Zoely Combined Pill

What is the Zoely Pill?

Zoely is a combined hormonal contraceptive pill containing two active ingredients, 17β-estradiol (1.5 mg) and nomegestrol acetate (2.5 mg). These hormones are similar to the naturally occurring female sex hormones, oestrogen and progesterone.Zoely is a 28-day pill, which means it is taken every day without a break between packs.

Each Zoely strip contains:

• 24 white film-coated pills that contain nomegestrol acetate and 17β-estradiol
• 4 yellow film-coated inactive tablets that do not contain any hormones and are called 'placebo pills'

When taken perfectly, Zoely is more than 99% effective at preventing an unwanted pregnancy. However, when typical use is considered, such as missing the pill or having sickness and/or diarrhoea, the NHS states that the combined pill is closer to being 91% effective. This means that 9 in 100 people who use Zoely will get pregnant every year. Along with preventing pregnancy, the pill is helpful in the treatment of irregular and painful menstruation.

It's important to note that the Zoely contraceptive pill does not protect against sexually transmitted infections (STIs), including chlamydia, HIV and AIDS. The most reliable method to protect you and your sexual partners against STIs is condoms.

How Does Zoely Work?

Zoely contains two active ingredients: nomegestrol acetate and 17β-estradiol. As it is a combination of hormones in a contraceptive pill, its mechanism of action interferes with the normal menstrual cycle in women.

The female sex hormones, oestrogen and progesterone, control the release of the egg during ovulation and its implantation in the uterus. The levels of hormones fluctuate throughout the menstrual cycle. These hormones also prepare the uterine lining for a successful pregnancy. If the egg is not fertilised by sperm, the hormonal levels fall, resulting in the shedding of the endometrium as a menstrual bleed.

Zoely pills prevent pregnancy in 3 ways:

1. Hindering egg release: Zoely's primary mechanism of action involves disrupting the monthly release of a mature egg from the ovaries
2. Changing cervical mucus: Thickens the mucus at the neck of the womb to make it more difficult for sperm to reach the womb and fertilise an egg
3. Thinning the endometrium: Affects the womb lining to reduce the chances of a fertilised egg implanting itself there

By preventing ovulation and making it harder for sperm to travel through the cervix, the active ingredients of the Zoely contraceptive pill greatly reduce the chances of becoming pregnant.

How Long Does Zoely Take to Work?

The active ingredients in Zoely pills work immediately to protect against pregnancy if taken on day 1 of your period (when you first have a bleed). If you begin your treatment regimen on any other day, you'll need to use an extra method of contraception (such as condoms) until you've correctly taken Zoely for 7 consecutive days.

How to Take Zoely Pills

Zoely tablets need to be taken daily as directed on the package to remain effective. It comes in a pack of 28 tablets, with 24 white active tablets and 4 yellow placebo pills.

The tablets are available with self-adhesive strips which bear a day of the week. Label the strip of tablets with the name of the day you start taking the pill. For example, if you begin taking Zoely on Sunday, mark the pill strip with a label of Sunday. Place the day label sticker on the blister pack where it reads 'place day label here'. This enables you to check whether you have taken your daily tablet. Follow the direction of the arrows on the blister pack: use the white active tablets first, then the yellow placebo ones.

After taking 24 active tablets, you will take 4 placebo tablets to maintain the routine. Skipping these yellow tablets will not affect contraception. You should get a withdrawal bleed, similar to a period, during the four days that you take the placebo pills.

Start taking the next strip of Zoely pills the day after you take the last yellow placebo pill, even if you are still bleeding. Doing so will mean that you'll always start a new pack on the same day of the week, and you should also have your period on roughly the same days each month.

When to Start Zoely

If you start taking the Zoely pill on the first day of your period, you will be protected against pregnancy straight away. Beginning the treatment on any other day will involve needing to use an additional method of contraception, such as condoms, for the first 7 days.

Each time you start a new blister pack of Zoely, take the number 1 white active tablet in the top left-hand corner. Look at the 7 stickers with day indicators and choose the one in the grey column that begins with your starting day.

What if I Miss a Zoely Pill?

If you forget to take an active Zoely pill, what you need to do will depend on how late you are taking the missed pill.

If it has been less than 24 hours since you should have taken the pill, take a tablet as soon as possible, then take your next pill at the usual time.

If you are more than 24 hours late taking the pill, you will need to follow the guidance below, depending on which week you are currently in:

Days 1 to 7

• Take the missed white pill as soon as possible, even if that means taking 2 pills at the same time.
• Take your next tablet at the usual time.
• Use condoms until you have taken your pills correctly for 7 days in a row.

Days 8 to 17

• Take the missed white pill as soon as possible, even if that means taking 2 pills at the same time.
• Take your next tablet at the usual time.
• If you took your pills correctly in the 7 days before missing the pill, your protection is maintained, and you do not need to use extra contraception.
• If you missed more than 1 pill, use condoms until you have taken your pills correctly for 7 days in a row.

Days 18 to 24

Missing a white pill at this time increases your chance of getting pregnant. If you have taken your pills correctly in the 7 days leading up to the missed pill, you do not need to use condoms. 

If you did not take your pills correctly, you will need to use condoms for the next 7 days and do either of the following:

Option 1

• Take the missed white pill as soon as possible, even if that means taking 2 pills at the same time.
• Take your next tablet at the usual time.
• Start the next strip as soon as the white pills in your current pack have finished. Skip the yellow placebo pills.
• You may not have a withdrawal bleed until you take the placebo pills at the end of the second pack.

Option 2

Stop taking the white active pills and start taking the yellow pills for a maximum of 3 days so that the total number of yellow placebo and white active pills is not more than 4. Start a new Zoely pack the day after the yellow pills have finished.

If you cannot remember how many of the white active tablets you've missed, or choosing Option 2 would mean that the total number of missed white active pills plus yellow placebo pills would be more than 4, follow Option 1 and use a barrier method of contraception like condoms as an extra precaution until you have used Zoely tablets correctly for 7 days in a row. If you've forgotten to take white active tablets and do not experience the expected monthly period while taking the yellow tablets from the same blister, you may be pregnant. Contact your doctor before starting the next blister, and you may also want to take a pregnancy test.

Just missing any of the yellow pills should not reduce your protection against pregnancy, as they do not contain any hormones. Throw away any missed yellow tablets and start a new pack at the usual time. You can find out more information about missing Zoely pills in the Patient Information Leaflet.

What if I Take Too Many Zoely Pills?

Taking too many Zoely pills is unlikely to cause you any serious harm, but you may feel or be sick or have vaginal bleeding. You should speak to a clinician for advice if you take too many tablets.

What Should I Do if I Am Sick (Vomit) or Have Diarrhoea When Taking Zoely?

If you are sick (vomit) within 3 to 4 hours of taking a white active pill or you have severe diarrhoea, there is a chance that your body will not have absorbed all of the active ingredients in the Zoely pill.

After vomiting or having diarrhoea, take another white active pill from a different strip as soon as you can. If possible, take it within 24 hours of your usual pill time, then take the next tablet at your usual time. If this is not possible, or if 24 hours or more have passed, you should follow the guidance for a forgotten pill.

If you are sick of having diarrhoea within 3 to 4 hours of taking a yellow inactive pill, you are still protected against pregnancy and do not need to do anything.

How to Switch to Zoely From Another Contraceptive Pill

If you are switching to Zoely from another combined pill, start Zoely on the day after you have taken your last active pill in your current pack. If your current pill also contains inactive tablets, start Zoely the day after your last active pill.

If you are switching from the progestogen-only or mini pill, you can switch at any time, but you must use an extra method of contraception, like condoms, for the first 7 days that you take Zoely.

Zoely Side Effects and Cautions

Although the Zoely contraceptive pill is generally well-tolerated, side effects can happen. The treatment may also be associated with an increased risk of certain conditions, so it's important to have a clear understanding of what you might encounter before starting the tablets.

Potential Side Effects of Zoely

All medications can cause side effects, though not everybody experiences them. Familiarising yourself with the risks associated with Zoely pills and being vigilant for any side effects or changes is an important part of your treatment.

Possible Zoely side effects include:

Please be aware that this is not an exhaustive list of Zoely side effects. Further information can be found in the Patient Information Leaflet that accompanies the medication.

If you experience any side effects, whether listed above or in the patient information leaflet enclosed with your medicine, inform your doctor or a pharmacist for advice. You can also report them via the Yellow Card scheme from the Medicines and Healthcare products Regulatory Agency (MHRA).

Zoely Pills and Allergic Reactions

Do not take Zoely if you are allergic to nomegestrol acetate, 17β-estradiol or any of the other ingredients listed in the patient information leaflet.

If you experience the signs of an allergic reaction, stop taking Zoely and seek immediate medical attention.

Signs of allergic reaction include:

• Difficulty breathing or wheezing
• Dry, red and cracked skin
• Itchy, red, watery eyes
• Raised, itchy, red rash (hives)
• Swelling of the face, lips, tongue or throat
• Tightness of the chest
• Tummy pain, nausea, vomiting and diarrhoea

Zoely and Meningioma Risk

Taking medications that contain nomegestrol acetate, including Zoely, can increase the risk of meningioma (non-cancerous tumours of the tissue layer between the brain and the skull).

The risk of meningioma increases if you take high doses of nomegestrol acetate for several years. If you notice any of the following symptoms, contact your doctor straight away:

• Vision changes
• Hearing loss or ringing in the ears
• Loss of smell
• Headaches that get worse over time
• Memory loss
• Seizures
• Weakness in your arms or legs

If you have had meningioma before, tell your doctor and do not take Zoely.

Zoely and the Risk of Blood Clots

All combined pills, including Zoely, are associated with a slightly increased risk of developing blood clots compared to people who do not use the combined pill.

The risk of developing a blood clot in people who:

• Are not taking Zoely and not pregnant is about 2 out of 10,000 people each year
• Take a combined pill containing levonorgestrel, norethisterone, or norgestimate is about 5 to 7 out of 10,000 people each year
• Take Zoely is about 5 to 7 out of 10,000 people each year

While the risk of developing a blood clot while taking Zoely pills is small, it can be increased if you:

• Are very overweight (BMI over 30)
• Have a close relative who has had a blood clot in their leg, lung, or other organ
• Need an operation or are going to be off your feet for a while
• Are over 35
• Gave birth less than 3 weeks ago
• Are in your first year of treatment or are restarting after a break of 4 weeks or more

You can find more information about the risks and signs of blood clots when taking the Zoely contraceptive pill in the Summary of Product Characteristics, which can be viewed online.

Zoely Interactions and Warnings

Zoely may not be suitable for everyone. You should tell the clinician about any medical conditions you have or any medications you are taking, so they can assess whether this treatment is safe and suitable for you.

Do not take Zoely if you:

• Are allergic to 17β-estradiol, nomegestrol acetate, or any other ingredients listed in the pill
• Have or have ever had a blood clot in a blood vessel in your legs, lungs, or any other organ
• Have a blood-clotting disorder
• Need an operation or are going to be off your feet for a while
• Have ever had a heart attack or stroke
• Have ever had angina pectoris or a transient ischaemic attack
• Have a condition that increases the risk of a blood clot in your arteries, such as severe diabetes with blood vessel damage, very high blood pressure, very high blood fat levels, or hyperhomocysteinaemia
• Have ever had a migraine with aura
• Have ever had pancreatitis associated with high levels of fat in your blood
• Have ever had a severe liver disease, and your liver function has not yet returned to normal
• Have ever had a liver tumour
• Have or think you may have cancer of the breast or genital organs
• Have or have ever had meningioma
• Have unexplained vaginal bleeding

Tell the clinician before taking Zoely about any medical conditions you have, even if they are not listed here. The combined pill may not be suitable for you if you smoke and are over 35. Your clinician may recommend the mini pill instead.

Zoely pills contain lactose, so if you've been informed by a doctor that you have an intolerance to some sugars, get medical advice before starting the medication.

Zoely and Other Medications

Before starting Zoely, tell the clinician if you are taking any prescribed, over-the-counter, or herbal medicines, as these may interact with Zoely and reduce its effectiveness, and vice versa.

The following medicines may stop Zoely from working properly:

• Primidone, phenytoin, phenobarbital, carbamazepine, oxcarbazepine, topiramate, and felbamate for treating epilepsy
• Rifampicin for treating tuberculosis
• Rifabutin, ritonavir, and efavirenz for HIV
• Griseofulvin
• Protease inhibitors
• Bosentan
• St. John's Wort

Tell your clinician if you have hepatitis C and you are taking medicines that contain:

• Ombitasvir/paritaprevir/ritonavir
• Dasabuvir
• Glecaprevir/pibrentasvir
• Sofosbuvir/velpatasvir/voxilaprevir

While most antibiotics are considered safe to use with Zoely, treatments that affect liver enzymes (such as rifabutin and rifampicin) are not recommended. This is because they can reduce Zoely's effectiveness in preventing pregnancy.

Pregnancy and Breastfeeding

Do not take Zoely if you are pregnant, think you might be pregnant, or plan on becoming pregnant in the near future. Speak to your doctor for further information. If you become pregnant while taking Zoely, stop taking the contraceptive pill and inform your doctor.

Zoely is not usually recommended during breastfeeding. If you wish to use the pill while breastfeeding, speak to your doctor for advice.

Frequently Asked Questions