Cerelle

What is Cerelle?

Cerelle is a progestogen-only pill (POP), sometimes referred to as the mini-pill. Each tablet contains 75 micrograms of desogestrel and is taken daily without a break. It does not contain oestrogen, which makes it suitable for women who cannot use combined hormonal contraceptives.

Cerelle is available on prescription in the UK and is one of several branded versions of desogestrel 75 micrograms. Cerazette, Zelleta, and Feanolla contain the same active ingredient at the same dose and are considered clinically equivalent.

How does Cerelle work?

Most older progestogen-only pills work mainly by thickening cervical mucus to prevent sperm from reaching the egg. Cerelle goes a step further: its dose of desogestrel is high enough to prevent ovulation in most cases, which is the primary way combined pills work. This makes Cerelle more effective than older POPs.

As secondary mechanisms, it also thickens cervical mucus and alters the lining of the uterus, providing additional contraceptive protection.

Cerelle has a 12-hour window. This means that as long as you take your tablet within 12 hours of your usual time, you remain protected. Older progestogen-only pills have a much shorter 3-hour window, so this is a meaningful advantage for women who do not always take their pill at exactly the same time each day.

Who is Cerelle suitable for?

Cerelle is a good option for women who cannot use combined hormonal contraceptives, as well as those looking for a first-choice contraceptive who prefer a pill without oestrogen. It is particularly suitable for:

• Women who smoke and are over 35
• Women who experience migraines with aura
• Women who are breastfeeding
• Women with certain cardiovascular risk factors

You should not take Cerelle if you have, or have ever had:

• A blood clot (thrombosis) in the legs, lungs, heart, or brain
• Jaundice or severe liver disease where liver function has not returned to normal
• Breast cancer or other progestogen-sensitive cancers
• Unexplained vaginal bleeding

Speak to your UK-registered prescriber before starting Cerelle if you have a history of breast cancer, liver cancer, diabetes, epilepsy, high blood pressure, or thrombosis.

How to take Cerelle

Take one tablet every day at the same time, swallowed whole with water. Each strip contains 28 tablets. When one strip is finished, start the next one the following day with no break and no need to wait for bleeding.

For immediate protection, start Cerelle on the first day of your period. If you start on days 2 to 5, use an additional barrier method such as a condom for the first 7 days.

If you are less than 12 hours late taking your tablet, take it as soon as you remember and continue as normal. You remain protected.

If you are more than 12 hours late, take the missed tablet as soon as you remember and continue the rest of the strip at the usual time. Use additional contraception for the next 7 days. If you missed a tablet in the first week and had unprotected sex in the week before, speak to your UK-registered prescriber. If you vomit within 3 to 4 hours of taking your tablet, or have severe diarrhoea, treat this as a missed pill.

Side effects

Like all medicines, Cerelle can cause side effects, although not everyone experiences them.

Common side effects (may affect up to 1 in 10 people):

• Irregular or absent periods
• Mood changes or depression
• Reduced sex drive
• Headache
• Nausea
• Acne
• Breast pain
• Weight gain

Uncommon side effects (may affect up to 1 in 100 people):

• Vaginal infection
• Vomiting or hair loss
• Ovarian cysts
• Tiredness or painful periods

Ovarian cysts are an uncommon side effect. They are usually benign and resolve without treatment, but speak to your UK-registered prescriber if you experience persistent pelvic pain.

Unlike combined hormonal contraceptives, the patient information leaflet (PIL) notes that the VTE (blood clot) risk with progestogen-only pills like Cerelle is believed to be lower than with pills that also contain oestrogen.

Seek medical attention straight away if you experience signs of a blood clot, including swelling or pain in the leg, sudden breathlessness, chest pain, or sudden severe headache.

Cerelle and your periods

Changes to your bleeding pattern are very common with Cerelle and are a recognised effect of the medicine, not a sign that something is wrong. Your periods may become lighter, more irregular, or stop altogether. For many women, absent or very light periods are a welcome change.

Some spotting or irregular bleeding is normal, particularly in the first few months. This does not mean Cerelle is not working. If bleeding becomes heavy or prolonged, speak to your UK-registered prescriber.

If your periods stop completely and you have had unprotected sex, a pregnancy test is a sensible precaution before starting your next pack.

Cerelle, Cerazette, and other desogestrel pills

Cerelle, Cerazette, Zelleta, and Feanolla all contain desogestrel 75 micrograms. They are bioequivalent, meaning they work in the same way to the same standard. There is no clinical reason to prefer one brand over another, and switching between them does not require any additional contraceptive precautions.

Some women are switched to a generic version of desogestrel by their GP, usually for prescribing cost reasons rather than clinical ones. At DoktorABC, you can discuss your preferences during your consultation and your UK-registered prescriber can advise on the most suitable option for you.

Starting Cerelle after other contraceptives

The PIL provides the following guidance on switching to Cerelle:

• From a combined pill, vaginal ring, or patch: start Cerelle the day after your last active tablet or on the day of removal, with no break needed. No additional contraception is required.
• From another progestogen-only pill: switch on any day, with no extra precautions needed.
• From an implant or hormonal IUD: start Cerelle on the day of removal. No additional contraception is required.
• From an injectable: start Cerelle when your next injection would have been due. No additional contraception is required.
• After having a baby: start Cerelle between 21 and 28 days after the birth. If you start later, use an additional barrier method for the first 7 days. Women who are breastfeeding can use Cerelle; the PIL states it does not affect the production or quality of breast milk, and studies found no effect on the growth or development of breastfed children up to 2.5 years of age.

If you are unsure when to start, your UK-registered prescriber can advise.

How to get Cerelle through DoktorABC

To access Cerelle through DoktorABC, complete a short online consultation with a UK-registered prescriber, who will review your medical history and assess your suitability for treatment. Ongoing repeat prescriptions are also available through the platform, so you can manage your contraception without repeated clinic visits.