Combined oral contraceptive (monophasic)

Estradiol with nomegestrol

Brand names: Zoely

Adult dose

Dose: 1 tablet OD for 24 days then 4 days placebo

Route: Oral

Frequency: OD (24/4 regimen)

Clinical pearls

FSRH UKMEC eligibility criteria for prescribing
17β-estradiol-based COC with shorter hormone-free interval — reduced withdrawal bleeding
Quick start permitted with negative pregnancy test

Contraindications

History of VTE/arterial events
Migraine with aura
Breast cancer
Severe hepatic disease
Smokers >35 years
Pregnancy

Side effects

Breakthrough bleeding
Headache
Mood changes
Acne
VTE
Hypertension

Interactions

CYP3A4 inducers (carbamazepine, rifampicin, ritonavir)
Antibiotics (enzyme-inducers only — non-enzyme-inducers no interaction per FSRH)

Monitoring

BP at baseline and annually
BMI
Migraine pattern
VTE risk factors

Reference: BNF; FSRH CHC guideline; UKMEC; https://bnf.nice.org.uk/drugs/estradiol-with-nomegestrol/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways