Zoely

Zoely is a combined oral contraceptive pill. It holds two hormones: nomegestrol acetate and estradiol. It is the first combined pill to use estradiol.

This is a natural oestrogen that matches the hormone your ovaries make. Most other combined pills use a man-made oestrogen called ethinylestradiol instead.

Nomegestrol acetate is a strong progestogen. That means a hormone like the body's own progesterone. It stops the release of an egg by blocking a rise in luteinising hormone (LH).

Estradiol also helps prevent pregnancy. It partly lowers follicle-stimulating hormone (FSH) and steadies the womb lining. Together they give reliable cover.

Zoely's Pearl Index, a measure of how often pregnancy occurs, is similar to other combined pills.

Zoely follows a 24/4 pattern. You take 24 active white tablets, then 4 inactive yellow placebo tablets. This shorter break from hormones may stop egg release better than the older 21/7 pattern.

You may have a withdrawal bleed during the placebo days. But many women bleed very little or not at all.

Because Zoely uses natural estradiol instead of ethinylestradiol, it may be gentler on the body's chemistry. It seems to affect liver proteins, clotting factors, and blood fats less.

Even so, long-term data on heart and blood vessel risks are still limited.

Take one tablet every day at about the same time. Follow the order shown on the blister. Take the 24 white active tablets first, then the 4 yellow placebo tablets.

Start the next blister straight after the current one, with no gap between packs.

Swallow the tablet whole with water. If you take a white (active) tablet more than 12 hours late, it may not protect you from pregnancy.

Check the patient information leaflet for advice on missed pills. The advice changes depending on the week of your cycle.

Being sick within four hours of taking a tablet may stop your body absorbing it. If this happens, use a barrier method such as condoms for seven days.

Take one tablet daily for 28 days in a row. That is 24 active tablets plus 4 placebo tablets. Each active tablet contains nomegestrol acetate 2.5 mg and estradiol 1.5 mg.

The placebo tablets contain no active ingredients.

If you start on day 1 of your period, you are protected straight away. If you start on days 2 to 5, use extra contraception for the first seven days. There is no other dose to choose from.

Acne is one of the more common side effects. It affects about 5 per cent of users. This may be due to the androgenic activity of nomegestrol acetate, an effect linked to male-type hormones.

Breast tenderness, headache, nausea, and mood changes are also reported often.

Irregular bleeding is common, especially in the first few months. Many women have lighter withdrawal bleeds or none at all. This is harmless, but it can make some women worry about pregnancy.

Some users notice weight gain, lower sex drive, and tummy discomfort. Any combined pill carries a risk of venous thromboembolism, a blood clot in a vein.

How often this happens with Zoely, compared with older pills, has not been measured exactly.

Rarely, combined oral contraceptives have been linked to liver adenomas (non-cancerous liver growths), gallbladder disease, and high blood pressure.

Combined oral contraceptives raise the risk of blood clots in both veins and arteries.

Get medical help at once if you have sudden leg pain or swelling, chest pain, unexplained shortness of breath, or a severe headache with changes in your vision.

Smoking sharply raises the risk to your heart and blood vessels. Women over 35 who smoke should not use combined oral contraceptives, including Zoely.

Other things that raise clot risk include obesity, long periods of not moving, and a family history of clotting disorders.

Tell your prescriber if you develop new migraine with aura (warning signs before a headache), lasting high blood pressure, or jaundice (yellowing of the skin or eyes) while taking Zoely.

You may need to stop the pill.

Do not use Zoely if you have, or have had, blood clots in a vein or artery. Avoid it if you have a known clotting disorder, migraine with aura, or high blood pressure that is not controlled.

Do not use it if you have severe liver disease or liver tumours, a known or suspected cancer that depends on hormones, vaginal bleeding with no known cause, or an allergy to any ingredient.

Do not use Zoely during pregnancy. Do not use it if you have pancreatitis (inflammation of the pancreas) linked to very high blood fats called triglycerides.