Femodette

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Femodette on Prescriptsy

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Femodette is a low-dose combined oral contraceptive pill used to prevent pregnancy.

Each tablet contains two active hormones: gestodene 75 micrograms (a progestogen) and ethinylestradiol 20 micrograms (an oestrogen).

Femodette is manufactured by Bayer and is the lower-dose counterpart of Femodene, which contains the same progestogen with a higher oestrogen dose (30 micrograms).

Femodette is taken daily for 21 days followed by a 7-day pill-free break.

This page provides a comprehensive clinical guide to Femodette, covering how it works, dosing instructions, who can and cannot use it, expected side effects, important safety warnings, and how to access it in the United Kingdom.

Low-dose combined oral contraceptives were developed to maintain reliable pregnancy prevention while reducing the incidence and severity of oestrogen-related side effects.

The original combined pills introduced in the 1960s contained 50 micrograms or more of oestrogen and were associated with higher rates of nausea, breast tenderness, headache, and thromboembolic events.

Modern low-dose pills containing 20 micrograms of ethinylestradiol represent a significant step forward in tolerability while preserving contraceptive efficacy.

In the UK, a wide range of combined oral contraceptives is available on the NHS, and the choice of pill is made through shared decision-making between the woman and her prescriber, taking into account individual clinical factors and preferences.

Important safety information about Femodette

Before continuing, be aware of the following critical safety points.

• Femodette is a prescription-only medicine and requires a clinical assessment before it can be prescribed.
• All combined hormonal contraceptives carry a small but real increased risk of blood clots (venous thromboembolism), heart attack, and stroke.
• The lower oestrogen dose in Femodette does not eliminate thrombotic risk.
• Do not use Femodette if you have migraine with aura, uncontrolled hypertension, or a history of blood clots.
• Women aged 35 and over who smoke must not use any combined hormonal contraceptive.
• Learn the warning signs of blood clots and seek emergency help immediately if they occur.

Understanding low-dose combined contraception

Combined oral contraceptives contain an oestrogen and a progestogen.

The oestrogen component primarily suppresses follicle-stimulating hormone (FSH), preventing follicular development, while the progestogen inhibits the luteinising hormone (LH) surge that triggers ovulation.

Together, these actions reliably prevent the release of a mature egg. The progestogen also thickens cervical mucus to block sperm and thins the endometrium.

The term "low-dose" refers to pills containing 20 micrograms of ethinylestradiol, compared with "standard-dose" pills containing 30 or 35 micrograms.

The lower oestrogen content reduces the incidence of oestrogen-dependent side effects, including nausea, breast tenderness, bloating, headache, and fluid retention.

However, the lower dose may provide slightly less consistent cycle control, meaning breakthrough bleeding or spotting may be more common, particularly in the first few months.

The FSRH and NICE guideline NG37 state that low-dose combined pills are as effective as standard-dose pills when taken correctly.

Women who experience oestrogen-related side effects on a 30 or 35 microgram pill may benefit from switching to a 20 microgram formulation such as Femodette.

How Femodette works: mechanism of action

Femodette delivers two hormones in a fixed daily dose. Ethinylestradiol at 20 micrograms suppresses FSH secretion sufficiently to prevent follicular maturation.

Gestodene at 75 micrograms, a potent third-generation progestogen, blocks the mid-cycle LH surge to prevent ovulation. The dual hormonal suppression provides a highly effective contraceptive effect.

Beyond ovulation suppression, gestodene induces changes in the cervical mucus that make it thick, scanty, and hostile to sperm penetration.

The endometrium becomes thin and atrophic, which contributes to lighter withdrawal bleeds and adds a further barrier to implantation in the unlikely event of fertilisation.

Gestodene is rapidly and completely absorbed from the gastrointestinal tract, with high bioavailability and a half-life of approximately 12 to 15 hours.

It binds strongly to sex hormone-binding globulin (SHBG). Ethinylestradiol increases SHBG production by the liver, which in turn reduces free androgen levels in the blood.

This mechanism may contribute to improvements in acne and hirsutism in some women, though Femodette is not specifically indicated for these conditions.

Clinical evidence and UK prescribing context

Low-dose combined pills have been available in the UK since the 1980s and have accumulated extensive clinical evidence.

Large observational studies and systematic reviews confirm that 20 microgram ethinylestradiol pills are as effective as 30 microgram pills in preventing pregnancy.

The Cochrane Collaboration has reviewed the evidence and concluded that while breakthrough bleeding rates may be slightly higher with 20 microgram preparations in the first few cycles, overall satisfaction and continuation rates are comparable.

Femodette is listed in the BNF and is prescribed within the framework of NICE NG37 and FSRH combined hormonal contraception guidelines.

Prescribers in the UK follow the UKMEC to assess eligibility.

A UKMEC category 1 indicates no restriction; category 2 indicates that benefits generally outweigh risks; category 3 indicates that risks usually outweigh benefits; and category 4 indicates an unacceptable health risk.

Women with UKMEC category 1 or 2 for combined hormonal contraception can be offered Femodette after discussion of available options.

Femodette compared with Femodene and other pills

The key difference between Femodette and Femodene is the oestrogen dose: 20 micrograms in Femodette versus 30 micrograms in Femodene. Both contain gestodene 75 micrograms.

Women who experience nausea, breast tenderness, or headache on Femodene may find these symptoms reduced with Femodette.

Conversely, women who experience troublesome breakthrough bleeding on Femodette may achieve better cycle control with Femodene or another standard-dose pill.

Compared with second-generation low-dose pills (such as Loestrin 20, containing norethisterone 1 mg and ethinylestradiol 20 micrograms), Femodette uses a third-generation progestogen with lower androgenic activity.

This may offer slight advantages for women concerned about acne or oily skin.

However, the VTE risk is marginally higher with third-generation progestogens, and this difference should be discussed with each woman.

Other low-dose combined pills available in the UK include Mercilon (desogestrel 150 micrograms / ethinylestradiol 20 micrograms) and various generic equivalents.

The choice between these options depends on individual response, side effect profile, and patient preference. Your prescriber can help you find the best fit.

Non-contraceptive benefits

Like other combined pills, Femodette offers several non-contraceptive benefits.

Periods typically become lighter, shorter, and less painful, which is helpful for women with heavy menstrual bleeding or severe dysmenorrhoea.

Regular cyclical bleeding improves predictability and quality of life.

Long-term use is associated with reduced risk of ovarian cancer (approximately 40 to 50% reduction with 5 or more years of use), endometrial cancer (approximately 50% reduction), ovarian cysts, and pelvic inflammatory disease.

These protective effects can persist for years after stopping the pill.

Dosage and administration

Take one tablet daily at the same time for 21 days, then take a 7-day break. A withdrawal bleed will usually start during the break. Begin the next strip after the break ends, whether or not bleeding has finished.

Consistent timing is especially important with low-dose pills because the hormonal margin that suppresses ovulation is narrower. Set a daily alarm on your phone or use a pill reminder app to help you remember.

Starting rules, missed pill guidance, and switching instructions are the same as for Femodene. One missed pill (up to 24 hours late) requires no additional precautions.

Two or more missed pills require barrier contraception for 7 days, and the pill-free interval should be omitted if fewer than 7 pills remain in the current strip.

If you experience vomiting within 3 to 4 hours of a pill or severe diarrhoea, treat it as a missed pill and follow the guidance above.

Side effects of Femodette

Common side effects

The most frequently reported effects include headache, nausea (usually milder than with 30 microgram pills), breast tenderness, mood changes, and irregular bleeding or spotting.

These typically settle within the first 2 to 3 cycles. Weight change and decreased libido have also been reported.

Breakthrough bleeding

Breakthrough bleeding is more common with 20 microgram pills than with standard-dose preparations, particularly in the first 1 to 3 months.

If it persists beyond 3 months, consult your GP.

They may check for other causes (such as chlamydia infection, missed pills, or drug interactions) or consider switching to a higher-dose pill if appropriate.

Rare but serious side effects

Venous thromboembolism (DVT and PE) and arterial thromboembolism (heart attack and stroke) are the most significant rare risks.

The VTE risk with gestodene-containing pills is approximately 9 to 12 per 10,000 women per year.

This risk is small in absolute terms but is higher than the background rate of 2 per 10,000 in non-users.

The risk is greatest during the first year of use and in women with additional risk factors.

A small increase in breast cancer and cervical cancer risk is associated with long-term combined pill use; this returns to background levels within approximately 10 years of stopping.

When to seek emergency help

Call 999 or attend A&E immediately if you develop sudden severe chest pain, difficulty breathing, coughing blood, sudden swelling or pain in one leg, sudden severe headache, visual disturbance, collapse, or one-sided weakness or numbness.

Contact your GP or NHS 111 for persistent headaches, mood changes, breast lumps, or any other new symptoms. Report suspected adverse reactions to the MHRA at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Femodette must not be used by women with current or past VTE or arterial thromboembolism, known thrombophilic disorders, migraine with aura, uncontrolled hypertension, diabetes with vascular damage, active or severe liver disease, known or suspected breast cancer, undiagnosed vaginal bleeding, or hypersensitivity to any ingredient.

Women aged 35 and over who smoke must not use Femodette.

Risk assessment

Before prescribing, your clinician will check blood pressure, BMI, smoking status, migraine history, and personal and family history of VTE and arterial disease.

Reassessment should occur at least annually. Inform your prescriber of any new diagnoses, changes in weight, or new medications between reviews.

Drug interactions

Enzyme-inducing medicines (including carbamazepine, phenytoin, rifampicin, rifabutin, some HIV antivirals, and St John's wort) reduce contraceptive efficacy.

Additional barrier contraception or an alternative method is needed during and after use of these drugs.

Always tell your pharmacist and prescriber that you take Femodette before starting any new medicine.

Surgery and immobilisation

Stop Femodette 4 to 6 weeks before planned major surgery involving prolonged immobilisation. Restart only after full mobilisation. Use alternative contraception during this period.

How to get Femodette in the UK

Femodette is a prescription-only medicine available free on the NHS.

You can obtain it from your GP, a sexual health or contraception clinic, or an authorised online prescriber after a clinical assessment.

Contraception prescriptions are exempt from NHS charges throughout the UK. Annual reviews are recommended to reassess eligibility and discuss any changes in your health.

Sources

• Femodette Tablets, Summary of Product Characteristics (EMC)
• Ethinylestradiol with gestodene, British National Formulary (BNF)
• FSRH Clinical Guideline: Combined Hormonal Contraception
• NICE NG37: Contraception
• Combined pill, NHS
• MHRA Yellow Card Scheme