Zoely

Zoely is a combined oral contraceptive pill containing nomegestrol acetate and estradiol.

It is the first combined pill to use estradiol, a natural oestrogen identical to the hormone produced by the ovaries, rather than the synthetic ethinylestradiol found in most other combined pills.

Nomegestrol acetate is a potent progestogen that suppresses ovulation by inhibiting the luteinising hormone (LH) surge.

Estradiol contributes to contraceptive efficacy by partially suppressing follicle-stimulating hormone (FSH) and stabilising the endometrium.

The combination provides reliable contraception with a Pearl Index comparable to other combined oral contraceptives.

Zoely uses a 24/4 regimen: 24 active white tablets followed by 4 inactive yellow placebo tablets.

This shorter hormone-free interval may improve ovulation suppression compared with the traditional 21/7 regimen.

A withdrawal bleed may occur during the placebo days, although a significant proportion of women experience very light or absent bleeding.

Because Zoely uses natural estradiol rather than ethinylestradiol, it may have a more favourable metabolic profile, with less impact on liver protein synthesis, clotting factors, and lipid parameters.

However, comparative clinical data on long-term cardiovascular outcomes remain limited.

Take one tablet daily at approximately the same time, following the order indicated on the blister. Take the 24 white active tablets first, then the 4 yellow placebo tablets.

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

Swallow the tablet whole with water. If you miss a white (active) tablet by more than 12 hours, contraceptive protection may be reduced.

Refer to the patient information leaflet for missed pill guidance, which varies by the week of the cycle.

Vomiting within four hours of taking a tablet may impair absorption. Use additional barrier contraception for seven days if this occurs.

One tablet daily for 28 consecutive days (24 active plus 4 placebo). Each active tablet contains nomegestrol acetate 2.5 mg and estradiol 1.5 mg. The placebo tablets contain no active ingredients.

Starting on day 1 of the menstrual cycle provides immediate contraceptive cover. If started on days 2 to 5, use additional contraception for the first seven days. No dose adjustment is available.

Acne is one of the more commonly reported side effects, occurring in approximately 5 per cent of users. This may reflect the androgenic activity of nomegestrol acetate.

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

Irregular bleeding patterns are common, particularly in the first few months.

A substantial proportion of women experience reduced or absent withdrawal bleeds, which, though medically harmless, may cause concern about pregnancy.

Weight gain, decreased libido, and abdominal discomfort have been noted.

Venous thromboembolism remains a risk with any combined pill, though the absolute incidence with Zoely has not been precisely quantified relative to older formulations.

Rarely, liver adenomas, gallbladder disease, and hypertension have been reported with combined oral contraceptive use.

Combined oral contraceptives increase the risk of venous and arterial thromboembolism.

Seek immediate medical attention if you develop sudden leg pain or swelling, chest pain, unexplained breathlessness, or severe headache with visual disturbance.

Smoking increases cardiovascular risk markedly. Women over 35 who smoke should not use combined oral contraceptives, including Zoely.

Other risk factors for thrombosis include obesity, prolonged immobility, and a family history of clotting disorders.

Inform your prescriber if you develop new migraine with aura, sustained hypertension, or jaundice while taking Zoely, as these may necessitate stopping the pill.

Zoely is contraindicated in women with venous or arterial thromboembolism (current or past), known thrombophilic conditions, migraine with aura, uncontrolled hypertension, severe hepatic disease or liver tumours, known or suspected hormone-dependent malignancies, undiagnosed vaginal bleeding, and known hypersensitivity to any ingredient.

It should not be used during pregnancy or by women with pancreatitis associated with severe hypertriglyceridaemia.