Cerazette

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Cerazette on Prescriptsy

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Cerazette is a progestogen-only contraceptive pill (POP) containing desogestrel 75 micrograms, manufactured by Organon and widely prescribed in the United Kingdom for the prevention of pregnancy.

Unlike older progestogen-only pills that rely primarily on cervical mucus thickening, Cerazette consistently inhibits ovulation in approximately 97% of treatment cycles, providing contraceptive reliability comparable to combined oral contraceptives while avoiding oestrogen-related risks.

It is taken continuously, one tablet every day without a pill-free interval, and has a 12-hour missed-pill window rather than the 3-hour window associated with traditional progestogen-only pills.

Cerazette is particularly valuable for women who cannot use combined hormonal contraception due to contraindications such as a history of venous thromboembolism, migraine with aura, uncontrolled hypertension, or age over 35 with smoking.

It is also suitable for use during breastfeeding.

This page provides a comprehensive clinical overview of how Cerazette works, dosing instructions, what to expect regarding bleeding patterns, side effects, important safety information, and how to obtain a prescription in the UK.

Important safety information about Cerazette

Before reading further, note the following key safety points. Cerazette is a prescription-only medicine (POM) in the United Kingdom and should be started following a clinical assessment.

• Cerazette does not protect against sexually transmitted infections. Use condoms in addition if STI protection is needed.
• The missed-pill window is 12 hours. If a pill is taken more than 12 hours late, use additional barrier contraception for the next 7 days and consider emergency contraception if unprotected intercourse occurred in the preceding 7 days.
• Seek urgent medical advice if you develop sudden sharp lower abdominal pain (possible ectopic pregnancy), symptoms of venous thromboembolism (leg swelling, sudden breathlessness, chest pain), or a new breast lump.
• Inform your prescriber about any history of breast cancer, liver disease, or venous thromboembolism before starting Cerazette.

What is Cerazette and what does it contain

Cerazette contains 75 micrograms of desogestrel, a third-generation synthetic progestogen.

It is classified as a desogestrel-only pill (sometimes called a "new-generation POP") because its mechanism of action differs significantly from traditional progestogen-only pills such as norethisterone-based products.

The active metabolite of desogestrel is etonogestrel, which exerts its contraceptive effect primarily by suppressing the mid-cycle surge of luteinising hormone (LH), thereby preventing ovulation.

This is the same metabolite released by the Nexplanon contraceptive implant.

Each tablet also contains the following excipients: lactose monohydrate, maize starch, povidone, stearic acid, all-rac-alpha-tocopherol, colloidal anhydrous silica, and hypromellose. Women with galactose intolerance, the Lapp lactase deficiency, or glucose-galactose malabsorption should not take Cerazette due to its lactose content.

How Cerazette works: mechanism of action

Cerazette provides contraception through three complementary mechanisms. The primary mechanism is ovulation inhibition.

Desogestrel suppresses the hypothalamic-pituitary-ovarian axis, preventing the LH surge required for follicular rupture and egg release.

In clinical studies comparing Cerazette to the traditional POP levonorgestrel, Cerazette inhibited ovulation in 97% of cycles versus only 60% with levonorgestrel.

The secondary mechanisms are cervical mucus thickening and endometrial changes. Desogestrel increases the viscosity of cervical mucus, creating a physical barrier that prevents sperm penetration.

It also thins the endometrial lining, reducing the likelihood of implantation in the unlikely event that ovulation and fertilisation occur.

The combined effect of these three mechanisms gives Cerazette a Pearl Index of approximately 0.4 with consistent and correct use, and approximately 0.5 to 1.2 with typical use.

This places its efficacy alongside combined oral contraceptives and significantly ahead of traditional progestogen-only pills.

Clinical evidence and NICE/FSRH guidance

The Faculty of Sexual and Reproductive Healthcare (FSRH) Clinical Guideline on Progestogen-only Pills (updated 2022) recognises desogestrel 75 micrograms as a distinct category of POP with reliable ovulation inhibition.

The guideline recommends that women be counselled that desogestrel POPs are more effective than traditional POPs and have a wider missed-pill window of 12 hours.

NICE Clinical Guideline CG30 (Long-acting reversible contraception) and the associated quality standard QS129 recommend that women be offered a full range of contraceptive options.

Where combined hormonal methods are contraindicated (UK Medical Eligibility Criteria for Contraceptive Use, UKMEC category 3 or 4), the desogestrel POP is a first-line oral option.

The UKMEC classifies the desogestrel POP as category 1 (no restriction) for most clinical situations including breastfeeding from 6 weeks postpartum, history of venous thromboembolism, migraine with aura, and hypertension.

The efficacy of desogestrel 75 micrograms was established in two large European multicentre trials involving over 1,600 women.

These demonstrated consistent ovulation inhibition as measured by serum progesterone levels and ultrasound monitoring of follicular development.

The contraceptive failure rate was comparable to combined oral contraceptive pills when used correctly.

Who can take Cerazette

Cerazette is suitable for most women of reproductive age seeking oral contraception.

It is particularly appropriate for women with contraindications to oestrogen-containing methods, including those with a personal or family history of venous thromboembolism, women with migraine with aura, those with uncontrolled or treated hypertension, women aged over 35 who smoke, and women who are breastfeeding (from 6 weeks postpartum, or earlier if the benefits outweigh risks).

Cerazette is contraindicated in women with known or suspected pregnancy, active venous thromboembolic disease, known or suspected sex-steroid-sensitive malignancies (including certain types of breast cancer), undiagnosed vaginal bleeding, severe hepatic disease with abnormal liver function, and hypersensitivity to desogestrel or any of the excipients.

Special caution is advised in women with a history of breast cancer that has been in remission for at least 5 years, liver tumours, diabetes with vascular complications, and conditions that first occurred or worsened during pregnancy or previous use of sex steroids (including cholestatic jaundice, herpes gestationis, and chorea).

These situations require specialist assessment and shared decision-making.

Dosage and administration

One Cerazette tablet should be taken every day at approximately the same time, without any break between strips. Each blister strip contains 28 tablets.

When one strip is completed, the next should be started the following day.

There is no pill-free week and no withdrawal bleed period, which is different from most combined oral contraceptive pill regimens.

For women starting Cerazette without previous hormonal contraception, the first tablet should be taken on day 1 of the menstrual cycle (the first day of bleeding).

When started on day 1, contraceptive protection begins immediately. If starting on days 2 to 5, additional barrier contraception should be used for the first 7 days.

When switching from a combined oral contraceptive, start Cerazette the day after the last active pill of the previous pack (no need to wait for a pill-free interval or placebo days).

When switching from another POP, start on any day and no additional contraception is needed.

When switching from an injectable, start Cerazette on the day the next injection would be due.

When switching from an implant or intrauterine system, start on the day of removal.

Following childbirth, Cerazette may be started on day 21 postpartum.

If started later, additional barrier contraception should be used for the first 7 days and pregnancy should be excluded if intercourse has already occurred.

Following first-trimester miscarriage or termination, Cerazette can be started immediately with no additional precautions.

Missed pills and late pills

If a pill is taken fewer than 12 hours late, contraceptive protection is maintained. Take the late pill as soon as remembered and continue taking pills at the normal time.

If a pill is taken more than 12 hours late, contraceptive protection may be reduced.

Take the missed pill as soon as remembered (even if this means taking two pills on the same day), then continue taking pills at the usual time.

Use additional barrier contraception (condoms) for the next 7 days. If unprotected intercourse occurred in the 7 days before the missed pill, emergency contraception should be considered.

If vomiting occurs within 3 to 4 hours of taking a tablet, or if severe diarrhoea persists, absorption may be incomplete. Follow the same guidance as for a missed pill.

Bleeding patterns on Cerazette

Changes in menstrual bleeding are the most commonly reported effect of Cerazette and are the leading reason for discontinuation. Women should be counselled that bleeding patterns are likely to change and that these changes are not harmful.

In clinical trials, approximately 50% of women experienced infrequent bleeding or amenorrhoea (no bleeding at all) after the first few months of use.

Around 20 to 30% of women had frequent or prolonged bleeding, particularly during the first three months.

Bleeding patterns tend to stabilise after 3 to 6 months of continuous use. A small proportion of women experience unpredictable spotting throughout treatment.

If heavy or prolonged bleeding develops after a period of amenorrhoea, or if bleeding is accompanied by pain, a clinical review should be arranged to exclude other causes such as pregnancy, ectopic pregnancy, or cervical pathology.

Side effects of Cerazette

Common side effects

The most frequently reported side effects in clinical trials (affecting 1 in 10 or more women) are altered bleeding patterns (discussed above), headache, mood changes (including depressed mood and mood swings), decreased libido, nausea, acne, breast pain and tenderness, and irregular menstruation.

Uncommon side effects

Uncommon side effects (affecting between 1 in 100 and 1 in 1,000 women) include ovarian cysts, fatigue, vomiting, alopecia (hair thinning), dysmenorrhoea, vaginal infection, and difficulty wearing contact lenses due to changes in tear film.

Rare side effects

Rare side effects include skin reactions such as erythema nodosum, rash, urticaria, and angioedema. Very rarely, ectopic pregnancy may occur, although the absolute risk is lower than in women using no contraception.

When to seek medical advice

Contact your GP or call NHS 111 if you develop persistent low mood or depression, new or worsening migraine-type headaches, or a breast lump.

Seek emergency medical care (call 999 or attend A&E) if you experience sudden sharp lower abdominal pain with missed or irregular bleeding (possible ectopic pregnancy), signs of a severe allergic reaction (swelling of the face, lips, tongue, or throat, or difficulty breathing), or symptoms suggesting a blood clot (sudden leg swelling, chest pain, or unexplained breathlessness).

Report any suspected adverse reactions via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Breast cancer risk

Epidemiological evidence suggests a slightly increased relative risk of breast cancer diagnosis in women using hormonal contraception, including progestogen-only methods.

The absolute increase in risk is small and declines after discontinuation. Women with a personal history of breast cancer should not use Cerazette.

Women with a strong family history of breast cancer should discuss individual risk with their prescriber.

Venous thromboembolism

Although progestogen-only pills are not considered to carry the same VTE risk as combined hormonal contraceptives, a small increase in risk cannot be excluded.

Women with active venous thromboembolism should not use Cerazette. Women with a history of VTE should have an individual risk assessment before starting.

Liver disease

Cerazette is contraindicated in women with active severe hepatic disease until liver function has returned to normal.

If jaundice or significant deterioration in liver function develops during use, Cerazette should be discontinued.

Women with a history of cholestatic jaundice of pregnancy or jaundice related to previous pill use should be monitored closely.

Diabetes

Progestogens may affect carbohydrate metabolism. Women with diabetes mellitus, particularly those with vascular complications, should monitor blood glucose levels when starting Cerazette. Routine adjustment of diabetes treatment is not usually required, but awareness of potential changes is important.

Interactions with other medicines

Enzyme-inducing drugs can reduce the contraceptive efficacy of Cerazette.

These include certain antiepileptics (carbamazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, eslicarbazepine, topiramate at doses above 200 mg daily), rifampicin, rifabutin, some antiretrovirals (ritonavir, nelfinavir, nevirapine, efavirenz), and the herbal remedy St John's Wort (Hypericum perforatum).

Women taking enzyme-inducing medications should use an alternative non-hormonal contraceptive method or a long-acting method not affected by enzyme induction (such as the copper IUD).

Additional barrier contraception should be used during concurrent treatment and for 28 days afterwards if enzyme-inducing drugs are used short-term.

How to get Cerazette in the UK

Cerazette (branded product) is a prescription-only medicine in the UK.

It can be prescribed by your GP, at an NHS sexual health clinic, or by an authorised online prescriber following a clinical assessment.

The standard NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Cerazette is also available on private prescription from registered pharmacies.

Since 2021, desogestrel 75 microgram products marketed under the brand names Hana and Lovima have been reclassified as pharmacy (P) medicines and are available without prescription from pharmacies following a pharmacist consultation.

These contain the same active ingredient and dose as Cerazette. Your pharmacist or GP can advise which product is most appropriate.

Cerazette and breastfeeding

Cerazette is suitable for use during breastfeeding.

Small quantities of desogestrel and its metabolite etonogestrel are excreted into breast milk, but studies have not demonstrated adverse effects on infant growth, development, or health.

The FSRH and NICE support the use of progestogen-only pills during lactation from 6 weeks postpartum (or earlier if clinically appropriate).

Breastfeeding mothers should discuss the timing of initiation with their midwife or GP.

Fertility after stopping Cerazette

Return to fertility after stopping Cerazette is usually rapid.

Ovulation typically resumes within one to two cycles, and most women can expect their menstrual pattern to return to its pre-treatment state within three months.

There is no evidence that prior use of Cerazette has any long-term adverse effect on fertility.

Sources

• Cerazette 75 microgram Film-coated Tablet, Summary of Product Characteristics (EMC)
• Desogestrel, British National Formulary (BNF)
• FSRH Clinical Guideline: Progestogen-only Pills
• NICE CG30: Long-acting reversible contraception
• Progestogen-only pill, NHS
• MHRA Yellow Card Scheme