Femodene

Femodene is a combined oral contraceptive pill (COC) containing two synthetic hormones — gestodene and ethinylestradiol — that work together to prevent pregnancy. It is a monophasic pill, meaning each active tablet contains the same fixed dose of both hormones throughout the 21-day cycle. Femodene uses gestodene, a third-generation progestogen with a particularly low androgenic profile, making it a suitable option for women who experience androgen-related side effects with other contraceptive pills.

How Femodene Works

Femodene prevents pregnancy through several complementary mechanisms. The primary effect is suppression of ovulation: the combined hormonal activity inhibits the mid-cycle surge of luteinising hormone (LH) and follicle-stimulating hormone (FSH), preventing the release of an egg from the ovary. In addition, Femodene thickens the cervical mucus, making it more difficult for sperm to penetrate, and alters the endometrium in a way that makes implantation of a fertilised egg less likely. When taken correctly and consistently, Femodene is over 99% effective at preventing pregnancy.

Third-Generation Progestogen

Gestodene, the progestogen component of Femodene, belongs to the third generation of synthetic progestogens. Compared with older progestogens such as levonorgestrel, gestodene has a significantly lower androgenic activity, meaning it is less likely to cause androgen-related effects such as acne, seborrhoeic skin, or unwanted facial hair in susceptible women. It also has some antimineralocorticoid and antiandrogenic activity, which may be beneficial in women prone to bloating or fluid retention.

VTE Risk Considerations

Femodene carries a slightly higher risk of venous thromboembolism (VTE) compared with combined pills containing older progestogens such as levonorgestrel. This risk is well established from observational data and should be discussed with patients before prescribing, particularly those with additional VTE risk factors. The absolute risk remains small in otherwise healthy women, but it is an important consideration in individual prescribing decisions.

How to Take Femodene

Femodene is taken once daily for 21 consecutive days, followed by a seven-day pill-free break. A withdrawal bleed typically occurs during the break, resembling a lighter period. Start the next pack on the same day of the week after the seven-day break, whether or not bleeding has finished.

For women starting for the first time, begin on day 1 of your period for immediate contraceptive protection. If starting on days 2 to 5, use condoms for the first seven days. If you miss a tablet by more than 12 hours, take it as soon as you remember, continue the pack, and use condoms for the next seven days.

Switching Pills

If switching from another combined oral contraceptive, start Femodene the day after finishing your last active tablet, without a pill-free interval between packs.

Each Femodene tablet contains gestodene 75 micrograms and ethinylestradiol 30 micrograms. One tablet is taken daily for 21 consecutive days at approximately the same time each day, followed by a 7-day pill-free interval during which a withdrawal bleed occurs. Each new pack of 21 tablets is then started on the day after the 7-day break.

Tablets should be taken in the order indicated on the blister pack and swallowed whole with water. Taking the pill at the same time each day helps to maintain consistent hormone levels and reduces the likelihood of missed or delayed doses affecting contraceptive efficacy.

Femodene is not suitable for use during pregnancy or breastfeeding. It is not recommended in women with severe hepatic impairment. No dose adjustment applies for age within the standard prescribing range, though the risks and benefits of combined hormonal contraception in older reproductive-age women should be reviewed regularly. Women over 35 who smoke should generally not take combined hormonal contraceptives due to substantially increased cardiovascular risk.

Common Side Effects

• Nausea, particularly in the first one to three months (taking the tablet with food or at bedtime helps)
• Breast tenderness or enlargement
• Headache or migraine
• Mood changes, including low mood or irritability
• Reduced sex drive
• Breakthrough spotting in the first few cycles

These effects often improve after the first two to three cycles as the body adjusts.

Serious Risks

Femodene, like all combined pills, carries a small increased risk of blood clots (venous thromboembolism), stroke, and high blood pressure. The absolute risk for healthy young non-smoking women is low, but it rises significantly with smoking, obesity, and age. Do not take Femodene if you smoke and are over 35. Seek urgent medical attention if you develop sudden leg pain, chest pain, difficulty breathing, or severe headache.

Thrombosis Risk

Combined oral contraceptives, including Femodene, increase the risk of venous and arterial thromboembolism. This risk is higher in women who smoke, are obese, have a personal or family history of VTE, have thrombophilic conditions, are immobile for extended periods, or who have other risk factors. Femodene should be discontinued at least four to six weeks before planned major surgery or prolonged immobilisation and restarted at least two weeks after full mobilisation. Women with migraine with aura should not take combined hormonal contraceptives due to the increased risk of ischaemic stroke.

Cardiovascular and Blood Pressure

Blood pressure should be checked before prescribing Femodene and monitored annually during use. If sustained hypertension develops during treatment, the pill should be discontinued and alternative contraception provided. Women over 35 who smoke carry a substantially elevated risk of myocardial infarction and stroke on combined oral contraceptives and should be offered a non-oestrogen-containing alternative.

Cervical and Breast Cancer

Long-term use of combined oral contraceptives is associated with a small increase in the risk of cervical cancer and breast cancer, although the absolute excess risk is small and decreases after stopping. Regular cervical screening and breast awareness are important for all women of reproductive age, regardless of contraceptive method.

Femodene must not be used in women who:

• Have a current or past history of venous or arterial thromboembolism (DVT, PE, stroke, myocardial infarction)
• Have known thrombophilic conditions (such as Factor V Leiden mutation, protein C or S deficiency, antiphospholipid syndrome)
• Have migraine with aura
• Have severe or uncontrolled hypertension
• Have diabetes mellitus with vascular complications
• Are pregnant or suspected to be pregnant
• Are breastfeeding (within the first six weeks postpartum)
• Have severe hepatic impairment or a history of hepatic tumour
• Have unexplained vaginal bleeding
• Have or have had sex hormone-sensitive cancers such as breast or endometrial cancer
• Are heavy smokers aged over 35 years