Monophasic COC with natural estrogen
Updated · Methodology
First line
Regular contraception for reproductive-age women. Per SEGO 2023, preferred to minimize hemostatic and lipid effects. Dose 1.5 mg estradiol + 2.5 mg nomegestrol, 24 active + 4 placebo tablets. Amenorrhea in 20–30% is expected, not pathological.
Sources
ICD-10: Z30.0 · ICD-11: QA21
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Zoely while breastfeeding. MEC 2015 category 4 first 6 weeks, then 2. Natural estradiol still affects milk supply. Nomegestrol transfers to milk in small amounts. Progestin-only is preferred.
Sources
ICD-10: Z30.0 · ICD-11: QA21
Estradiol + nomegestrol acetate – monophasic COC. Nomegestrol is a 19-norprogesterone derivative with antigonadotropic effect, no androgenic activity. Per 2011 (INAS-FOCUS) Pearl Index 0.4 perfect-use. VTE profile comparable to 2nd-gen COCs.
Discontinue if pregnant.
WHO MEC first 6 weeks – category 4. Natural estradiol reduces milk supply. Nomegestrol RID about 1.2%, Hale L3.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
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Estradiol + Nomegestrol acetate is evaluated for the following indications with varying evidence strength: Contraception (evidence tier A), Contraception during breastfeeding (evidence tier D). See the full indication matrix with dosing and citations above on this page.
Common side effects of Estradiol + Nomegestrol acetate (≥ 1 in 100): Acne (10%), Amenorrhea (20–30%), Headache, Breast tenderness, Decreased libido. See the Safety section for uncommon and serious reactions.
Discontinue if pregnant.
WHO MEC first 6 weeks – category 4. Natural estradiol reduces milk supply. Nomegestrol RID about 1.2%, Hale L3.
Estradiol + Nomegestrol acetate is contraindicated in: VTE; Thrombophilia; Smoking after 35; Migraine with aura; HTN. Full list in the Safety section.
Estradiol valerate + Dienogest, Ethinylestradiol, Ethinylestradiol + Desogestrel, Ethinylestradiol + Gestodene, Ethinylestradiol + Levonorgestrel, Medroxyprogesterone acetate depot, Red clover (Trifolium pratense), Cyproterone acetate + Ethinylestradiol