Combined oral contraceptive (3rd-generation progestogen) Pregnancy: Not indicated during pregnancy — if pregnancy occurs during treatment, further intake must be stopped. Extensive epidemiological studies have revealed neither an increased risk of birth defects in children born to women who used COCs before pregnancy nor a teratogenic effect when COCs were taken inadvertently in early pregnancy. Consider the increased risk of VTE in the postpartum period when re-starting. Use during lactation may reduce the volume of milk produced and change its composition; minute amounts of the active substances are excreted in milk and may affect the child, particularly in the first 6 weeks post-partum — breast-feeding mothers may be advised to use another method of contraception.

Ethinylestradiol with gestodene

Brand names: Femodene, Femodette, Katya

A combined oral contraceptive combining ethinylestradiol with gestodene, a third-generation progestogen.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1 tablet daily for 21 days (Akizza 75 microgram/30 microgram tablets)

Route: Oral

Frequency: First treatment cycle — 1 tablet daily for 21 days, starting on the first day of the menstrual cycle (contraceptive protection begins immediately). Subsequent cycles — tablet-taking from the next pack is continued after a 7-day interval, beginning on the same day of the week as the first pack

SWITCHING — from a 21-day combined oral contraceptive: take the first tablet on the first day immediately after the end of the previous course; no additional precautions required. From a combined Every Day (28-day) pill: start after the last active tablet of the Every Day pack, taking the first tablet the next day; no additional precautions required. From a progestogen-only pill: take the first tablet on the first day of bleeding, even if a POP has already been taken that day; no additional precautions required, and discard the remaining progestogen-only pills. POST-PARTUM AND POST-ABORTUM — after pregnancy, oral contraception can be started 21 days after a vaginal delivery provided the patient is fully ambulant and there are no puerperal complications, with additional contraceptive precautions for the first 7 days of tablet taking; because the first post-partum ovulation may precede the first bleeding, another method should be used between childbirth and the first course of tablets. After a first-trimester abortion, oral contraception may be started immediately with no additional precautions. MISSED/DELAYED TABLET — a single delayed tablet should be taken as soon as possible; if within 12 hours of the correct time, contraceptive protection is maintained. With longer delays additional contraception is needed: take only the most recently delayed tablet (omit earlier missed tablets) and use additional non-hormonal contraception (not the rhythm or temperature methods) for the next 7 days while the next 7 tablets are taken. If tablet(s) were missed during the last days of a pack, there should be no break before the next pack is started, and a withdrawal bleed should not be expected until the end of the second pack; some breakthrough bleeding on tablet-taking days is not clinically significant. If there is no withdrawal bleed in the tablet-free interval after the second pack, exclude pregnancy before starting the next pack. GASTRO-INTESTINAL UPSET — vomiting or diarrhoea may reduce efficacy by preventing full absorption. If it occurs within 4 hours of a tablet, continue tablet-taking from the current pack and use additional non-hormonal contraception (not rhythm or temperature methods) during the upset and for 7 days afterwards; if those 7 days overrun the end of a pack, start the next pack without a break and do not expect a withdrawal bleed until the end of the second pack (exclude pregnancy if none occurs). Consider other contraceptive methods if the gastro-intestinal disorder is likely to be prolonged. SPECIAL POPULATIONS — Children: not applicable. Elderly: not applicable.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Presence or risk of venous thromboembolism — current VTE (on anticoagulants) or history of DVT/PE; known hereditary or acquired predisposition (APC-resistance including Factor V Leiden, antithrombin-III deficiency, protein C deficiency, protein S deficiency); major surgery with prolonged immobilisation; high risk of VTE due to multiple risk factors
Presence or risk of arterial thromboembolism — current or previous ATE (e.g. myocardial infarction) or prodromal condition (e.g. angina pectoris); cerebrovascular disease (current or previous stroke, or TIA); known hereditary or acquired predisposition (hyperhomocysteinaemia, antiphospholipid antibodies); history of migraine with focal neurological symptoms; high risk of ATE due to multiple risk factors or one serious risk factor such as diabetes mellitus with vascular symptoms, severe hypertension or severe dyslipoproteinaemia
Presence or history of severe hepatic disease, e.g. active viral hepatitis and severe cirrhosis, as long as liver function values have not returned to normal
Presence or history of liver tumours (benign or malignant)
Current or history of breast cancer
Hypersensitivity to the active substance(s) or to any of the excipients
Concomitant use with medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir, glecaprevir/pibrentasvir, or sofosbuvir/velpatasvir/voxilaprevir

Side effects

Nausea and abdominal pain (common); vomiting, diarrhoea (uncommon)
Headache (common); migraine (uncommon)
Depressed mood, mood altered (common); libido decreased (uncommon), libido increased (rare)
Breast pain, breast tenderness (common); breast hypertrophy (uncommon); vaginal discharge, breast discharge (rare); reduced menstrual flow, spotting, breakthrough bleeding, missed withdrawal bleeding, post-pill amenorrhoea (post-marketing)
Weight increased (common), weight decreased (uncommon); fluid retention (common)
Venous thromboembolism (VTE) and arterial thromboembolism (ATE) — the serious adverse reactions; increased risk of arterial and venous thrombotic and thromboembolic events including myocardial infarction, stroke, transient ischaemic attack, venous thrombosis and pulmonary embolism

Interactions

Medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir, glecaprevir/pibrentasvir, or sofosbuvir/velpatasvir/voxilaprevir — concomitant use is contraindicated (stated in SPC §4.3 cross-referring to §4.5; the full §4.5 interaction section was not captured in this bundle — clinician to review it)

Clinical monograph

How it works

Ovulation is suppressed via the hypothalamic-pituitary axis, with additional contraceptive effect from cervical mucus thickening and endometrial changes that hinder implantation.

Prescribing in practice

Gestodene-containing pills carry a higher VTE risk than levonorgestrel, norethisterone or norgestimate preparations, so ensure the woman is counselled and accepts this risk.
Screen against UKMEC for thrombotic, cardiovascular and migraine-with-aura contraindications.
Advise on missed-pill rules and reduced efficacy with enzyme inducers or significant gastrointestinal upset.

Monitoring

Check blood pressure and reassess VTE and cardiovascular risk at initiation and at regular reviews.

Counselling the patient

Be aware this pill has a slightly higher clot risk than some alternatives.
Take at the same time each day and follow missed-pill advice.
Seek urgent help for calf swelling, chest pain, breathlessness or sudden severe headache.

Evidence & guidelines

MHRA reviews and UKMEC document higher relative VTE risk for third-generation progestogen combined pills.

Reference: FSRH CHC guideline; MHRA Drug Safety Update; UKMEC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Ethinylestradiol with desogestrel · Combined oral contraceptive (3rd-generation progestogen)

Pathways