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

Nextstellis 28 Day is a combination oral contraceptive — commonly called a birth control pill — that received FDA approval in April 2021. It is unique among oral contraceptives because it contains a newly approved estrogen called estetrol (E4), the first new contraceptive estrogen approved in the United States in more than 50 years. This article answers the most common questions patients have about Nextstellis.

What Is Nextstellis?

Nextstellis (drospirenone and estetrol tablets) is a combination oral contraceptive manufactured by Mayne Pharma, developed in partnership with Mithra Pharmaceuticals. Each active tablet contains:

• Drospirenone 3 mg: A synthetic progestin that is a spironolactone analogue, with anti-androgenic and anti-mineralocorticoid properties.
• Estetrol 14.2 mg: A synthetic analogue of a naturally occurring estrogen produced by the fetal liver during pregnancy, now manufactured from plant sources for pharmaceutical use.

Each 28-tablet blister pack contains 24 pink active tablets and 4 white inert (placebo) tablets.

What Is Nextstellis Used For?

Nextstellis is FDA-approved for prevention of pregnancy in females of reproductive potential. Like other combination oral contraceptives, it may also provide secondary benefits, including:

• More regular menstrual cycles
• Reduced menstrual blood loss and cramping (dysmenorrhea)
• Decreased risk of ovarian cysts
• Potential improvement in acne and symptoms related to androgen excess (due to drospirenone's anti-androgenic properties)

Important: Nextstellis does not protect against HIV or other sexually transmitted infections (STIs). It is not for use as emergency contraception.

Who Is Nextstellis Approved For?

Nextstellis is indicated for use by females of reproductive potential. Clinical trials included participants between the ages of 16 and 50. However, it is contraindicated in females ≥35 years of age who smoke.

Nextstellis may be less effective in females with a BMI ≥30 kg/m². It has not been studied in patients with BMI ≥35 kg/m².

How to Take Nextstellis: Dosage Instructions

Take one tablet by mouth at the same time every day for 28 consecutive days:

• Days 1–24: One pink active tablet each day.
• Days 25–28: One white inactive tablet each day.

After finishing the 28-tablet pack, start the next pack the following day without a break. Nextstellis can be taken with or without food. For best effectiveness, take it at the same time every day — set a phone alarm to help you remember.

When to Start Nextstellis

If starting Nextstellis for the first time with no current hormonal contraceptive use, begin on the first day of your menstrual period. If you cannot start on Day 1 of your period, use backup contraception (condoms) for the first 7 days.

If switching from another combination oral contraceptive, start Nextstellis on the day you would have taken your next pill. If switching from a progestin-only pill, IUD, implant, or injection, follow the instructions in the full prescribing information or ask your provider.

What to Do If You Miss a Dose

If you miss one active tablet: Take it as soon as you remember, even if it means taking two on the same day. Continue taking the rest of the pack as scheduled. No backup contraception is needed if only one pill is missed.

If you miss two or more active tablets: Follow the instructions in the package insert or contact your provider. You may need to use backup contraception for 7 days.

Who Should Not Take Nextstellis?

Nextstellis is contraindicated in patients who:

• Are ≥35 years old and smoke
• Have a history of deep vein thrombosis (DVT), pulmonary embolism, stroke, or heart attack
• Have active or history of hormone-sensitive cancer (e.g., breast cancer)
• Have liver disease or adrenal insufficiency
• Are using hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir
• Have undiagnosed abnormal uterine bleeding

How Effective Is Nextstellis?

Based on Phase 3 clinical study results, about 2 out of 100 women may become pregnant in the first year of using Nextstellis. This is typical for combination oral contraceptives with typical use. With perfect use (taking the pill correctly every day), the rate is significantly lower.

How to Get and Fill a Nextstellis Prescription

Because Nextstellis is brand-only, not every pharmacy stocks it. medfinder can call pharmacies near you to check which ones have it in stock. To learn about side effects in detail, read our guide on Nextstellis side effects.