup birth control during the first seven days of the new blister pack.

• If you miss a placebo green pill in the fourth week:

  • Throw away the missed pill and take the next pill on the appropriate day. 

• If there’s any uncertainty about a missed dose, use backup birth control. 

How long can you take Estarylla?

Estarylla is intended as a long-term oral contraceptive. It can be taken for as long as it’s needed as long as it doesn’t cause intolerable or serious side effects.

How do I stop taking Estarylla?

Estarylla can be stopped at any time without causing withdrawal symptoms other than withdrawal bleeding. However, women who stop taking Estarylla can become pregnant unless they use other birth control methods.

If Estarylla is not an option for birth control, there are other combination oral contraceptives that have different progestogens. If estradiol is a problem, women can use a “mini-pill” that only contains progestin. 

Other hormonal contraceptives include hormonal skin patches, shots, implants, and vaginal rings. 

If hormonal contraception is not an option, women can opt for non-hormonal birth control, such as barrier methods or a non-hormonal IUD.

What is the maximum dosage for Estarylla?

Do not exceed the recommended dosage. To make up for a missed dose, a maximum of two pills can be taken in a single day.

Can you overdose on Estarylla?

An overdose of norgestimate/ethinyl estradiol should not cause serious problems, though some women may experience nausea or withdrawal bleeding. If too many pills are taken, call a poison control center or healthcare provider for medical advice.

What interacts with Estarylla?

Estarylla should never be used with any hepatitis C drug containing ombitasvir/paritaprevir/ritonavir with or without dasabuvir.

Some drug interactions can reduce the effectiveness of hormonal birth control and increase the risk of pregnancy. Women taking these drugs may need to use other forms of birth control, such as barrier methods and spermicide. These drugs include:

• The antiseizure drugs carbamazepine, phenytoin, oxcarbazepine, and topiramate

• Barbiturates

• Antiviral drugs called protease inhibitors

• The COVID-19 treatment Paxlovid

• The tuberculosis antibiotics rifampicin and rifabutin

• Aprepitant, bosentan, felbamate, griseofulvin, rufinamide

• The herbal supplement St. John’s wort

Some prescription drugs or foods can increase the risk of Estarylla side effects, including: 

• The antifungal drugs ketoconazole, itraconazole, voriconazole, and fluconazole

• Acetaminophen, atorvastatin, and rosuvastatin

• Grapefruit juice

• Vitamin C (ascorbic acid)

Women taking thyroid hormones may need their dose adjusted when taking Estarylla.

What happens when you mix Estarylla and alcohol?

Alcohol does not affect birth control pills. However, ask the prescriber for medical advice about drinking and birth control, particularly heavy or binge drinking.

Is it safe to take Estarylla during pregnancy?

Women who are pregnant should not take Estarylla pills. If you become pregnant, stop taking Estarylla and tell your doctor right away.

Is it safe to take Estarylla while breastfeeding?

Women should avoid Estarylla while breastfeeding. Birth control pills can reduce lactation.

Who shouldn’t take Estarylla?

Estarylla can be too hazardous for some women to take, so the drug is contraindicated in women who have:

• Liver disease

• A history of stroke or blood clots

• Coronary artery disease, cerebrovascular disease, uncontrolled high blood pressure, certain types of heart valve problems, or diabetes with blood vessel disease

• Unexplained vaginal bleeding

• A history of hormone-sensitive breast cancer

• Certain types of severe migraine headaches 

Women who are older than 35 years of age and who smoke should not take combination oral contraceptives like Estarylla.

What are the side effects of Estarylla?

The most common side effects of Estarylla are:

• Headache

• Breast tenderness, pain, enlargement, or discharge

• Stomach pain

• Gas

• Vaginal infections

• Mood changes

• Depression

• Weight changes

• Nervousness

What are the most serious side effects of Estarylla?

The most serious side effects of Estarylla include:

• Blood clots (deep vein thrombosis or pulmonary embolism)

• Stroke

• Heart attack

• Liver disease (including liver tumors)

• Gallbladder problems

• High blood pressure

• High cholesterol

• Depression

• Cervical or breast cancer

• Cysts

• Severe allergic reactions, such as angioedema.

When should I talk to a doctor?

When taking Estarylla, immediately talk to a doctor if you think you’re pregnant, miss two or more periods, or if you have symptoms of a serious side effect, such as:

• Chest pain

• Shortness of breath

• Persistent leg pain

• Sudden vision changes

• Numbness or weakness on one side of your body

• Sudden or severe headache

• Sudden vision, speech, or walking problems 

• Dark urine or pale stools

• Jaundice (yellow skin or eyes)

• Breast lumps

• Severe stomach pain

• Depression

• Swelling in the face, lips, mouth, or throat

Sources

• Estarylla- norgestimate and ethinyl estradiol kit, DailyMed (2023)

• Norgestimate, PubChem (2025)

• Oral contraceptive pills, StatPearls (2024)