Ginette‑35 (Cyproterone + Ethinylestradiol): Uses, Risks, Dosage, and Safer Alternatives [2025]

This pill clears stubborn acne and tames facial hair better than many standard birth control pills-but it comes with a higher blood clot risk. If that trade-off is on your mind, you’re in the right place. Here’s exactly what Ginette-35 is, who it’s for, how to take it safely, and when to consider other options.

TL;DR: Quick facts you actually need

• What it is: A combined hormonal pill (cyproterone acetate 2 mg + ethinylestradiol 35 mcg) used to treat severe acne and hirsutism in women who also need contraception.
• Biggest caution: Higher risk of blood clots than standard combined pills. Don’t use if you’ve had a clot, migraine with aura, or you smoke and are 35+.
• How to take: 1 pill daily for 21 days, then a 7-day break. Start on day 1 of your period for instant protection.
• How long: Use the lowest effective duration; review at 3-6 months. If acne/hirsutism improves, stop 3-4 cycles after symptoms clear.
• Not for: Pregnancy, breastfeeding early postpartum, or as a first-choice birth control when acne isn’t a big issue-safer alternatives exist.

What is Ginette‑35 and who is it for?

Ginette‑35 is a prescription combined oral pill that pairs an anti-androgen (cyproterone acetate) with ethinylestradiol. It is similar to brands like Diane‑35/Dianette used in Europe and other regions. The anti-androgen component reduces the effect of androgens on oil glands and hair follicles, so it often helps when acne or hirsutism is clearly driven by hormones.

Regulators position it as an acne/hirsutism treatment with contraceptive benefit-not as a default birth control pill. Why? The clot risk is higher than with standard combined pills. In many countries, guidelines say reserve it for moderate-to-severe acne or hirsutism after topical treatments, antibiotics, or other options haven’t worked well.

Who usually benefits:

• Women with persistent moderate-to-severe acne or hirsutism that worsens around cycles or has lab/clinical signs of androgen excess.
• Those who also want reliable contraception while treating acne/hirsutism.
• People who have tried first-line acne treatments (benzoyl peroxide, topical retinoids) and possibly oral options (like doxycycline) without enough improvement.

Who should avoid it or be cautious:

• History of blood clots, clotting disorders, stroke, or heart attack.
• Smokers aged 35+; anyone with uncontrolled high blood pressure; severe liver disease; migraine with aura.
• Recent postpartum and breastfeeding (especially within 6 weeks)-combined pills can reduce milk supply.
• Past or current meningioma (rare brain tumor). Cyproterone at high doses is linked to meningioma; low-dose use is still avoided if you’ve had one.

Where it’s available in 2025: Widely prescribed in the UK/EU and many regions under names like Diane‑35, Dianette, and similar generics. It’s not FDA‑approved in the US; US clinicians typically use other oral contraceptives or add spironolactone for anti‑androgen effect.

Evidence snapshot: Multiple randomized trials and a Cochrane review found combined pills improve acne versus placebo, and anti‑androgenic formulations like cyproterone/EE or drospirenone/EE often have stronger effects on acne and hirsutism. Regulators (EMA, MHRA) emphasize careful selection and shortest effective duration due to clot risk.

How to take it: starting, schedules, missed pills, and switching

Standard schedule: 21 active tablets followed by a 7‑day pill‑free break. You’ll usually have a withdrawal bleed during the break. Then start the next pack on time even if you’re still bleeding.

Starting options:

• Day‑1 start (best): Take your first pill on the first day of your period. You’re protected right away.
• Quick start (any day): Take the first pill today. Use condoms for the first 7 days.
• Post‑pregnancy: If not breastfeeding, you can usually start from day 21 postpartum if no extra clot risks; if breastfeeding, combined pills are usually deferred until at least 6 weeks-check with your clinician.

What to expect: Acne improvement can start after 2-3 cycles, with clearer results by 3-6 months. Hair growth reductions take longer due to hair growth cycles-roughly 6-9 months for visible change.

Missed pills-simple rules you can remember:

• If you’re less than 24 hours late (i.e., under 48 hours since your last pill): Take it as soon as you remember and carry on. No extra protection needed.
• If you’re 48 hours or more late (missed 2+ pills): Take the most recent missed pill now, skip the others, continue the pack, and use condoms for 7 days.
• If the 7 extra‑protection days run into your pill‑free week: Skip the break. Start the next pack immediately.

Vomiting or severe diarrhea within 3-4 hours of a pill counts like a missed pill. Take another pill as soon as possible and follow the missed rules above if needed.

Switching from another method:

• From another combined pill: Start Ginette‑35 the day after your last active pill. No gap, no backup needed.
• From progestin‑only pill: Start any day; use condoms for 7 days.
• From implant, injection, or hormonal IUD: Start on removal day (or when the next injection is due); use condoms for 7 days.
• From copper IUD: Start up to 7 days before removal or on removal day with 7 days of backup.

How long should you stay on it? Guidelines usually advise using the shortest effective duration. If acne is under control, many prescribers recommend stopping 3-4 cycles after clear skin is maintained, then switching to a standard lower‑risk contraceptive if ongoing birth control is needed.

Fertility after stopping: Ovulation typically returns quickly-often within 1-2 months. Acne can return if the underlying hormonal drive is still present.

Safety, side effects, risks, and interactions (2025)

Common, usually mild effects (often settle in 2-3 cycles):

• Nausea, breast tenderness, headache, mood changes, spotting between bleeds.
• Period changes: lighter bleeds are common on combined pills.

Serious effects-know the red flags and act fast:

• Blood clot symptoms: leg swelling/pain (usually one side), chest pain, sudden shortness of breath, coughing blood, sudden severe headache or vision/speech changes. Seek urgent care.
• Severe tummy pain, yellowing of skin/eyes (liver issues), or severe migraines with neurologic symptoms-stop and get help.

Why clot risk matters here: Combined pills already raise clot risk compared with not taking hormones. Cyproterone/EE combinations tend to sit at the higher end of that risk range compared with levonorgestrel‑based pills.

Sources used by clinicians: EMA safety review on cyproterone/EE combinations (2013 with updates), MHRA advisories, FSRH Combined Hormonal Contraception guideline (latest updates through 2023), WHO Medical Eligibility Criteria, and national formularies (e.g., BNF 2025). Exact numbers vary by study and population, but the pattern-higher risk with cyproterone/EE versus levonorgestrel pills-has been consistent.

Who must not use it (typical absolute contraindications):

• Current or past venous thromboembolism (DVT/PE) or known thrombophilia.
• Migraine with aura at any age.
• Smoker aged 35+; severe hypertension; major cardiovascular disease.
• Severe liver disease or liver tumors; unexplained vaginal bleeding.
• Known or previous meningioma; current pregnancy.

Higher caution if: BMI is high, a close relative had clots under 50, you’re immobilized (major surgery, long flight), or you have other risk layers (SLE with antiphospholipid antibodies, complicated diabetes, etc.). These are nuanced-talk them through with your clinician.

Drug interactions that matter:

• Strong enzyme inducers lower pill levels-think rifampicin/rifabutin, carbamazepine, phenytoin, phenobarbital, primidone, some protease inhibitors, and St John’s Wort. Use a non‑interacting method (e.g., copper IUD) or condoms during and for 28 days after the inducer.
• Topiramate at higher doses (≥200 mg/day) can reduce effectiveness; discuss backup.
• Lamotrigine levels drop with estrogen-seizure control can change. Neurology review is wise.
• Most common antibiotics do not reduce pill effectiveness-rifampicin‑class is the key exception.

Mood and skin notes: Some people feel better skin and mood; others notice low mood or anxiety. If mood changes are strong or persistent, consider switching-there’s no one‑size‑fits‑all here.

Meningioma signal: High‑dose cyproterone (≥10 mg/day) has a clear meningioma link. At 2 mg/day in Ginette‑35, the absolute risk appears much lower, but regulators still list past or current meningioma as a contraindication and advise stopping if diagnosed.

Cancer risk: Combined pills overall reduce ovarian and endometrial cancer risk with long‑term use. Breast and cervical cancer findings are mixed and small in absolute terms; risk seems to decrease after stopping. Your personal risk profile matters more than averages-ask if you’re unsure.

Checklists, tips, and safer alternatives

Quick pre‑check before starting:

• Blood pressure measured and normal?
• Any clot history, migraines with aura, or smoking at 35+? If yes, don’t use.
• Other clot risks (recent postpartum, surgery/immobility, strong family history)? Weigh carefully.
• Current meds checked for interactions (especially enzyme inducers, topiramate, lamotrigine)?
• Plan to review in 3 months to see if acne/hirsutism is improving?

Daily routine tips that actually help:

• Pick a fixed time you won’t forget-tie it to brushing teeth or your morning coffee.
• Use phone alarms or a pill‑tracking app. Keep a spare strip in your bag.
• If you miss, don’t panic-use the simple rules above. The week‑3 skip‑the‑break trick prevents pregnancy when you’ve missed late in the pack.

When to stop or switch fast:

• Any clot warning sign, migraine with aura, or severe chest/leg pain-seek urgent care and stop.
• No skin or hair improvement by month 6? It may not be the right tool for you.
• Breakthrough bleeding that persists beyond 3 cycles or is heavy-review for causes and options.

Alternatives if you want lower clot risk or different acne strategy:

• Lower‑risk combined pills (EE + levonorgestrel): Good contraceptive choice with a better safety profile. Skin may still improve, just sometimes not as strongly as cyproterone‑based pills.
• Drospirenone/EE: Anti‑androgenic, often helpful for acne; clot risk sits between levonorgestrel and cyproterone pills.
• Progestin‑only options (desogestrel POP, drospirenone‑only POP, levonorgestrel IUD): Very low clot risk; acne effect varies (some improve, some worsen). Great for those who can’t use estrogen.
• Non‑hormonal contraception (copper IUD, condoms): Zero hormone‑related clot risk.
• Dermatology route: Topical adapalene or tretinoin, benzoyl peroxide, clindamycin in short bursts; oral doxycycline courses; spironolactone (popular anti‑androgen in the US); and, for severe nodulocystic acne, isotretinoin under strict pregnancy prevention.

Choosing between them-simple decision cues:

• If contraception is your main goal and acne is mild: start with a levonorgestrel combined pill or a progestin‑only option.
• If acne/hirsutism is a major problem and you can use estrogen safely: a drospirenone pill or a short, monitored course of cyproterone/EE may be reasonable.
• If estrogen is a no‑go (migraine with aura, smoker 35+, recent clot): pick a progestin‑only or non‑hormonal method and tackle acne with topical/oral derm therapies.

FAQs and what to do next

How fast does it clear acne? You might see less oil and fewer breakouts by the second or third pack. Give it 3-6 months before judging. For hirsutism, expect 6-9 months for noticeable change.

Can it make acne worse at first? A mild flare is possible early on. If acne gets significantly worse or you’re not seeing any trend toward improvement by month 3, review your plan.

Is it safe long term? It’s meant for the shortest effective duration. Many prescribers aim to stop 3-4 cycles after acne is controlled and switch to a standard pill or non‑hormonal method if contraception is still needed.

Can I take it just for birth control? It’s not the first‑choice pill for contraception alone due to higher clot risk. Consider levonorgestrel‑based combined pills or non‑estrogen options.

What if I get a severe headache or see flashing lights? That’s a red flag for migraine with aura. Stop the pill and seek medical advice immediately.

Does it cause weight gain? Most studies don’t show large weight changes with combined pills. Bloating or water retention can happen and often settles.

Will it affect my mood? It can-either way. Strong or persistent mood changes are a good reason to switch.

What if I need surgery or a long flight? Major surgery or prolonged immobility increases clot risk. You may be told to pause the pill 4 weeks before major surgery and use alternatives. For long flights, move around, hydrate, and consider compression socks if you have risk factors.

Can I drink alcohol? Alcohol doesn’t reduce effectiveness, but vomiting soon after a dose can. If you vomit within 3-4 hours, take another pill.

Can I use it with spironolactone? Sometimes, yes, under medical supervision-especially outside regions where cyproterone/EE isn’t available. Watch potassium if using drospirenone methods or higher spironolactone doses.

Next steps based on your situation:

• New to hormonal contraception with acne concerns: Start with a lower‑risk combined pill if you can use estrogen, or a progestin‑only option if not. Add topical acne therapy.
• Severe acne/hirsutism after trying first‑line treatments: Discuss a time‑limited course of cyproterone/EE versus drospirenone/EE, plus a stop‑plan and follow‑up at 3 months.
• Complex medical history (migraines, clot history, postpartum): Book a contraception consultation; bring your medication list and family history.

What clinicians use to guide decisions: WHO Medical Eligibility Criteria (latest update), FSRH guidelines (UK, updated through 2023), EMA/MHRA safety statements on cyproterone/EE, and national formularies like the BNF (2025). These sources shape the risk categories, missed‑pill rules, and interaction warnings you’ve seen here.

Red‑flag recap-stop and get urgent help if you have: one‑sided leg swelling/pain, sudden chest pain or breathlessness, coughing blood, sudden severe headache with vision or speech changes, or signs of jaundice.

If you’re unsure whether Ginette‑35 fits you, write down: your age, smoking status, migraine history (with/without aura), blood pressure, BMI, any clot history in you or first‑degree relatives, current meds/supplements, and your top goals (clear skin vs contraception vs both). Bring that list to your appointment-it makes the decision fast and safer.