Zoely

Zoely is a combined oral contraceptive tablet containing nomegestrol acetate 2.5 milligrams and estradiol 1.5 milligrams per tablet. It is licensed in the United Kingdom for the prevention of pregnancy. Zoely belongs to the combined hormonal contraceptive group of medicines and works by suppressing ovulation, and also by altering cervical mucus and the endometrial lining to support contraceptive protection. It is available as a film-coated tablet in a 28-tablet pack: 24 active white tablets followed by 4 inactive yellow tablets, taken every day with no break between packs. Zoely is manufactured by Gedeon Richter UK Ltd. This page explains how Zoely works, how to take it correctly, what to be aware of, and what to expect from a consultation.

Zoely stands apart from every other combined pill covered on this site in one important respect: the oestrogen it uses is not ethinylestradiol. It contains estradiol, a form of oestrogen that is chemically identical to the oestrogen your body produces naturally. Every other combined pill available in the UK uses synthetic ethinylestradiol. This distinction has clinical consequences for how the pill behaves in the body, what its side effect profile looks like, and what the evidence says about its VTE risk compared with pills containing ethinylestradiol.

Zoely is a monophasic combined oral contraceptive. Every active tablet in the 24-tablet active phase delivers the same hormone dose. The 28-tablet pack contains:

1. 24 active white tablets: nomegestrol acetate 2.5 mg and estradiol 1.5 mg per tablet
2. 4 inactive yellow tablets: placebo tablets containing no hormones

You take one tablet every day in order, with no break between packs. The withdrawal bleed occurs during the 4 inactive tablet days as hormone levels fall.

Estradiol: A Different Oestrogen

All other combined pills available in the UK use ethinylestradiol, a synthetic oestrogen developed specifically for oral use because natural oestrogen is broken down rapidly in the digestive system. Zoely uses estradiol hemihydrate, a form of 17-beta-estradiol that mirrors the oestrogen produced by the ovaries. At the dose used in Zoely (1.5 mg), estradiol is effective for contraception while delivering a lower systemic oestrogenic effect than the ethinylestradiol doses used in standard combined pills.

The clinical significance of this is that estradiol-containing pills may have a different impact on certain oestrogen-sensitive parameters compared with ethinylestradiol-containing pills. Current evidence on VTE risk with Zoely is discussed in the safety section. Because Zoely uses a newer oestrogen type, its long-term safety data is less extensive than for ethinylestradiol-based pills. This is reflected in how it is prescribed.

Nomegestrol Acetate: A Selective Progestogen

Nomegestrol acetate is a synthetic progestogen derived from progesterone. It is highly selective for the progesterone receptor and has minimal activity at other steroid receptors, meaning it does not have the androgenic or oestrogenic side effects associated with some older progestogens. It is not the same as norgestimate, gestodene, desogestrel, or levonorgestrel. Nomegestrol acetate is used only in Zoely among UK-licensed combined pills.

Zoely works primarily by preventing ovulation. Estradiol and nomegestrol acetate together suppress the hormonal signals from the pituitary gland that normally trigger the release of an egg from the ovary. Without the luteinising hormone surge, ovulation does not occur.

Nomegestrol acetate also thickens cervical mucus, making it more resistant to sperm penetration. This secondary mechanism adds contraceptive reliability on any cycle where ovulation suppression is not fully complete.

The combined hormonal environment alters the endometrial lining, reducing its readiness for implantation. This is a third layer of protection, though ovulation suppression is so consistent when Zoely is taken correctly that this mechanism is rarely clinically relevant.

The 24-Plus-4 Cycle

Zoely uses a 24-day active tablet, 4-day inactive tablet format. This is a shorter hormone-free interval than the standard 7-day break used by most combined pills. The shorter inactive phase keeps hormone levels more stable across the monthly cycle. During the 4 inactive tablet days, oestrogen and progestogen levels fall and a withdrawal bleed typically occurs. Because estradiol is metabolised more quickly than ethinylestradiol, some women find their withdrawal bleed on Zoely is shorter than on standard combined pills.

When to Start

If you start on day one of your period, you are protected immediately. If you start between days two and five of your cycle, use condoms or another barrier method for your first seven days on the pill.

If you are switching from another combined pill, take the first active Zoely tablet the day after your last active tablet from the previous pack, or the day after the last inactive tablet if your previous pill had placebo days. You remain protected without interruption.

If you are switching from a progestogen-only pill, start Zoely on any day and use a barrier method for the first seven days.

Day to Day

Take one tablet at the same time every day, following the pack in order: 24 white active tablets first, then 4 yellow inactive tablets, then start the next pack immediately. There is no gap between packs.

Take each tablet whole with water. Consistent daily timing helps maintain stable hormone levels. The yellow tablets contain no hormones but keep the daily habit intact during the inactive phase. A withdrawal bleed usually begins during the inactive tablet days.

If you vomit within three to four hours of taking an active tablet, or have severe diarrhoea, absorption may be incomplete. Treat this as a missed active tablet and follow the guidance below.

If You Miss a Tablet

Missed a yellow inactive tablet: discard it and carry on. Your contraceptive protection is unaffected.

Missed one white active tablet, under 12 hours late: take it straight away and continue at the usual time. You remain protected. Note that Zoely has a shorter missed pill window than most pills. The reliable window is 12 hours, not 24 hours.

Missed one white active tablet, over 12 hours late: take the missed tablet now and take the next at the usual time, even if two fall on the same day. Use a barrier method for the next seven days.

Missed two or more active tablets: take only the most recently missed one and discard the others. Continue the pack and use condoms for seven days. If the missed tablets fell in week one and you had unprotected sex, contact your prescriber or pharmacist urgently about emergency contraception.

Important: Zoely has a 12-hour missed pill window, not the 24-hour window that applies to most other combined pills. If you take Zoely more than 12 hours late, treat it as a missed pill and use additional contraception for seven days.

Zoely comes in one strength. Each active tablet contains nomegestrol acetate 2.5 milligrams and estradiol 1.5 milligrams. Every active tablet in the pack is identical.

Each pack contains 24 white active tablets and 4 yellow inactive tablets, giving 28 tablets in total. You take one every day without a break between packs. Your prescriber confirms the right starting day for your circumstances.

How Zoely Compares to Other Combined Pills

Zoely is the only UK-licensed combined pill to use estradiol rather than ethinylestradiol as its oestrogen component. It is also the only UK-licensed combined pill to use nomegestrol acetate as the progestogen. There is no generic equivalent of Zoely. No other product contains this specific combination.

The 24-plus-4 tablet format gives Zoely a shorter hormone-free interval than standard 21-day pills with a 7-day break, or 28-tablet pills with 7 inactive days. This shorter gap may result in a lighter or shorter withdrawal bleed for some women, though this varies between individuals.

The information below is based on the current UK SmPC for Zoely. Not everyone experiences side effects. Read the Patient Information Leaflet in full before starting treatment.

Common Side Effects

Common side effects include acne, headache, nausea, breast tenderness, mood changes, reduced libido, and irregular spotting or changes to the withdrawal bleed pattern. Absence of a withdrawal bleed during the inactive tablet phase is also reported and is not necessarily a cause for concern, though your prescriber should be informed if this happens in two consecutive cycles.

Less Common Side Effects

• Weight changes
• Contact lens intolerance due to changes in corneal curvature
• Chloasma: patches of darker skin on the face, worsened by sun exposure
• Changes in vaginal discharge

Serious Side Effects: Seek Urgent Help If You Notice

• Sudden chest pain, difficulty breathing, or coughing up blood
• Swelling, pain, redness, or warmth in one leg only
• Sudden severe headache, visual disturbance, speech difficulty, or one-sided weakness
• Severe abdominal pain
• Yellowing of the skin or whites of the eyes

These can indicate a blood clot, stroke, or liver problem and require immediate medical attention.

VTE Risk and Estradiol

The VTE risk profile of Zoely differs from that of ethinylestradiol-containing combined pills. Current clinical evidence, including studies referenced in the UK SmPC, suggests that the VTE risk with Zoely may be lower than with ethinylestradiol-containing combined pills. However, the evidence base is less extensive than for pills that have been in use for decades. All combined pills carry some increased VTE risk compared with no hormonal contraception. Your prescriber will assess your individual risk factors before recommending Zoely.

Medicines That Reduce Zoely's Effectiveness

Enzyme-inducing medicines increase the breakdown of both estradiol and nomegestrol acetate, reducing their blood levels and contraceptive reliability:

• Rifampicin and rifabutin
• Antiepileptic medicines: phenytoin, carbamazepine, phenobarbital, primidone, topiramate
• HIV antiretrovirals: ritonavir, efavirenz, and others
• St John's Wort, available without prescription

Declare every medicine, supplement, and herbal product to your prescriber at every consultation.

Zoely Is Not Suitable If You:

• Have ever had a blood clot: deep vein thrombosis, pulmonary embolism, stroke, or heart attack
• Have migraine with aura
• Have uncontrolled high blood pressure
• Have active or past liver disease or liver tumours
• Have or have had breast cancer or another hormone-sensitive cancer
• Are pregnant
• Are breastfeeding a baby under six weeks old
• Smoke and are 35 or older
• Have diabetes with established vascular complications

Zoely May Be Appropriate If You:

• Are a healthy adult woman with no contraindications to combined hormonal contraception
• Have experienced oestrogen-related side effects such as nausea or breast tenderness on ethinylestradiol-based pills, and your prescriber considers a natural oestrogen preparation worth exploring
• Prefer a 24-plus-4 format, which some women find gives a more predictable and shorter withdrawal bleed
• Have no personal or family history of blood clots, stroke, or cardiovascular disease
• Have not previously responded well to standard combined pills and a prescriber has suggested Zoely as an alternative

Talk to Your Prescriber First If You:

• Smoke and are under 35
• Have a BMI above 30
• Have a first-degree family member who had a blood clot before the age of 50
• Experience migraine without aura
• Are planning long-haul travel or extended periods of immobility
• Have a history of depression or are currently being treated for a mood disorder

Pharmacy Planet is a GPhC registered UK online pharmacy. Every Zoely prescription is issued following a clinical consultation reviewed individually by a registered prescriber. Zoely requires particular care at the prescribing stage because its VTE evidence base, while encouraging, is less extensive than for pills that have been prescribed for several decades. Your prescriber will take this into account alongside your personal risk profile when making their decision.

You complete a clinical questionnaire covering your health history, medicines, smoking status, BMI, family history of blood clots, migraine status, and any previous experience with hormonal contraception. The prescriber reads your answers and makes a clinical judgement. The outcome may be a prescription for Zoely, a recommendation for a different preparation, a request for more information, or a referral for an in-person review. Completing a questionnaire is the first step, not a guarantee of any outcome.

Repeat prescriptions follow the same individual review process with no automatic renewal.

Store Zoely below 25°C, away from direct heat and sunlight. Keep tablets in the original blister strip so you can follow the pack order and distinguish active white tablets from inactive yellow ones. Store out of reach of children and check the expiry date on the carton before use.

Return unused or out-of-date tablets to any UK pharmacy for safe disposal. Pharmacies accept returned medicines at no charge. Do not dispose of tablets in household waste or flush them down the toilet.

This reference guide compares the contraceptive preparations available at Pharmacy Planet, grouped by delivery method and formulation type. Every preparation is a Prescription Only Medicine. A registered prescriber will review your individual health profile, contraceptive history, and risk factors before recommending any preparation. This table is a clinical reference, not a recommendation.

Combined Oral Contraceptive Tablets (Monophasic)

Monophasic combined pills contain the same dose of both hormones in every active tablet. The table below compares commonly prescribed monophasic combined oral contraceptives by progestogen type, oestrogen dose, VTE risk category, pack format, and key clinical characteristics.

Important: This comparison is for general information only and does not replace medical advice. A prescriber will decide which treatment is suitable for you following an online consultation.

Zoely is unlike any other combined pill we prescribe. Its use of natural estradiol rather than synthetic ethinylestradiol makes the prescribing assessment different. The evidence base is evolving, and the prescriber's job is to match what is currently known about Zoely's benefits and risks to your individual health profile. At Pharmacy Planet, our prescribers approach Zoely consultations with that level of clinical attention.

We do not issue prescriptions automatically or on the basis of patient preference alone. If Zoely is not appropriate for you at this time, your prescriber will say so and explain why. They may suggest a different preparation or recommend an in-person review if your profile requires it.

Our GPhC registration is publicly verifiable at www.pharmacyregulation.org. The Internet Pharmacy logo on our site confirms our status as a regulated UK online pharmacy. Our team is available throughout the consultation process and after dispensing if you have questions.

• Gedeon Richter UK Ltd. Zoely 2.5 mg/1.5 mg film-coated tablets – Summary of Product Characteristics. Available at: www.medicines.org.uk/emc. Accessed May 2026.
• Faculty of Sexual and Reproductive Healthcare (FSRH). Combined Hormonal Contraception – Clinical Guidance. Available at: www.fsrh.org. Accessed May 2026.
• NHS. Combined pill – your contraception guide. Available at: www.nhs.uk/conditions/contraception/combined-contraceptive-pill. Accessed May 2026.
• British National Formulary (BNF). Estradiol with nomegestrol acetate. Available at: bnf.nice.org.uk. Accessed May 2026.
• MHRA. Combined hormonal contraceptives and venous thromboembolism – updated guidance. Available at: www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency. Accessed May 2026.
• Gaussem P et al. Haemostatic effects of a new combined oral contraceptive, nomegestrol acetate/17β-estradiol, compared with those of levonorgestrel/ethinyl estradiol. Thrombosis and Haemostasis, 2011.