Zoely

Zoely is a combined oral contraceptive (COC) tablet containing nomegestrol acetate 2.5mg and estradiol 1.5mg. It is distinctive among combined pills because it uses estradiol, a form of oestrogen chemically identical to the oestrogen produced by the human ovary, rather than the synthetic ethinylestradiol found in most other combined contraceptive pills.

A Unique Hormonal Profile

The oestrogen component of Zoely, estradiol, is classified as body-identical because it shares the same molecular structure as endogenous oestradiol. Nomegestrol acetate is a highly selective progestogen derived from the progesterone family, with strong binding affinity for the progesterone receptor and minimal activity at oestrogen, androgen, glucocorticoid, or mineralocorticoid receptors.

Contraceptive Efficacy and Regimen

Zoely is taken on a 24/4 regimen, 24 active white tablets containing hormones, followed by 4 inactive yellow tablets in each 28-day pack. This shortened hormone-free interval maintains more consistent suppression of ovulation throughout the cycle. The withdrawal bleed, which typically occurs during the four inactive days, is often lighter and shorter than that associated with pills using a seven-day break. When taken correctly and consistently, Zoely is over 99% effective at preventing pregnancy.

Period and Cycle Effects

Clinical studies have shown that Zoely tends to produce lighter withdrawal bleeds, with some women experiencing absent or very scanty bleeding during the inactive tablet days. This is considered normal and does not indicate a health problem, though some women find absent withdrawal bleeds initially disconcerting. Breakthrough bleeding during the active phase may be more common in the first few cycles.

Zoely is taken orally, one tablet daily for 28 consecutive days with no break between packs. The pack contains 24 active (white) tablets and 4 inactive (yellow) tablets, taken in order.

Starting Zoely

If you are starting Zoely on the first day of your period (day 1 start), you are protected immediately. If you start on day 2-5, use additional contraception such as condoms for the first nine days of active tablets. When switching from another combined pill, begin Zoely immediately after the last active tablet of the previous pack. When switching from a progestogen-only pill (mini-pill), start Zoely the day after your last mini-pill and use condoms for the first nine days.

Maintaining Consistency

Tablets should be taken at the same time each day, in the correct order as indicated by the pack arrows. The four inactive yellow tablets at the end of the pack do not contain hormones and are included only to help maintain the daily tablet-taking habit. If a white (active) tablet is missed by more than 24 hours, take the missed tablet and use additional contraception for the next nine days, as Zoely has a stricter missed pill rule due to its shorter hormone-free interval.

Zoely comes as a fixed-combination tablet (nomegestrol acetate 2.5mg / estradiol 1.5mg) taken once daily. There are no alternative dose strengths. The 28-pill pack contains 24 active white tablets and 4 inactive yellow tablets. Packs are taken consecutively without any gap between them. Zoely is not recommended for use in women with hepatic impairment, as sex steroids are metabolised by the liver. Women with severe renal impairment should seek specialist advice before starting. There are no routine dose adjustments for women with mild or moderate renal impairment.

Common Side Effects

• Acne (particularly in the first few cycles)
• Headache or migraine
• Nausea
• Breast tenderness
• Mood changes, including depressed mood or irritability
• Reduced libido
• Breakthrough bleeding or spotting (common in first 3 cycles)
• Absent or light withdrawal bleed during inactive tablet days

Serious Side Effects

• Venous thromboembolism: leg swelling, pain, or chest pain with breathlessness, seek emergency care
• Arterial events: stroke or myocardial infarction symptoms, facial drooping, arm weakness, speech difficulty
• Severe hepatic disorders: jaundice, right upper abdominal pain
• Hypertension: blood pressure should be monitored before starting and periodically during use

Zoely contains oestrogen and carries the class-related risk of venous thromboembolism (VTE) associated with all combined oral contraceptives. The absolute risk of VTE in healthy young women taking COCs remains low, but is elevated relative to non-use. Women should be made aware of the warning signs of blood clots: persistent leg pain or swelling, chest pain, or breathlessness.

Migraine Warning

Women who develop migraine with aura while taking Zoely should discontinue the pill and seek medical advice immediately, as this pattern of migraine is a contraindication to combined hormonal contraception due to the associated risk of ischaemic stroke.

Hepatic and Metabolic Monitoring

Because Zoely is metabolised by the liver, any woman who develops symptoms of hepatic dysfunction -- including jaundice, severe abdominal pain, or dark urine -- should stop the tablet and seek medical assessment. Women with a history of chloasma should minimise sun exposure as hormonal contraceptives can provoke recurrence. Blood pressure should be monitored periodically. Zoely does not protect against sexually transmitted infections.

• Current or past venous or arterial thromboembolic events
• Migraine with aura
• Severe or uncontrolled hypertension
• Diabetes with vascular complications
• Hepatic disease or liver tumours
• Unexplained vaginal bleeding
• Breast cancer or other oestrogen/progestogen-sensitive malignancies
• Known thrombophilic disorders
• Hypersensitivity to nomegestrol acetate, estradiol, or any excipient
• Pregnancy or breastfeeding