CERAZETTE: AN ORAL PROGESTOGEN-ONLY CONTRACEPTIVE Pill

Picture of Cerazette

The active ingredient of Cerazette is desogestrel which is a synthetic progestogen that is very similar to the natural progesterone that the ovaries produce.

The desogestrel acts in three ways,

  • by preventing the release of an egg from the ovary.
  • by increasing the thickness of the mucus at the neck of the womb, by doing this it makes it harder for the sperm to cross from the vagina into the womb.
  • it changes the quality of the womb lining (endometrium) so if the previous two have failed than this will prevent the implantation of a fertilised egg onto the wall of the womb.

What are progestogen only oral contraceptive Pills?

As the name implies, the progestogen-only pill (sometimes called the mini-pill) only contains progestogen - whereas the combined oral contraceptive pill contains oestrogen and a progestogen.

Table 14.1  Progestogen-only pills.

 

Preparation Progestogen  (mg) Manufacturer
Cerazette Desogestrel 75 micrograms Organon
Femulen Ethynodiol diacetate 500 Searle
Micronor Norethisterone 350 Janssen-Cilag
Norgeston Levonorgestrel 30 Schering
Noriday Norethisterone 350 Searle

How do progestogen-only contraceptive pills work?

Progestogen-only pills prevent the mucus changes around the time of ovulation so that sperm cannot get through to the egg thus preventing fertilisation. The lining of the womb (endometrium) is kept thin so that, even if an egg is fertilised, it is unlikely to be able to implant and develop.

The combined oral contraceptive pill (COP), with occasional exceptions, prevents egg release (ovulation). It is now recognised that the progestogen-only pill also interferes with ovulation although not as effectively as COPs.

How do progestogen-only pills and combined oral contraceptive pills compare.

Progestogen-only pills (POPs) Combined pills (COPs)
Alternative when COPs have side effects (Q15.7)
Alternative when COPs contraindicated (Q16.8) New low dose pills have fewer side effects.
Excellent contraception (Table 14.1). More effective than POPs (Table 14.1.
Very effective when breast feeding. Not recommended when breast feeding.
Very effective beyond the age of 40 years. Acceptable up to the menopause (but see Q16.25.
No benefits to cycle control. Excellent cycle control and reduced bleeds.
Timing of bleeds cannot be adjusted. Timing of withdrawal bleeds can be adjusted.
 
  • For medical disorders where COPs are only prescribed with caution e.g. For diabetic patients (Q16.7 ).
  • If COPs are contraindicated e.g. history of thromboembolism (Q16.8)
  • If several combined pills are associated with side effects (Q15.7)
  • High blood pressure.
  • Severe migraine.
  • Obesity (seeQ14.8)
  • Breast feeding.
  • Sickle cell disease.

How effective is Cerazette?

  • This depends on patient compliance and age.
  • The quoted results vary from 0.3 to 4 per hundred women years (Q13.6).
  • The progestogen-only pill is very effective during breast-feeding.
  • Failure rates may be higher if you are overweight; if you are heavier than 11 stones (70KG) it is advisable to take two pills daily.

When should Cerazette be started and when does it become effective?

The progestogen-only pill can be commenced on the first day of a period and it will then provide immediate protection.

When should Cerazette be taken?

  • Cerazette should be taken daily - there are no pill-free intervals.

  • Ideally, the POP should be taken within an hour of the elected time - there is only a three-hour maximum safety margin compared to the 12 hours with combined oral contraceptive pills.

  • Many women find that early evening is the best time for the POP to be taken.

  • A pill should be regarded as missed if it is taken more than three hours late.
  • The manufacturers indicate, that if the POP is taken late, additional precautions are required for seven days.
  • Emergency contraception (Q17.23

What will happen to my periods when I take the Cerazette?

It is likely that they will continue as before but there is no consistent pattern.

What should I do if my periods stop whilst I am taking a Cerazette?

If this happens within two hours of taking a Cerazette,  another should be taken.

If another pill is not taken within this time additional precautions are required throughout the illness and for a further seven days.

Should additional precautions be taken when I am on antibiotics?

The only antibiotics that definitely necessitate additional precautions are rifampicin and griseofulvin.

If you need to take these drugs long-term, you will require a different method of contraception. No special action is required with other antibiotics.

Can Cerazette cause ovarian cysts?

Functional cysts (8), but not true ovarian cysts, occur more frequently amongst those taking progestogen-only pills.

If a woman taking a POP develops pain and a period is late the question of an ectopic pregnancy has to be addressed.

At one time laparoscopy was required to exclude the diagnosis. For nearly twenty years, we have had Beta HCG (pregnancy) tests, which are extremely sensitive; if the test is negative, an ectopic can be excluded. Unless there are severe symptoms, functional cysts can be left alone and they will regress over the course of a few weeks.

Related Medical Abstracts - Click on the paper title:-

Should I stop taking my Cerazette before surgery?

  • There is no reason for The Cerazette to be discontinued.
  • The advice with the progestogen-only pill differs from that with the combined pill (Q16.23).

Indications 

Contraception

Cautions 

  • arterial disease
  • sex-steroid dependent cancer
  • past ectopic pregnancy
  • malabsorption syndromes
  • active trophoblastic disease (until return to normal of urine and plasma gonadotrophin concentration) functional ovarian cysts
  • active liver disease; recurrent cholestatic jaundice; history of jaundice in pregnancy;

Other conditions 

The product literature advises caution in patients with history of thromboembolism, hypertension, diabetes mellitus and migraine; evidence for caution in these conditions is unsatisfactory

Contra-indications 

  • pregnancy
  • undiagnosed vaginal bleeding
  • severe arterial disease
  • liver tumour
  • porphyria
  • history of breast cancer but can be used after 5 years if no evidence of disease and non-hormonal contraceptive methods unacceptable

side effects 

  • menstrual irregularities
  • nausea, vomiting, headache, dizziness, breast discomfort, depression, skin disorders, disturbance of appetite, weight changes, changes in libido

Breast cancer

There is a small increase in the risk of having breast cancer diagnosed in women using, or who have recently used, a progestogen-only contraceptive pill; this relative risk may be due to an earlier diagnosis. The most important risk factor appears to be the age at which the contraceptive is stopped rather than the duration of use; the risk disappears gradually during the 10 years after stopping and there is no excess risk by 10 years. The CSM has advised that a possible small increase in the risk of breast cancer should be weighed against the benefits

Dose

  • 1 tablet of Cerazette daily at same time each day, starting on day 1 of cycle then continuously; if administration of Cerazette is delayed for 3 hours or more it should be regarded as a "missed pill"

The Scottish Medicines Consortium has advised (September 2003) that recommends progestogen only pills should be restricted for use in women who cannot tolerate oestrogen-containing contraceptives or in whom these preparations are contra-indicated.


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