Combined oral contraceptives (COC), third generation
ATC code: G03AA09 (Desogestrel and estrogen)
Ethinylestradiol + desogestrel (metabolized to active etonogestrel). Desogestrel is a third-generation progestin with minimal androgenic activity, reducing acne and improving the lipid profile. Suppresses ovulation via FSH/LH suppression. Per MEGA study and MHRA 2014, desogestrel COCs carry a higher VTE risk (9-12 per 10,000 woman-years) vs levonorgestrel (5-7).
First line
Regular contraception for reproductive-age women. Per SEGO 2023, preferred for moderate acne, painful menses, or intolerance to second-generation COCs. Due to higher VTE risk, 2019 and MHRA recommend trying levonorgestrel COCs first. Dose 20-30 µg ethinylestradiol + 150 µg desogestrel. 21 days on, 7 days off.
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
Ethinylestradiol + Desogestrel during breastfeeding. MEC 2015 category 4 in the first 6 weeks postpartum (higher VTE risk than 2nd-gen COCs), category 2 after 6 weeks with established lactation. Estrogen reduces milk supply more than 2nd-gen COCs. Desogestrel via etonogestrel metabolite transfers to milk, RID about 0.7%. Progestin-only is preferred. If prescribed in the first 6 weeks, consider a second opinion.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Contraindicated in pregnancy. Accidental use in the first month is not linked to defects. Stop on confirmation.
Estrogen reduces milk supply. WHO MEC: first 6 weeks – category 4, then 2. Etonogestrel (active desogestrel metabolite) transfers to milk, RID about 0.7%, Hale L3.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Ethinylestradiol + Desogestrel 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 Ethinylestradiol + Desogestrel (≥ 1 in 100): Nausea, Breast tenderness, Spotting in first 1-3 cycles, Headache, Decreased libido. See the Safety section for uncommon and serious reactions.
FDA category X. Contraindicated in pregnancy. Accidental use in the first month is not linked to defects. Stop on confirmation.
Estrogen reduces milk supply. WHO MEC: first 6 weeks – category 4, then 2. Etonogestrel (active desogestrel metabolite) transfers to milk, RID about 0.7%, Hale L3.
Ethinylestradiol + Desogestrel is contraindicated in: History/current VTE; Thrombophilia; Smoking after 35; Migraine with aura; Uncontrolled hypertension. Full list in the Safety section.