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PACKAGE LEAFLET: INFORMATION FOR THE USER

Lestramyl®

150/20 micrograms tablets

Desogestrel/ethinylestradiol

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

•    Keep this leaflet. You may need to read it again.

•    If you have any further questions, ask your doctor or pharmacist.

•    This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.

•    If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.

Important things to know about combined hormonal contraceptives (CHCs):

•    They are one of the most reliable reversible methods of contraception if used correctly

•    They slightly increase the risk of having a blood clot in the veins and arteries, especially in the first year or when restarting a combined hormonal contraceptive following a break of 4 or more weeks

•    Please be alert and see your doctor if you think you may have symptoms of a blood clot (see section 2 "Blood clots”)

What is in this leaflet

1.    What Lestramyl® 150/20 micrograms tablets are and what it is used for

2.    What you need to know before you take Lestramyl®

150/20 micrograms tablets

3.    How to take Lestramyl® 150/20 micrograms tablets

4.    Possible side effects

5.    How to store Lestramyl® 150/20 micrograms tablets

6.    Contents of the pack and other information

1. What Lestramyl® 150/20 micrograms tablets are and what it is used for

Lestramyl® 150/20 micrograms tablet is a combined oral contraceptive, also called the pill. Each tablet contains a small amount of two types of female hormones, namely, a progestogen, desogestrel and an oestrogen, ethinylestradiol.

These help to stop you from getting pregnant, just as your natural hormones would stop you conceiving again when you are already pregnant.

The combined contraceptive pill protects you against getting pregnant in three ways. These hormones

1.    Stop the ovary from releasing an egg each month (ovulation).

2.    Also thicken the fluid (at the neck of the womb) making it more difficult for the sperm to reach the egg.

3.    Alter the lining of the womb to make it less likely to accept a fertilised egg.

2. What you need to know before you take Lestramyl®

150/20 micrograms tablets General notes

Before you start using Lestramyl® 150/20 micrograms tablets you should read the information on blood clots (thrombosis) in section 2.

It is particularly important to read the symptoms of a blood clot - see Section 2 "Blood clots”).

Before you can begin taking Lestramyl® 150/20 micrograms tablets, your doctor will ask you some questions about your personal health history and that of your close relatives. The doctor will also measure your blood pressure, and depending upon your personal situation, may also carry out some other tests.

In this leaflet, several situations are described where you should stop using Lestramyl® 150/20 micrograms tablets, or where the reliability of the pill may be decreased. In such situations you should either not have sex, or you should take extra non-hormonal contraceptive precautions (e.g. use a condom or another barrier method). Do not use rhythm or temperature methods. These methods can be unreliable because Lestramyl® 150/20 micrograms tablets alters the monthly changes of body temperature and of cervical mucus.

Lestramyl® 150/20 micrograms tablets, like other hormonal contraceptives, does not protect against HIV infection (AIDS) or any other sexually transmitted disease.

When you should not use Lestramyl® 150/20 micrograms tablets:

You should not use Lestramyl® 150/20 micrograms tablets if you have any of the conditions listed below. If you do have any of the conditions listed below, you must tell your doctor. Your doctor will discuss with you what other form of birth control would be more appropriate.

•    If you have (or have ever had) a blood clot in a blood vessel of your legs (deep vein thrombosis, DVT), your lungs (pulmonary embolism) or other organs

•    if you know you have a disorder affecting your blood clotting - for instance, protein C deficiency, protein S deficiency, antithrombin-III deficiency, Factor V Leiden or antiphospholipid antibodies

•    if you need an operation or if you are off your feet for a long time (see section "Blood clots” (thrombosis and embolus)

•    If you have (or have ever had) a heart attack or stroke

•    if you have (or have ever had) angina pectoris (a condition that causes severe chest pain and may be a first sign of a heart attack) or transient ischaemic attack (TIA - temporary stroke symptoms)

•    if you have any of the following diseases that may increase the risk of a clot in the arteries.

•    severe diabetes with blood vessel damage

•    very high blood pressure

•    a very high level of fat in the blood (cholesterol or triglycerides)

•    a condition known as hyperhomocysteinaemia

•    If you have (or have ever had) a type of migraine called 'migraine with aura'

•    If you have (or have ever had) an inflammation of the pancreas (pancreatitis)

•    If you have (or have ever had) a liver disease and your liver function is still not normal

•    If you have (or have ever had) a tumour in the liver

•    If you have (or have ever had) or if you are suspected to having breast cancer or cancer of the genital organs

•    If you have any unexplained bleeding from the vagina

•    overgrowth of the lining of the uterus (womb)

•    If you are allergic to ethinylestradiol or desogestrel, or any of the other ingredients of this medicine (listed in section 6).

When to take special care with Lestramyl® 150/20 micrograms tablets Tell your doctor if any of the following conditions apply to you.

When should you contact your doctor?

Seek urgent medical attention

•    if you notice possible signs of a blood clot that may mean you are suffering from a blood clot in the leg (i.e. deep vein thrombosis), a blood clot in the lung (i.e. pulmonary embolism), a heart attack or a stroke (see "Blood clot” (thrombosis) section below.

For a description of the symptoms of these serious side effects please go to "How to recognise a blood clot”.

In some situations you need to take special care while using Lestramyl® 150/20 micrograms tablets or any other combination pill, and your doctor may need to examine you regularly. If any of the following conditions applies to you, tell your doctor before starting to use Lestramyl® 150/20 micrograms tablets. If the conditions develops, or gets worse while you are using Lestramyl® 150/20 micrograms tablets, you should tell your doctor:

•    if a close relative has or has ever had breast cancer

•    if you have a disease of the liver or the gallbladder

•    if you have diabetes

•    if you have depression

•    if you have Crohn's disease or ulcerative colitis (chronic inflammatory bowel disease

•    if you have systemic lupus erythematosus (SLE - a disease affecting your natural defence system)

•    if you have haemolytic uraemic syndrome (HUS - a disorder of blood clotting causing failure of the kidneys)

•    if you have sickle cell anaemia (an inherited disease of the red blood cells)

•    if you have epilepsy (see "The pill and using other medicines”)

•    if you have elevated levels of fat in the blood (hypertriglyceridaemia) or a positive family history for this condition. Hypertriglyceridaemia has been associated with an increased risk of developing pancreatitis (inflammation of the pancreas)

•    if you need an operation, or you are off your feet for a long time (see in section 2 "Blood clots”)

•    if you have just given birth you are at an increased risk of blood clots.

You should ask your doctor how soon after delivery you can start taking Lestramyl® 150/20 micrograms tablets

•    if you have an inflammation in the veins under the skin (superficial thrombophlebitis)

•    if you have varicose veins

•    if you have a disease that first appeared during pregnancy or earlier use of sex hormones for example, hearing loss, a blood disease called porphyria, skin rash with blisters during pregnancy (gestational herpes) a nerve disease causing sudden movements of the body (Sydenham's chorea)

•    if you have or have ever had chloasma (a discoloration of the skin especially of the face or neck known as "pregnancy patches”). If so, avoid direct sunlight or ultraviolet light.

•    If you have hereditary angioedema, products containing oestrogens may cause or worsen symptoms. You should see your doctor immediately

if you experience symptoms of angioedema such as swollen face, tongue and/or throat and/or difficulty swallowing or hives together with difficulty breathing.

•    high blood pressure BLOOD CLOTS

Using a combined hormonal contraceptive such as Lestramyl®

150/20 micrograms tablets, increases your risk of developing a blood clot compared with not using one.

Blood clots can develop:

•    in veins (referred to as a 'venous thrombosis', 'venous thromboembolism' or VTE)

•    in the arteries (referred to as an 'arterial thrombosis', 'arterial thromboembolism' or ATE).

Recovery from blood clots is not always complete. Rarely, there may be serious lasting effects or, very rarely, they may be fatal.

It is important to remember that the overall risk of a harmful blood clot due to Lestramyl® 150 micrograms/ 20 micrograms tablet is small.

How to recognise a blood clot

Seek urgent medical attention if you notice any of the following signs or symptoms.

Blood clots in a vein

What can happen if a blood clot forms in a vein?

•    The use of combined hormonal contraceptives has been connected with an increase in the risk of blood clots in the vein (venous thrombosis). However, these side effects are rare. Most frequently, they occur in the first year of use of a combined hormonal contraceptive.

•    If a blood clot forms in a vein in the leg or foot it can cause a deep vein thrombosis (DVT).

•    If a blood clot travels from the leg and lodges in the lung it can cause a pulmonary embolism.

•    Very rarely a clot may form in a vein in another organ such as the eye (retinal vein thrombosis).

When is the risk of developing a blood clot in a vein highest?

The risk of developing a blood clot in a vein is highest during the first year of taking a combined hormonal contraceptive for the first time.

The risk may also be higher if you restart taking a combined hormonal contraceptive (the same product or a different product) after a break of 4 weeks or more. After the first year, the risk gets smaller but is always slightly higher than if you were not using a combined hormonal contraceptive.

When you stop Lestramyl® 150/20 micrograms tablets your risk of a blood clot returns to normal within a few weeks.

What is the risk of developing a blood clot?

The risk depends on your natural risk of VTE and the type of combined hormonal contraceptive you are taking.

The overall risk of a blood clot in the leg or lung (DVT or PE) with Lestramyl® 150/20 micrograms tablets is small.

•    Out of 10,000 women who are not using any combined hormonal contraceptive and are not pregnant, about 2 will develop a blood clot in a year.

•    Out of 10,000 women who are using a combined hormonal contraceptive that contains levonorgestrel, norethisterone, or norgestimate about 5-7 will develop a blood clot in a year.

•    Out of 10,000 women who are using a combined hormonal contraceptive that contains desogestrel, such as with Lestramyl® 150/20 micrograms tablets, between about 9 and 12 women will develop a blood clot in a year.

•    The risk of having a blood clot will vary according to your personal medical history (see "Factors that increase your risk of a blood clot” below)

	Risk of developing a blood clot in a year
Women who are not using a combined hormonal pill/patch/ring and are not pregnant	About 2 out of 10,000 women
Women using a combined hormonal contraceptive pill containing levonorgestrel, norethisterone or norgestimate	About 5-7 out of 10,000 women
Women using Lestramyl® 150/20 micrograms tablets	About 9-12 out of 10,000 women

Factors that increase your risk of a blood clot in a vein

The risk of a blood clot with Lestramyl® 150/20 micrograms tablets is small but some conditions will increase the risk. Your risk is higher:

•    if you are very overweight (body mass index or BMI over 30kg/m²);

•    if one of your immediate family has had a blood clot in the leg, lung or other organ at a young age (e.g. below the age of about 50). In this case you could have a hereditary blood clotting disorder;

•    if you need to have an operation, or if you are off your feet for a long time because of an injury or illness, or you have your leg in a cast. The use of Lestramyl® 150/20 micrograms tablets may need to be stopped several weeks before surgery or while you are less mobile. If you need to stop Lestramyl® 150/20 micrograms tablets ask your doctor when you can start using it again.

•    as you get older (particularly above about 35 years);

•    if you gave birth less than a few weeks ago

The risk of developing a blood clot increases the more conditions you have.

Air travel (>4 hours) may temporarily increase your risk of a blood clot, particularly if you have some of the other factors listed.

It is important to tell your doctor if any of these conditions apply to you, even if you are unsure. Your doctor may decide that Lestramyl®

150/20 micrograms tablets needs to be stopped.

If any of the above conditions change while you are using Lestramyl® 150/20 micrograms tablets for example a close family member experiences a thrombosis for no known reason; or you gain a lot of weight, tell your doctor.

Blood clots in an artery

What can happen if a blood clot forms in an artery?

Like a blood clot in a vein, a clot in an artery can cause serious problems. For example, it can cause a heart attack or a stroke.

Factors that increase your risk of a blood clot in an artery

It is important to note that the risk of a heart attack or stroke from using

Lestramyl® 150/20 micrograms tablets is very small but can increase:

•    with increasing age (beyond about 35 years);

•    if you smoke. When using a combined hormonal contraceptive Lestramyl® 150/20 micrograms tablets you are advised to stop smoking. If you are unable to stop smoking and are older than 35 your doctor may advise you to use a different type of contraceptive;

•    if you are overweight;

•    if you have high blood pressure;

•    if a member of your immediate family has had a heart attack or stroke at a young age (less than about 50). In this case you could also have a higher risk ofhaving a heart attack or stroke;

•    if you, or someone in your immediate family, have a high level of fat in the blood (cholesterol or triglycerides);

•    if you get migraines, especially migraines with aura;

•    if you have a problem with your heart (valve disorder, disturbance of the rhythm called atrial fibrillation)

•    if you have diabetes.

If you have more than one of these conditions or if any of them are particularly severe the risk of developing a blood clot may be increased even more.

If any of the above conditions change while you are using Lestramyl® 150/20 micrograms tablets, for example you start smoking, a close family member experiences a thrombosis for no known reason; or you gain a lot of weight, tell your doctor.

The pill and cancer

Cervical cancer has been found more often in women taking oral contraceptives. However, this may be due to other causes including less frequent use of a condom.

Breast cancer has been observed slightly more often in women using combination pills, but it is not known whether this is caused by the treatment. For example it may be that more tumours are detected in women on combination pills because they are examined by their doctor more often. The occurrence of breast tumours becomes gradually less after stopping the combination hormonal contraceptives. It is important to regularly check your breasts and you should contact your doctor if you feel any lump.

In rare cases, benign liver tumours, and in even fewer cases malignant liver tumours have been reported in pill users. Contact your doctor if you have unusually severe abdominal pain.

Bleeding between periods

During the first few months that you are taking Lestramyl®

150/20 micrograms tablets, you may have unexpected bleeding (bleeding outside the gap week). If this bleeding occurs for more than a few months, or if it begins after some months, your doctor must find out what is wrong. What you must do if no bleeding occurs in the gap week If you have taken all the tablets correctly, have not had vomiting or severe diarrhoea and you have not taken any other medicines or any products which contain the herbal remedy St. John's wort (Hypericum perforatum), it is highly unlikely that you are pregnant.

Date: 23 OCT 2014

If the expected bleeding does not happen twice in succession, you may be pregnant. Contact your doctor immediately.

Do not start the next strip until you are sure that you are not pregnant. Children and adolescents

The use of Lestramyl® 150/20 micrograms tablets is not recommended as there are no clinical data on efficacy and safety in adolescents under 18 years of age.

Other medicines and Lestramyl® 150/20 micrograms tablets

Always tell the doctor which medicines or herbal products you are already using. Also tell any other doctor or dentist who prescribes another medicine (or the pharmacist) that you use Lestramyl® 150/20 micrograms tablets. They can tell you if you need to take additional contraceptive precautions (for example condoms) and if so, for how long.

Some medicines can make Lestramyl® 150/20 micrograms tablets less effective in preventing pregnancy, or can cause unexpected bleeding. These include:

•    Medicines used for the treatment of epilepsy (e.g. primidone, phenytoin, barbiturates, carbamazepine, oxcarbamazepine, topiramate, felbamate)

•    bosentan (a medicine for the treatment of hypertension in the lung arterie or ulcers of the fingers)

•    modafinil (a medicine for the treatment of narcolepsy)

•    Medicines used for the treatment of tuberculosis (e.g. rifampicin),

•    Medicines used for the treatment of HIV infections (ritonavir, nelfinavir, nevirapine, efavirenz) or other infections (antibiotics such as griseofulvin, penicillin, tetracycline, rifabutin)

•    the herbal remedy St. John's wort (Hypericum perforatum).

•    Lestramyl® 150/20 micrograms tablets may influence the effect of other medicines, e.g.

•    medicines containing cyclosporin,

•    the anti-epileptic lamotrigine (this could lead to an increased frequency of seizures).

Ask your doctor or pharmacist for advice before taking any medicine. Lestramyl® 150/20 micrograms tablets with food and drink Lestramyl® 150/20 micrograms tablets may be taken with or without food, if necessary with a small amount of water.

Laboratory tests:

If you need a blood test, tell your doctor or the laboratory staff that you are taking the pill, because hormone contraceptives can effect the results of some tests.

Pregnancy

If you are pregnant, do not take Lestramyl® 150/20 micrograms tablets.

If you become pregnant while taking Lestramyl® 150/20 micrograms tablets stop immediately and contact your doctor. If you want to become pregnant, you can stop taking the pill at any time.

Ask your doctor or pharmacist for advice before taking any medicine. Breast-feeding

Use of Lestramyl® 150/20 micrograms tablets is generally not advisable when a woman is breast-feeding. If you want to take the pill while you are breast feeding you should contact your doctor.

Ask your doctor or pharmacist for advice before taking any medicine.

Driving and using machines

There is no information suggesting that use of Lestramyl®

150/20 micrograms tablets affects driving or use of machines.

Lestramyl® 150/20 micrograms tablets contain lactose This product contains lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

3. How to take Lestramyl® 150/20 micrograms tablets

Take one tablet of Lestramyl® 150/20 micrograms tablets every day, if necessary with a small amount of water. You may take the tablets with or without food, but you should take the tablets every day around the same time.

The strip contains 21 tablets. Next to each tablet is printed the day of the week that it should be taken. If, for example you start on a Wednesday, take a tablet with "WED” next to it. Follow the direction of the arrow on the strip until all 21 tablets have been taken.

Then take no tablets for 7 days. In the course of these 7 tablet-free days (otherwise called a stop or gap week) bleeding should begin. This is so-called "withdrawal bleeding” usually starts on the 2^nd or 3^rd day of the gap week.

On the 8^th day after the last tablet of Lestramyl® 150/20 micrograms (that is, after the 7-day gap week), you should start with the following strip, whether your bleeding has stopped or not. This means that you should start every strip on the same day of the week and that the withdrawal bleed should occur on the same days each month.

If you use Lestramyl® 150/20 micrograms tablets in this manner, you are also protected against pregnancy during the 7 days when you are not taking a tablet.

When can you start with the first strip?

•    If you have not used a contraceptive with hormones in the previous month Begin with Lestramyl® 150/20 micrograms on the first day of the cycle (that is the first day of your period). If you start Lestramyl®

150/20 micrograms on the first day of your period you are immediately protected against pregnancy. You may also begin on day 2-5 of the cycle, but then you must use extra protective measures (for example, a condom) for the first 7 days.

•    Changing from a combination hormonal contraceptive, or combination contraceptive vaginal ring or patch

You can start Lestramyl® 150/20 micrograms preferably on the day after the last active tablet (the last tablet containing active substances) of your previous pill, but at the latest on the day after the tablet-free days of your previous pill (or after the last inactive tablet of your previous pill). When changing from a combination contraceptive vaginal ring or patch, follow the advice of your doctor.

•    Changing from a progestogen-only-method (progestogen-only pill, injection, implant or a progestogen-releasing IUD)

You may switch any day from the progestogen-only pill (from an implant or an IUD on the day of its removal, from an injectable when the next injection would be due) but in all of these cases use extra protective measures (for example, a condom) for the first 7 days of tablet-taking.

•    After a miscarriage

Follow the advice of your doctor.

•    After having a baby

You can start Lestramyl® 150/20 micrograms between 21 and 28 days after having a baby,. If you start later than day 28, use a so-called barrier method (for example, a condom) during the first seven days of Lestramyl® 150/20 micrograms use. If, after having a baby, you have had sex before starting Lestramyl® 150/20 micrograms (again), be sure that you are not pregnant or wait until your next period.

•    If you are breastfeeding and want to start Lestramyl® 150/20 micrograms tablets (again) after having a baby.

Read the section on "Breast feeding”

Ask your doctor what to do if you are not sure when to start.

Use in children and adolescents

No clinical data on efficacy and safety are available in adolescents below 18 years.

If you take more Lestramyl® 150/20 micrograms tablets than you should

There are no reports of serious harmful results of taking too many Lestramyl® 150/20 micrograms tablets. If you take several tablets at once then you may have symptoms of nausea or vomiting. Young girls may have bleeding from the vagina. If you have taken too many Lestramyl® 150/20 micrograms tablets, or you discover that a child has taken some, ask your doctor or pharmacist for advice.

What to do if you forget to take Lestramyl® 150/20 micrograms tablets

•    If you are less than 12 hours late taking a tablet, the protection against pregnancy is not reduced. Take the tablet as soon as you remember and then take the following tablets again at the usual time.

•    If you are more than 12 hours late taking a tablet, the protection against pregnancy may be reduced. The greater the number of tablets that you have forgotten, the greater is the risk of becoming pregnant.

The risk of incomplete protection against pregnancy is greatest if you forget a tablet at the beginning or the end of the strip. Therefore, you should keep to the following rules (see the the diagram below):

•    More than one tablet forgotten in this strip Contact your doctor.

•    One tablet forgotten in week 1

Take the forgotten tablet as soon as you remember, even if that means that you have to take two tablets at the same time. Continue taking the tablets at the usual time and use extra precautions for the next 7 days, for example, a condom. If you have had sex in the week before forgetting the tablet you may be pregnant. In that case, contact your doctor

•    One tablet forgotten in week 2

Take the forgotten tablet as soon as you remember, even if that means that you have to take two tablets at the same time. Continue taking the tablets at the usual time. The protection against pregnancy is not reduced, and you do not need to take extra precautions.

•    One tablet forgotten in week 3

You can choose between two possibilities:

1.    Take the forgotten tablet as soon as you remember, even if that means that you have to take two tablets at the same time. Continue taking the tablets at the usual time. Instead of taking the tablet-free period start next strip.

Most likely, you will have a period at the end of the second strip but you may also have light or menstruation -like bleeding during the second strip.

2.    You can also stop the strip and go directly to the tablet-free period of

7 days (record the day on which you forgot your tablet). If you want to start a new strip on the day you always start, make the tablet-free period less than 7 days.

If you follow one of these two recommendations, you will remain protected against pregnancy.

•    If you have forgotten any of the tablets in a strip, and you do not have bleeding in the first tablet-free period, you may be pregnant. Contact your doctor before you start the next strip.

What to do in case of vomiting or severe diarrhoea

If you vomit within 3-4 hours of taking a tablet or you have severe diarrhoea, there is a risk that the active substances in the tablet are not fully absorbed into your body. The situation is almost the same as forgetting a tablet. After vomiting or diarrhoea, take another tablet from a reserve strip as soon as possible. If possible take it within 12 hours of when you normally take your pill. If this is not possible or 12 hours have passed, you should follow the advice given under "If you forget to take Lestramyl® 150/20 micrograms tablets”

Delay of menstrual period: what you need to know Even though it is not recommended, you can delay your menstrual period by going straight to a new strip of Lestramyl® 150/20 micrograms tablets instead of the tablet-free period, and finishing it. You may experience light or menstruation-like bleeding while using this second strip. After the usual tablet-free period of 7 days, start the next strip.

You might ask your doctor for advice before deciding to delay your menstrual period.

Changing of the first day of your menstrual period: what you must know

If you take the tablets according to the instructions, then your period will begin during the tablet-free week. If you have to change this day, reduce the number of the tablet-free days (but never increase them - 7 is the maximum). For example, if your tablet-free days normally begin on a Friday, and you want to change this to a Tuesday (3 days earlier) start a new strip 3 days earlier than usual. If you make the tablet-free interval very short (for example, 3 days or less) you may not have any bleeding during these days. You may then experience light or menstruation-like bleeding.

If you are not sure what to do, consult your doctor.

If you want to stop taking Lestramyl® 150/20 micrograms Tablets You can stop taking Lestramyl® 150/20 micrograms tablets whenever you want. If you do not want to become pregnant, ask your doctor for advice about other reliable methods of birth control. If you want to become pregnant, stop taking Lestramyl® 150/20 micrograms tablets and wait for a period before trying to become pregnant. You will be able to calculate the expected delivery date more easily.

If you have any further questions on the use of this product, ask your doctor or pharmacist

4.    Possible side effects

Like all medicines, Lestramyl® 150/20 micrograms tablets can cause side effects, although not everybody gets them. If you get any side effect, particularly if severe and persistent, or have any change to your health that you think may be due to Lestramyl®

150/20 micrograms tablets, please talk to your doctor.

An increased risk of blood clots in your veins (venous thromboembolism (VTE)) or blood clots in your arteries (arterial thromboembolism (ATE)) is present for all women taking combined hormonal contraceptives.

For more detailed information on the different risks from taking combined hormonal contraceptives please see section 2 "What you need to know before you take Lestramyl® 150/20 micrograms tablets”

Serious reactions

More serious reactions associated with combined hormonal contraceptive pills are detailed above in section 2 under "Blood clots” and "The pill and cancer” Please read these subsections carefully, and if you have any questions, ask your doctor.

The following serious side effects have been reported in women using the pill: Crohn's disease or ulcerative colitis (chronic inflammatory bowel diseases), systemic lupus erythematosus (SLE, a disease of the connective tissue), epilepsy, the rash known as herpes gestationis, chorea (a movement disease), a blood disorder called haemolytic uraemic syndrome - HUS (a disorder where blood clots cause the kidneys to fail), brown patches on the face and body (chloasma), movement disorder called Sydenham's chorea, yellowing of the skin, gynaecological disorders (endometriosis, uterine myoma)

Other possible side effects

The following side effects have been reported in women using the pill, which can occur in the first few months after starting Lestramyl® 150/20 micrograms tablets, but they usually stop once your body has adjusted to the pill.

Very common (affects 1 in every 10 users): irregular bleeding and weight gain.

Common (affects 1 to 10 users in 100): no bleeding, tender breasts, breast pain, depression, headache, nervousness, dizziness, nausea, acne, high blood pressure, stomach (abdominal) pain, spotting or breakthrough bleeding (metrorrhagia), change in your mood.

Uncommon (affects 1 to 10 users in 1,000): breast enlargement, decreased sexual desire, migraine, vomiting, diarrhoea, rash, nettle-rash (urticaria), fluid retention

Rare (affects 1 to 10 users in 10,000): harmful blood clots in a vein or artery for example: • in a leg or foot (i.e. DVT), • in a lung (i.e. PE), • heart attack,

• stroke, • mini-stroke or temporary stroke-like symptoms, known as a transient ischaemic attack (TIA), • blood clots in the liver, stomach/ intestine, kidneys or eye, vaginal candidiasis (fungal infection), impaired hearing (otosclerosis), thromboembolism, hypersensitivity, increased sexual desire, eye irritation due to contact lens, loss of hair (alopecia), itching, skin disorders (erythema nodosum - a skin disease associated with joint pain, fever, hypersensitivity, or infection, and characterized by small, painful, pink to blue nodules under the skin and on the shins that tend to recur; erythema multiforme - a skin disease characterized by solid raised spots on the skin or fluid-filled blisters lesions and reddening or discoloration of the skin often in concentric zones about the lesions), vaginal discharge, breast discharge, loss of weight.

The chance of having a blood clot may be higher if you have any other conditions that increase this risk (see section 2 for more information on the conditions that increase risk for blood clots and the symptoms of a blood clot).

Before you have any blood tests

Tell your doctor or the laboratory staff that you are taking the pill, because oral contraceptives can affect the results of some tests.

If you get any side effects, talk to your doctor or pharmacist. This includes any side effects not listed in this leaflet.

5.    How to store Lestramyl® 150/20 micrograms tablets Keep this medicine out of the sight and reach of children.

Do not store this medicine above 25°C and store blisters in the original pouches in order to protect from moisture and light.

Expiry date

Do not use this medicine after the expiry date which is stated on the package after "EXP". The expiry date refers to the last day of that month.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6.    Contents of the pack and other information What Lestramyl® 150/20 micrograms tablets contains The active substances are desogestrel and ethinylestradiol.

The other ingredients are:

All-rac-alpha-tocopherol, potato starch, povidone (E1201), stearic acid (E570), silica colloidal anhydrous (E551) and lactose anhydrous.

What Lestramyl® 150/20 micrograms tablets look like and contents of the pack

Each tablet is round, white to off-white, uncoated, biconvex, debossed with '141' on one side and other side plain.

Each strip of Lestramyl® 150/20 micrograms tablets contains 21 white tablets.

Each box of Lestramyl® 150/20 micrograms tablets contains 1,3 or 6 strips of 21 tablets.

Not all pack sizes may be marketed Marketing Authorisation Holder

Mylan

Station Close Potters Bar, Herts EN6 1TL Manufacturer

Accord Healthcare Limited Sage House, 319 Pinner Road,

North Harrow, Middlesex HA1 4HF,

United Kingdom Gerard Laboratories,

35/36 Baldoyle Industrial Estate,

Grange State,

Dublin 13,

Ireland

Generics [UK] Limited,

Station Close,

Potters Bar,

Hertfordshire.

EN6 1TL

United Kingdom

This leaflet was last revised in    431840

03/2014

Date: 23 OCT 2014