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Ethinylestradiol + Desogestrel

Combined oral contraceptives (COC), third generation

ATC code: G03AA09(Desogestrel and estrogen)

Updated · Methodology

Indications

A

Contraception

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.

Sources

  1. AEMPS: Ficha técnica de Etinilestradiol + Levonorgestrel (2024)
  2. World Health Organization: Medical Eligibility Criteria for Contraceptive Use, 5th edition (2015)

ICD-10: Z30.0 · ICD-11: QA21

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

D

Contraception during breastfeeding

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.

Sources

  1. AEMPS: Ficha técnica de Etinilestradiol + Levonorgestrel (2024)
  2. WHO: Medical eligibility criteria for contraceptive use (2015)

ICD-10: Z30.0 · ICD-11: QA21

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

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).

Safety

Contraindications

  • History/current VTE
  • Thrombophilia
  • Smoking after 35
  • Migraine with aura
  • Uncontrolled hypertension
  • Ischemic heart disease, stroke
  • Severe hepatic impairment
  • Breast cancer
  • First 6 weeks postpartum
  • Pregnancy

Serious adverse effects

  • VTE (9–12 per 10,000 woman-years)
  • Ischemic stroke
  • Hypertension
  • Cholestasis
  • Benign liver tumors

Common adverse effects

  • Nausea
  • Breast tenderness
  • Spotting in first 1–3 cycles
  • Headache
  • Decreased libido

Pregnancy: can you take Ethinylestradiol + Desogestrel?

Contraindicated in pregnancy. Accidental use in the first month is not linked to defects. Stop on confirmation.

Breastfeeding: can you take Ethinylestradiol + Desogestrel?

Hale L3 · Probably compatible, limited data

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.

RID, infant dose via milk
0.7%
Maternal half-life
24.0 h
Maternal peak time
1.8 h
Peak milk concentration
0 mg/L
Milk-to-plasma ratio
0.4
Calculate RIDSafe feeding windowFull profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

21 days on, 7 days off. First-cycle start on day 1 of menses, or any day with a negative pregnancy test and 7-day backup. Mercilon 20 µg ethinylestradiol suits women with greater estrogen sensitivity (nausea, edema, breast tenderness).

Monitoring

BP check 3 months after start, then annually. Cervical cytology per SEGO schedule. New-onset migraine with aura, leg swelling, dyspnea, or sudden chest pain – stop immediately and seek emergency care.

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Frequently asked

What is Ethinylestradiol + Desogestrel used for?

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.

What are the side effects of Ethinylestradiol + Desogestrel?

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.

Is Ethinylestradiol + Desogestrel safe during pregnancy?

Contraindicated in pregnancy. Accidental use in the first month is not linked to defects. Stop on confirmation.

Is Ethinylestradiol + Desogestrel compatible with breastfeeding?

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.

Who should not take Ethinylestradiol + Desogestrel?

Ethinylestradiol + Desogestrel is contraindicated in: History/current VTE; Thrombophilia; Smoking after 35; Migraine with aura; Uncontrolled hypertension. Full list in the Safety section.

Other drugs in this group

Ethinylestradiol + Gestodene, Ethinylestradiol + Levonorgestrel, Ethinylestradiol + Norgestimate, Etonogestrel (implant), Follitropin alfa, Norethisterone, Ulipristal acetate, Dydrogesterone