What Is Amethyst 28 Day? Uses, Dosage, and What You Need to Know in 2026

Amethyst 28 Day is a prescription oral contraceptive that stands apart from most birth control pills on the market. Here's everything you need to know before starting — or considering — this continuous-cycle medication.

What Is Amethyst 28 Day?

Amethyst 28 Day is the brand name for a combination oral contraceptive tablet containing levonorgestrel 90 mcg (a synthetic progestin) and ethinyl estradiol 20 mcg (a synthetic estrogen). It is manufactured by Teva Pharmaceuticals and is the generic equivalent of Lybrel, which was the first FDA-approved continuous-cycle oral contraceptive before its discontinuation.

What makes Amethyst 28 Day unique is that all 28 tablets in each pack are active hormone tablets. There are no placebo pills. Most other 28-day oral contraceptive packs include 21 active pills and 7 placebo pills that allow for a withdrawal bleed. Amethyst 28 Day eliminates that break — and with it, the monthly withdrawal bleed.

What Is Amethyst 28 Day Used For?

Amethyst 28 Day is FDA-approved for one indication:

Prevention of pregnancy in women who choose to use oral contraceptives as their method of contraception

In addition to preventing pregnancy, combination oral contraceptives like Amethyst 28 Day may also:

Reduce or eliminate menstrual bleeding (the primary reason many patients choose this specific formulation over others)

Decrease symptoms of endometriosis, dysmenorrhea, or PMDD that worsen around the menstrual cycle

Reduce the risk of ovarian cysts

Decrease menstrual blood loss (relevant for patients with anemia)

These are off-label benefits — they are not FDA-approved indications for Amethyst 28 Day specifically, but they are established benefits of continuous oral contraceptive use supported by clinical evidence.

What Is in Amethyst 28 Day?

Each Amethyst 28 Day tablet contains:

Levonorgestrel: 90 mcg (0.09 mg) — a synthetic progestin that suppresses ovulation and thickens cervical mucus

Ethinyl estradiol: 20 mcg (0.02 mg) — a synthetic estrogen that suppresses ovulation and maintains uterine lining stability

The 28-pack contains 28 identical white tablets — all active, none placebo. Inactive (excipient) ingredients include croscarmellose sodium, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone.

How Do You Take Amethyst 28 Day?

Amethyst 28 Day is taken as one white tablet daily, at the same time each day, without any pill-free interval. When you finish one 28-tablet pack, you immediately start the next pack the following day. There is no break. There is no "reminder pill" week. You take one active pill every single day.

This continuous regimen is what distinguishes Amethyst 28 Day from virtually all other 28-day oral contraceptive packs, which include a week of placebo pills followed by a withdrawal bleed.

When to Start Amethyst 28 Day

If you're new to hormonal contraceptives: Start on the first day of your period. Use backup contraception (condoms) for the first 7 days.

If switching from a 21 or 28-day combined pill: Start Amethyst 28 Day on the first day of your withdrawal bleed. No more than 7 days should pass between your last active pill and your first Amethyst 28 Day tablet.

If switching from a progestin-only pill, implant, or injection: Follow your provider's specific instructions. You will likely need backup contraception for the first 7 days.

What to Expect When You Start Amethyst 28 Day

Because there is no scheduled withdrawal bleed, patients starting Amethyst 28 Day often experience unscheduled spotting or breakthrough bleeding — especially in the first 3-6 months. This is normal and expected. FDA clinical trials showed that this bleeding decreased significantly for most patients over time, with many experiencing little to no bleeding after 6-12 packs. Around 18% of trial participants discontinued due to bleeding patterns they found unacceptable.

Who Should Not Take Amethyst 28 Day?

Women who are pregnant or may be pregnant

Smokers over age 35 (boxed warning)

Women with a history of blood clots, stroke, or heart attack

Women with known or suspected breast cancer

Women with uncontrolled high blood pressure or liver disease

Women who are breastfeeding (estrogen may reduce milk production)

Finding Amethyst 28 Day at a Pharmacy Near You

Because Amethyst 28 Day is a niche continuous-cycle formulation, not every pharmacy stocks it. If your pharmacy is out, medfinder contacts pharmacies in your area and texts you which ones can fill your prescription — no phone calls required on your end. For more details, read our guide on how Amethyst 28 Day works and its mechanism of action.