Nomegestrol
progestogen · hormonal contraception
Our referenceBy the Layer Nutrition editorial team · How the atlas classifies the 664 molecules
What this medicine is for
Nomegestrol belongs to the category "progestogen (hormonal contraception)". This hormone is used in hormonal contraception: taken each day, it prevents ovulation and makes the body unfavourable to pregnancy, reversibly.
In the case of Nomegestrol, this means: Component of a hormonal contraception. It is most often a maintenance treatment, taken at regular times over long periods; its benefit is judged over time, not by how you feel on the day.
Under which brands it is found
In France, about 3 reimbursable presentations containing Nomegestrol are recorded. It is found under several brand names and as generics.
- Lutenyl
- Nomegestrol Acetate/Estradiol Viatris
- Zoely
Original brand-name products and generics deliver the same active substance; the choice between them is made with your doctor or pharmacist.
Our product for this treatment
Nomegestrol is one of the everyday treatments for which we have formulated a targeted supplement.
Layer Nutrition Contraception
Vitamin B6 helps you regulate your hormonal activity and reduce tiredness. Folate supports normal blood formation.
- Contributes to the regulation of hormonal activity (vitamin B6)
- Contributes to the reduction of tiredness (B6, folate, B12)
- Contributes to normal psychological function (B6, folate, B12)
B6 10 mg · Folate 250 µg · B2 4.2 mg · B12 50 µg
One bottle, one dose per day. Reduced price from the second box, free delivery from two boxes.
How nomegestrol works
Nomegestrol acetate belongs to the progestin family. It is derived from 19-norprogesterone and behaves as a selective, high-affinity agonist of the progesterone receptor. In the Zoely pill, it is combined with estradiol, an estrogen close to the one produced by the ovary. This combination acts first on the central control of the cycle: at doses of 1.5 to 5 mg per day, nomegestrol exerts an antigonadotropic effect that blocks the hormonal signal triggering ovulation.
Preventing ovulation is the first of the three contraceptive locks. Nomegestrol also alters the mucus of the cervix, which becomes harder for sperm to cross, and it thins the endometrium, the lining of the uterus. Pharmacologically, this molecule has a targeted profile: it has weak to moderate antiandrogenic activity, but no estrogenic, androgenic, glucocorticoid or antimineralocorticoid activity. It therefore focuses on the intended progestogenic effect, without the additional hormonal actions that other progestins can exert.
Why it is prescribed
Nomegestrol is prescribed as an oral contraceptive, in combination with estradiol. The aim is to achieve reliable contraception by acting at once on ovulation, on cervical mucus and on the endometrium. The choice of estradiol, an estrogen structurally identical to the natural hormone, sets this pill apart from the classic combinations built on synthetic ethinylestradiol.
A recent pharmacology review reports an emerging and still debated finding: in meta-analyses of observational studies, natural estrogen combinations such as estradiol and nomegestrol acetate appear to show a lower risk of venous thromboembolism than the combination of ethinylestradiol and levonorgestrel. This point has not been settled by the authorities: the summary of product characteristics for Zoely states that the comparative risk relative to levonorgestrel has not been established. This remains a hormonal contraceptive, with its own precautions, for women in whom the aim is to limit the synthetic estrogen load.
How to take it day to day
It is taken as one tablet per day, at roughly the same time. The blister pack covers 28 days: 24 active tablets, then 4 placebo tablets during which withdrawal bleeding occurs. The tablet can be taken either with or without food. Regular timing ensures efficacy: it is the consistency of intake, day after day, that maintains the blockade of ovulation.
This contraceptive should not be stopped on one's own initiative; any interruption or change is decided with the doctor who prescribed it. Pharmacokinetics explains why the molecule tolerates an ordinary life well: its elimination half-life at steady state is around 46 hours, within a range of 28 to 83 hours, which makes it a long-acting progestin. It binds 97.5 to 98% to blood albumin, without binding to SHBG or CBG, and it is transformed by the liver, mainly by the CYP3A4 and CYP3A5 enzymes, with a possible contribution from CYP2C19 and CYP2C8.
The effects to know about
Acne is among the most frequent adverse effects: it affects more than one woman in ten, with about 15.4% of women affected in clinical trials. Changes in menstruation are just as frequent: the European Medicines Agency cites acne and the absence or irregularity of periods as the two most common effects, in more than one woman in ten. These bleeding changes are part of the expected functioning of a pill that thins the endometrium.
Other effects are common, meaning observed in 1 to 10 women out of 100: headache and migraine, nausea, weight gain around 8.6%, altered mood, decreased libido, metrorrhagia, menorrhagia, breast pain and abnormal withdrawal bleeding. Many of these manifestations appear early and ease over the cycles. They should be reported to the doctor, who judges their impact and the course of action to take.
Interactions and monitoring
Certain medicines speed up the elimination of hormones and can reduce contraceptive efficacy. These are the enzyme inducers: rifampicin, St John's wort, carbamazepine, phenytoin, phenobarbital, oxcarbazepine. By stimulating the liver enzymes that break down nomegestrol, they lower sex hormone concentrations and expose the user to less reliable contraception. Furthermore, combined oral contraceptives can alter peripheral insulin resistance and glucose tolerance, without any adjustment of treatment being shown to be necessary in diabetic women using low-dose pills.
One point of vigilance concerns meningioma, a tumour of the membranes of the brain, most often benign. A French national case-control study showed that prolonged use of nomegestrol is associated with a strongly increased risk of intracranial meningioma, with an odds ratio of 4.93 (95% confidence interval: 4.50 to 5.41). This association is accompanied by observations of regression: a petroclival meningioma regressed after stopping a treatment combining estrogen and nomegestrol acetate. This risk justifies medical monitoring and the prompt reporting of neurological symptoms such as unusual headaches or visual disturbances.
On the plate
Oral contraception affects a well-identified nutritional terrain. A review reports that the use of oral contraceptives is associated with a decrease in folate (vitamin B9), vitamins B2, B6, B12, C and E, as well as magnesium, selenium and zinc. These same nutrients are found in everyday foods. Folate is found in spinach, lentils, chickpeas and broccoli. Vitamin B6 is provided by bananas, salmon and sweet potato, while magnesium comes from almonds, dark chocolate and pumpkin seeds.
Zinc, too, is drawn from pumpkin seeds, lentils and red meat. A varied diet that rotates these foods covers most of these needs. When daily intake remains irregular, targeting a few specific nutrients makes sense, in addition to your treatment, never in its place.
Sources
- Nomegestrol acetate
- Zoely, EPAR
- Zoely 2.5 mg/1.5 mg film-coated tablets, SmPC
- Use of progestogens and the risk of intracranial meningioma: national case-control study
- Petroclival meningioma regression after combined oestrogen and nomegestrol acetate interruption
- Oral contraceptives and changes in nutritional requirements
- A detailed review of pharmacokinetics/pharmacodynamics of progestogens in oral contraception
Related molecules
To explore in the « Hormones and contraception » family and its neighbours.
See the whole « Hormones and contraception » family · Back to the atlas
Frequently asked questions
What is nomegestrol used for?
Nomegestrol acetate is a synthetic progestogen, used depending on the product in contraception (combined with an estrogen) or for certain cycle-related disorders. For the exact indication of your treatment, refer to the package leaflet and to your doctor or pharmacist.
What are the side effects of nomegestrol?
The package leaflet notably mentions headaches, nausea, abdominal pain, a feeling of heavy legs and changes in bleeding. The full list and what to do are set out in the leaflet; discuss it with your doctor or pharmacist.
Nomegestrol and meningioma: what is it about?
Epidemiological studies link prolonged use of nomegestrol acetate (Lutényl and generics) to a risk of meningioma, which warrants enhanced monitoring measures. Follow-up, any MRI and what to do are matters for the package leaflet and your doctor.
Does nomegestrol cause weight gain?
Weight gain is listed in the package leaflet among the possible side effects. If it persists or worries you, discuss it with your doctor, who can adjust the treatment.
What interacts with nomegestrol?
The package leaflet notes that certain enzyme inducers (such as antiepileptics, rifampicin or griseofulvin) can reduce the effectiveness of the progestogen. Before combining another medicine, herb or supplement, ask your pharmacist or doctor for advice.
What should you do if you miss a tablet?
What to do depends on the product and on how much time has passed, and it is described precisely in the leaflet in your pack. If in doubt, contact your pharmacist or your doctor.
Nomegestrol and pregnancy: what should you do?
This type of treatment has no indication during pregnancy; if a pregnancy is discovered while on treatment, the leaflet advises stopping it and speaking to your doctor. Follow the package leaflet and medical advice.
Can you breastfeed while taking nomegestrol?
The package leaflet states that contraceptives of this type are generally not recommended while breastfeeding, as they can alter the milk. The decision rests with your doctor depending on your situation.
Can you drink alcohol while taking nomegestrol?
The package leaflet does not describe any specific interaction with alcohol, but it remains the reference for your particular product. If you have any questions about your treatment, speak to your doctor or pharmacist.
Nomegestrol acetate, Lutényl, Zoely: are they the same thing?
The active molecule is nomegestrol acetate; it is found in branded products and generics, alone or combined with an estrogen for contraception. The name and form of your treatment appear on the pack and in the package leaflet; your pharmacist can specify them for you.
Does oral contraception affect certain nutrients?
A research review (Palmery et al., Eur Rev Med Pharmacol Sci, 2013) links oral contraception to a lower status in folate (vitamin B9), vitamin B6 and magnesium. This is an association described in the literature, not a cause-and-effect link established for any given person.
Folate, B6, magnesium: which form to choose?
On the angle documented by research (Palmery et al., 2013), the nutrients to consider are folate (favour a methylated form, methylfolate), vitamin B6 and magnesium. This is precisely the layer that Layer Nutrition's CO01 reference adds on top of contraception; a blood test and your doctor's advice remain the best compass.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.