Qlaira Tablets

Qlaira is a combined oral contraceptive tablet containing estradiol valerate and dienogest in a quadriphasic dose pattern. It is licensed in the United Kingdom for the prevention of pregnancy and for the treatment of heavy menstrual bleeding in women who do not have an organic cause for their heavy periods and who wish to use oral hormonal contraception. Qlaira belongs to the combined hormonal contraceptive group of medicines and works by suppressing ovulation and altering cervical mucus and the endometrial lining. It is available as a 28-tablet film-coated pack comprising 26 active tablets in four distinct dose phases and 2 inactive tablets, taken daily with no break between packs. This page provides information about how Qlaira works, how to take it correctly, its unique quadriphasic structure, and important safety information.

Qlaira is one of only two UK-licensed combined pills that uses estradiol valerate rather than synthetic ethinylestradiol as its oestrogen component. Estradiol valerate is a prodrug converted in the body to estradiol, the same oestrogen produced naturally by the ovaries. Zoely is the other UK-licensed combined pill using a natural oestrogen (estradiol hemihydrate). No other combined pill in routine UK prescribing uses this oestrogen type. Qlaira is manufactured by Bayer plc and has no generic equivalent available in the UK.

Qlaira is a quadriphasic combined oral contraceptive. Quadriphasic means the hormone doses change four times across the 28-tablet pack. This is more complex than triphasic pills such as Logynon (three phases) and far more complex than the monophasic pills that make up most of this site's contraception range.

The pack contains 28 tablets in five groups: four active phases and one inactive phase. The doses of both estradiol valerate and dienogest step up and then down in a deliberate pattern designed to closely mirror the hormonal rhythm of a natural menstrual cycle. This dose-stepping approach is why Qlaira must be taken in strict tablet order, every day, with no pack breaks.

The Active Ingredients

Estradiol valerate is a prodrug. After you take a tablet, the body converts it to estradiol, which is chemically identical to natural ovarian oestrogen. This is the same pharmacological principle used by Zoely (which uses estradiol hemihydrate). Both differ from ethinylestradiol, the synthetic oestrogen in every other combined pill. The clinical significance of this is discussed in the VTE section.

Dienogest is a synthetic progestogen derived from norethisterone. It is highly selective for the progesterone receptor and has a mild anti-androgenic profile. It is not the same as levonorgestrel, desogestrel, gestodene, norgestimate, or drospirenone. Dienogest is used only in Qlaira among UK-licensed combined pills.

The Two Licensed Indications

Qlaira is the only combined pill in this series licensed for two separate indications: prevention of pregnancy and treatment of heavy menstrual bleeding (menorrhagia) without an organic cause, in women who also want oral contraception. Both indications require the same prescription process. The prescriber will assess which indication applies to your circumstances and whether Qlaira is clinically appropriate for either or both.

Ovulation Suppression

Estradiol valerate and dienogest together suppress the hypothalamic-pituitary hormonal signals that drive ovulation. Follicle-stimulating hormone and luteinising hormone are both inhibited. Without the luteinising hormone surge, the ovary does not release an egg. This is the primary contraceptive mechanism.

Cervical Mucus and Endometrial Effects

Dienogest thickens cervical mucus, making it more resistant to sperm penetration. The combined hormonal environment also alters the endometrial lining. In the context of heavy menstrual bleeding, this endometrial effect is clinically significant: by maintaining a hormonally stable endometrial environment throughout the cycle, Qlaira reduces the proliferative activity that drives heavy menstrual blood loss.

Why the Quadriphasic Structure Matters

Most combined pills deliver the same hormone dose every day during the active phase (monophasic), or change doses two or three times (biphasic or triphasic). Qlaira steps through four distinct active dose combinations across 26 tablets. This pattern is designed to deliver estradiol valerate in a way that more closely approximates the oestrogen fluctuation of a natural cycle, with the dienogest component rising to its full dose during the main active phase and then stepping back down at the end.

This architecture has two practical consequences. First, you must take Qlaira tablets in strict sequence every day. Second, because the pack contains two inactive tablets at the end rather than a break between packs, the transition from one pack to the next is seamless. There is no ring-free week, no seven-day gap, and no pill-free interval.

Following the Pack Order

Qlaira tablets must be taken in the exact order marked on the blister strip. The five tablet types are colour-coded. Take one tablet every day at the same time, beginning with the first dark yellow tablet and following the sequence through to the final two white inactive tablets. Then start the next pack immediately.

Unlike most combined pills, there is no break between packs and no ring-free week. Qlaira is a continuous daily pill. You start a new pack the day after completing the previous one, without any gap.

When to Start

1. No previous hormonal contraception: start on day one of your period for immediate protection. Starting on days two to five requires additional barrier contraception for the first nine days of tablet-taking.
2. Switching from a combined pill: start Qlaira on the day after your last active tablet from the previous pack, or immediately after the last inactive tablet if your previous pill had placebo days. Protection continues without interruption.
3. Switching from a progestogen-only pill: start Qlaira on any day. Use barrier contraception for the first nine days.
4. Switching from a vaginal ring or contraceptive patch: start Qlaira on the day of removal or the day the next ring or patch would have been applied.

Missed Pill Rules

Because Qlaira uses estradiol valerate rather than synthetic ethinylestradiol, its pharmacokinetics differ from conventional combined pills. The missed pill guidance for Qlaira reflects this difference.

1. Missed one active tablet: take it as soon as you remember. If fewer than 12 hours have passed since your usual time, continue the pack and protection is maintained. If more than 12 hours have passed, take the missed tablet and use barrier contraception for the next nine days.
2. Missed two or more active tablets: take the most recently missed tablet as soon as you remember and use barrier contraception for nine days. If unprotected sex occurred during the missed tablet period, seek advice about emergency contraception.
3. Missed an inactive (white) tablet: discard it. No action needed and protection is unaffected.

The nine-day additional contraception requirement is specific to Qlaira and longer than the seven-day requirement for most other combined pills. This reflects the longer time needed for the quadriphasic hormonal pattern to re-establish full contraceptive protection. Always follow the Patient Information Leaflet for Qlaira specifically; guidance for other combined pills does not apply.

Qlaira contains 28 tablets per pack arranged in five groups. The hormone doses change at each active phase. Every tablet must be taken in the sequence shown on the blister strip.

Phase 1 (2 dark yellow tablets): estradiol valerate 3 mg only, no dienogest. This oestrogen-only opening phase primes the endometrium.

Phase 2 (5 medium red tablets): estradiol valerate 2 mg + dienogest 2 mg. Dienogest begins at a lower dose.

Phase 3 (17 light yellow tablets): estradiol valerate 2 mg + dienogest 3 mg. The main active phase with full-dose dienogest.

Phase 4 (2 dark red tablets): estradiol valerate 1 mg only, no dienogest. Oestrogen steps down to initiate the controlled bleed.

Inactive (2 white tablets): no active hormones. The withdrawal bleed typically occurs during these two days.

The Withdrawal Bleed

Because of Qlaira's unique dose pattern, the withdrawal bleed occurs during the two-day inactive phase and sometimes continues into the first phase 1 tablets of the next pack. This is normal for Qlaira. The bleed is typically shorter and lighter than a natural period. Do not delay starting the next pack if bleeding has not finished.

The following is based on the current UK SmPC for Qlaira. Not everyone experiences side effects. Read the Patient Information Leaflet in full before starting treatment.

Common Side Effects

Common side effects include headache, breast tenderness, irregular spotting or changes to the bleeding pattern (particularly in the first few cycles), nausea, mood changes, acne, and reduced libido. Because of the quadriphasic dose pattern, some women experience more variable bleeding in the first two to three cycles compared with monophasic pills. This usually settles with continued use.

Less Common Side Effects

1. Weight changes
2. Contact lens intolerance
3. Chloasma: patches of darker skin, typically on the face, worsened by sun exposure
4. Changes in vaginal discharge

Serious Signs: Seek Urgent Medical Help If You Notice

1. Sudden chest pain, breathlessness, or coughing up blood
2. Swelling, pain, redness, or warmth in one leg
3. Sudden severe headache, visual disturbance, speech difficulty, or weakness on one side of your body
4. Severe abdominal pain
5. Yellowing of the skin or whites of the eyes

VTE Risk and Estradiol Valerate

The VTE risk profile of Qlaira differs from that of ethinylestradiol-containing combined pills. The UK SmPC and available clinical studies suggest that the VTE risk with Qlaira may be lower than with some ethinylestradiol-containing combined pills, which may relate to the different metabolic profile of estradiol valerate compared with synthetic ethinylestradiol. However, the evidence base is smaller than for pills in clinical use for several decades. All combined pills carry some increased VTE risk above the baseline for women using no hormonal contraception. Your prescriber will assess your individual VTE risk factors before recommending Qlaira.

Medicines That Affect Qlaira

Enzyme-inducing medicines increase the breakdown of estradiol valerate and dienogest, reducing hormone levels and contraceptive reliability. These include rifampicin, certain antiepileptic medicines such as phenytoin, carbamazepine, phenobarbital, and topiramate, some HIV antiretrovirals, and St John's Wort. Inform your prescriber of every medicine, supplement, and herbal product you take.

Qlaira Is Not Suitable If You:

1. Have ever had a blood clot: deep vein thrombosis, pulmonary embolism, stroke, or heart attack
2. Have migraine with aura
3. Have uncontrolled high blood pressure
4. Have active or past liver disease or liver tumours
5. Have or have had breast cancer or another hormone-sensitive cancer
6. Are pregnant
7. Are breastfeeding a baby under six weeks old
8. Smoke and are 35 or older
9. Have diabetes with established vascular complications

Qlaira May Be Appropriate If You:

1. Are a healthy adult woman with no contraindications to combined hormonal contraception
2. Have heavy menstrual bleeding without an organic cause and also require oral contraception
3. Have experienced oestrogen-related side effects on ethinylestradiol-based combined pills and a prescriber is considering a natural oestrogen preparation
4. Are comfortable managing a complex quadriphasic pack and taking tablets in strict daily order
5. Have no personal or family history of blood clots, stroke, or cardiovascular disease

Discuss With Your Prescriber First If You:

1. Smoke and are under 35
2. Have a BMI above 30
3. Have a first-degree family member who had a blood clot before the age of 50
4. Have migraines without aura
5. Are planning long-haul travel or face extended immobility
6. Have a history of depression or are currently being treated for a mood disorder
7. Have heavy periods but have not yet been assessed to rule out organic causes such as fibroids or endometriosis

Pharmacy Planet is a GPhC registered UK online pharmacy. Every Qlaira prescription is issued following a clinical consultation reviewed by a registered prescriber. Qlaira has two licensed indications, a unique quadriphasic dose structure, a natural oestrogen type with a developing evidence base, and specific missed pill rules that differ from standard combined pills. The prescribing assessment for Qlaira therefore covers more clinical ground than for a standard monophasic combined pill.

Your prescriber will assess your suitability for combined hormonal contraception, your VTE risk profile, whether heavy menstrual bleeding is part of your clinical picture, and whether the quadriphasic format is appropriate for your circumstances. The outcome may be a prescription for Qlaira, a recommendation for a different preparation, or a referral for an in-person review if your presentation requires it. Completing a questionnaire is the start of the process. It does not determine the outcome.

Repeat supply prescriptions follow the same individual clinical review. There is no automatic renewal.

Store Qlaira below 25°C, away from direct heat and sunlight. Keep tablets in the original blister strip so that the colour coding and day markings remain visible and the sequence is preserved. Store out of reach of children. Check the expiry date on the carton before each pack.

Return unused or out-of-date tablets to any UK pharmacy for safe disposal. Do not flush tablets or put them in household waste.

This reference guide compares the contraceptive preparations available at Pharmacy Planet, grouped by delivery method and formulation type. Every preparation is a Prescription Only Medicine. A registered prescriber will review your individual health profile, contraceptive history, and risk factors before recommending any preparation. This table is a clinical reference, not a recommendation.

Multiphasic combined pills change hormone doses at defined points across the active tablet course. The table below compares the triphasic and quadriphasic preparations available at Pharmacy Planet by progestogen stepping, oestrogen stepping, VTE risk, and key distinguishing features.

Important: This comparison is for general information only and does not replace medical advice. A prescriber will decide which treatment is suitable for you following an online consultation.

Qlaira is not a pill to prescribe casually. Its dual indication, quadriphasic structure, natural oestrogen type, and specific nine-day missed pill requirement all mean that a prescriber needs to be actively engaged with the clinical context rather than processing a standard contraceptive request. At Pharmacy Planet, every Qlaira consultation is read individually by a registered prescriber who takes responsibility for the decision.

If Qlaira is not appropriate for your circumstances, the prescriber will explain why and discuss what is. The clinical assessment is the service. Supply is the outcome of that assessment, not the other way around.

Bayer plc. Qlaira film-coated tablets – Summary of Product Characteristics. Available at: www.medicines.org.uk/emc. Accessed May 2026.

Faculty of Sexual and Reproductive Healthcare (FSRH). Combined Hormonal Contraception – Clinical Guidance. Available at: www.fsrh.org. Accessed May 2026.

NHS. Combined pill – your contraception guide. Available at: www.nhs.uk/conditions/contraception/combined-contraceptive-pill. Accessed May 2026.

British National Formulary (BNF). Estradiol valerate with dienogest. Available at: bnf.nice.org.uk. Accessed May 2026.

MHRA. Combined hormonal contraceptives and venous thromboembolism – updated guidance. Available at: www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency. Accessed May 2026.

Endrikat J et al. Estradiol valerate/dienogest versus ethinylestradiol/levonorgestrel: effects on hemostatic parameters. Contraception, 2012.