Alysena Birth Control in Canada: Your Complete Guide

If you’ve been prescribed Alysena, or you’re trying to make sense of the difference between Alysena 28 and Alysena 21, you’ve probably got a few practical questions. Many women wonder what to expect while taking Alysena, if it will affect their weight, and whether it’s the same as Alesse. Those are the right questions to ask, and we’ll answer them all in this article.

Alysena birth control is one of the most widely used low-dose pills in Canada. It’s the generic version of Alesse, which means it contains the same active ingredients and works in exactly the same way. The main difference is that Alysena is usually more affordable. So if your prescription says Alesse but the pharmacy hands you Alysena, that’s why.

Below, we’ll walk through what Alysena is and how it works. We cover the difference between the 28- and 21-day packs (including which pill to start with), and explain how to take it, how effective it is, side effects, how it compares to Alesse, and what Alysena costs in Canada.

An Overview of Alysena Birth Control

Alysena is a combined oral contraceptive, often shortened to COC, and commonly called “the pill.” Its two active ingredients are 100 mcg of levonorgestrel (a progestin, which is a synthetic version of the natural hormone progesterone) and 20 mcg of ethinyl estradiol (a synthetic form of estrogen). Every active tablet contains the same dose, which makes Alysena a monophasic birth control pill.

Produced by Apotex, Alysena is the bioequivalent generic of Alesse, meaning Health Canada has confirmed it delivers the same amount of hormone to your body in the same way. In Canada, Alysena’s authorized use is to prevent pregnancy in women of reproductive age. The same hormones can also help with acne, although the formal Health Canada approval for that specific use belongs to the brand-name version (more on that in our Alesse guide).

Is Alysena a Combination Pill?

Because it contains both an estrogen and a progestin, Alysena is what’s known as a combination (or combined) pill, the most common type of birth control pill. There are pills that contain only a progestin, but Alysena isn’t one of them.

Alysena is also a low-dose pill. Older birth control pills once contained 50 mcg or more of estrogen, and many common pills today sit around 30 to 35 mcg. At 20 mcg of ethinyl estradiol, Alysena is at the lower end, which tends to mean fewer estrogen-related side effects for many people. The trade-off is that lower-dose pills can be a little more prone to spotting between periods, especially in the first few months. The lower dose doesn’t make Alysena any less effective at preventing pregnancy.

How Does Alysena Work?

Alysena prevents pregnancy in a few overlapping ways. Its main job is to stop ovulation, so your ovaries don’t release an egg each month. It does this by quietening the hormone signals that would normally trigger an egg to mature and release.

On top of that, Alysena thickens the mucus at the cervix, which makes it harder for sperm to get through, and it thins the lining of the uterus. Together, these effects make pregnancy very unlikely when the pill is taken as directed.

Alysena 28 vs. Alysena 21: What’s the Difference?

Alysena comes in two pack formats, and both deliver exactly the same amount of hormone. The only difference is what happens during the fourth week:

• Alysena 28: Contains 21 pink active pills (each engraved “100” on one side and “20” on the other), plus 7 white inactive “reminder” pills. You take one pill every single day with no break, then start a new pack the day after the last white pill.
• Alysena 21: Contains the same 21 pink active pills and nothing else. You take one pink pill a day for 21 days, then take no pills for 7 days (this is usually when your period comes), and start your next pack after that.

Which Pill Do You Start With?

You always start with a pink active pill. 

With Alysena 28, you take the 21 pink pills first, followed by the 7 white reminder pills, which contain no hormones and exist only to keep you in the daily habit so you don’t have to count a 7-day gap. With Alysena 21, you simply start a fresh pack of pink pills after your 7 pill-free days. 

Whichever pack you use, take your pill at roughly the same time each day for the most reliable protection.

Alysena Dosage and How to Take It

The dosing of Alysena 28 and Alysena 21 is straightforward: one tablet by mouth, once a day, ideally at the same time each day. Each active pill delivers the same 100 mcg of levonorgestrel and 20 mcg of ethinyl estradiol, so there’s no increasing or decreasing of the dose through the pack the way there is with some other birth control pills.

Taking Alysena consistently is what keeps it working well. If you’re using Alysena 28, the built-in reminder pills make that easier. If you’re on Alysena 21, it helps to have a system for remembering when to restart after the 7-day break.

When Does Alysena Start Working?

If you start Alysena on the first day of your period, you’re protected straight away. Start it at any other point in your cycle and you’ll need a backup contraception method like condoms for the first 7 days while it takes full effect.

What If You Miss a Pill?

If you miss one active Alysena pill, take it as soon as you remember (even if that means two in one day), then carry on as normal, no backup contraception needed. 

If you miss two or more Alysena tablets in a row, take the most recent one right away, keep taking the pack, and use backup contraception for the next 7 days. If the missed pills fell in your first week and you’d had unprotected sex beforehand, ask about emergency contraception. The SOGC’s missed-pill guide covers every scenario.

Can Alysena Stop Your Period?

Alysena tends to make periods lighter, shorter, and more regular. Some women find that their period becomes very light or stops altogether while they’re taking it. On a low-dose combined pill, this is generally nothing to worry about. The pill keeps the uterine lining thin, so there’s simply less to shed.

It also helps to know that the bleeding you get during the hormone-free week with Alysena (the white reminder pills in Alysena 28, or the 7-day break with Alysena 21) isn’t a true period. It’s a withdrawal bleed caused by the dip in hormones, so a lighter or skipped withdrawal bleed is common and isn’t a sign that anything is wrong. The one exception is if you’ve missed pills and there’s any chance you could be pregnant. If this is the case, take a pregnancy test or check with your doctor to be sure.

You can also stop a period on purpose with Alysena. Skipping the hormone-free week and starting the next pack of active pills straight away delays the bleed, which is a common and generally safe way to push back a period. Just run it by your doctor if you decide to do this.

How Effective Is Alysena?

When taken correctly, Alysena is more than 99% effective at preventing pregnancy, meaning fewer than 1 in 100 people would become pregnant over a year of use.

Real life is rarely perfect, though. Like the combined pill in general, Alysena is more forgiving on paper than in practice. With typical use, where doses are occasionally missed or taken late, failure rates (becoming pregnant) for combined oral contraceptives run as high as 9 in 100 over a year. That gap between perfect and typical use is almost entirely about consistency, which is why a steady daily routine matters so much.

A few things can lower Alysena’s effectiveness:

• Missing pills or extending the pill-free week
• Vomiting or severe diarrhea shortly after a dose
• Certain interacting medications, such as some anticonvulsants and antiretrovirals

Effectiveness may also be slightly lower at higher body weights. A small increase in failures among women with a BMI over 30 can’t be ruled out, so it’s worth raising with your doctor if that applies to you.

Alysena Side Effects

Like any medication, Alysena can cause side effects. Because the active pills are identical in both packs, Alysena 28 side effects are the same as those for Alysena 21. Most are mild and tend to settle as your body adjusts over the first few months.

Common Side Effects

The most commonly reported side effects of Alysena include:

• Spotting or breakthrough bleeding: Light bleeding between periods, more likely with a low-dose pill.
• Breast tenderness: Often most noticeable in the first cycle or two.
• Nausea: Usually mild; taking the pill with food or at bedtime can help.
• Headaches, along with possible changes in mood, appetite, or libido.
• Skin changes: Some people notice darkened patches of skin (chloasma), especially with sun exposure. 

These side effects usually ease over the first three cycles and generally aren’t a reason to stop the pill on your own. Guidance suggests giving a new pill about three months before deciding whether it’s the right fit, but always check in with your doctor if something feels off.

Serious Side Effects

Serious side effects from Alysena are rare, but worth understanding. The most important is the risk of blood clots (venous thromboembolism).

Combined birth control pills raise the risk of blood clots. In a given year, about 2 in 10,000 women who aren’t pregnant and don’t take the pill develop a clot. The combined pill raises that to roughly 5 to 12 in 10,000, with levonorgestrel pills like Alysena at the lower end of that range, and pills built on some newer progestins such as desogestrel or drospirenone at the higher end. For perspective, pregnancy pushes the risk far beyond any pill, to roughly 5 to 20 in 10,000, and the first weeks after giving birth higher still, at around 40 to 65 in 10,000.

Even though the risk of blood clots is low, seek medical care promptly if you experience chest pain, trouble breathing, coughing up blood, pain or swelling in a calf, a sudden severe headache, vision or speech changes, or weakness on one side of the body.

Other rare risks linked to combined pills include a small possible increase in breast and cervical cancer risk in some users. The evidence on this is mixed, and any increase appears to fade within several years of stopping. Other very rare risks include liver tumours, gallbladder problems, and raised blood pressure.

Does Alysena Cause Weight Gain?

This is one of the most common worries about going on the pill, so it’s worth being clear. The best available evidence, from a large Cochrane review of combined birth control pills and the contraceptive patch, found no proof that they cause meaningful weight gain.

The honest caveat is that the studies weren’t strong enough to rule out a small effect entirely, and individual experiences vary. Some women notice mild water retention or appetite changes early on, which often settle. 

What the research doesn’t support is the idea that a combined pill like Alysena reliably leads to significant weight gain. This is different from the contraceptive injection, where some weight gain has been more clearly documented.

Who Should Not Take Alysena?

Alysena isn’t suitable for everyone, and some conditions make it unsafe. 

You generally should not take Alysena if you have or have had:

• A blood clot, a clotting disorder, or a history of heart attack, angina, or stroke
• Migraines with aura (warning signs such as flashing lights or numbness before a headache)
• Known or suspected breast cancer or another estrogen-dependent cancer
• Uncontrolled high blood pressure
• Diabetes that has affected your circulation or blood vessels
• Active liver disease or a liver tumour, or unexplained vaginal bleeding
• Treatment with a specific older hepatitis C antiviral combination (ombitasvir/paritaprevir/ritonavir, with or without dasabuvir), which can cause liver enzyme spikes alongside estrogen

Smoking matters too: combined pills generally aren’t recommended for people who smoke and are over 35, because the combination sharply raises cardiovascular risk.

A couple of points above aren’t clear-cut and are worth a conversation with your doctor. Having diabetes without circulation or blood-vessel complications is usually a reason for caution, rather than an outright no. And the hepatitis C warning applies only to that particular older drug combination, not to most modern hepatitis C treatments. Other situations, such as well-controlled high blood pressure, a history of depression, or gallbladder disease, also call for advice from your doctor rather than ruling the pill out automatically.

Alysena vs. Alesse: What’s the Difference?

This is the question that trips a lot of people up. The short answer is that there’s no clinical difference — Alysena is the generic version of Alesse. 

Both Alysena and Alesse contain the identical 100 mcg of levonorgestrel and 20 mcg of ethinyl estradiol. Both come in 21- and 28-day packs. Both can be presumed to work the same way, because Health Canada requires a generic to be bioequivalent to the brand it copies.

The practical differences between Alysena and Alesse come down to the:

• Name on the box
• Manufacturer (Apotex makes Alysena; Pfizer makes Alesse)
• Price (the generic is usually cheaper)
• Small cosmetic details like tablet markings

There is one formal distinction worth knowing. The brand-name Alesse carries a Health Canada approval to treat moderate acne, whereas Alysena’s approved use is only contraception.  We cover that, and the question of whether Alesse has been discontinued, in our full Alesse guide.

Alysena Cost and Coverage in Canada

As a generic, Alysena is usually one of the more affordable birth control pills. For an exact figure, your pharmacist is the best person to ask, since they can factor in your specific coverage.

The good news for many people is that coverage has expanded significantly. British Columbia provides prescription contraception at no cost to residents, which covers oral contraceptives like Alysena. A federal pharmacare initiative is also rolling out broader contraception coverage across the country, though the details continue to vary as agreements are put in place.

Frequently Asked Questions About Alysena

Does Alysena protect against STIs? Alysena prevents pregnancy but offers no protection against sexually transmitted infections — condoms are still the way to reduce that risk.

Will Alysena affect my future fertility? There’s no evidence that the pill lowers your fertility in the long run. Your cycle may take a little while to settle back into its usual pattern after you stop, but your ability to conceive isn’t diminished by having been on it.

Can Alysena be used during perimenopause? It can be, for the right person. Age alone isn’t a barrier — healthy non-smokers without other risk factors can generally use a combined contraceptive pill up to around 50. Because the risks tied to estrogen rise with age, things like smoking, blood pressure, and migraines matter more in your 40s. This is different from menopausal hormone replacement therapy, which does a different job.

Is Alysena Right for You?

Alysena is a low-dose combined pill that’s highly effective at preventing pregnancy, widely available in Canada, and as a generic, it’s usually one of the more affordable options. For many women, Alysena is a straightforward, well-tolerated choice for birth control.

That said, Alysena isn’t the right pill for everyone. The best option depends on your health history and how your body responds. Birth control is rarely one-size-fits-all. Finding the right fit sometimes takes a conversation with your doctor and occasionally a switch or two.

If you’d like to speak to a doctor about whether Alysena might be a good option for you, there’s no need to wait for an in-person appointment. At Walk-In, Canadian-licensed doctors can review your health history through an online consultation, answer your questions, and send a prescription to you or your pharmacy. Book an online consultation to get started.

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