Estradiol with nomegestrol

How it works

The oestrogen and progestogen suppress the hypothalamic-pituitary axis to inhibit ovulation, while the progestogen additionally thickens cervical mucus and renders the endometrium unfavourable to implantation.

Prescribing in practice

• Like all combined hormonal contraceptives it carries a risk of venous and arterial thromboembolism; assess personal and family VTE risk and avoid in those with significant risk factors or migraine with aura.
• Use the UKMEC framework to screen for cardiovascular, hepatic and breast-related contraindications before prescribing.
• Counsel on missed-pill rules and the reduced efficacy seen with enzyme-inducing drugs and significant vomiting or diarrhoea.

Monitoring

Review blood pressure and reassess VTE and cardiovascular risk at initiation and periodically thereafter.

Counselling the patient

• Take at the same time each day and follow the missed-pill instructions if a dose is delayed.
• Seek urgent care for calf swelling, chest pain, breathlessness, sudden severe headache or visual disturbance.
• Tell any clinician you are taking a combined contraceptive before starting new medicines.

Evidence & guidelines

UK Medical Eligibility Criteria (UKMEC) and MHRA guidance underpin combined hormonal contraceptive prescribing and VTE risk stratification.