Understanding Desogestrel: A Progestin-Only Contraceptive
Desogestrel is a synthetic progestin, a man-made version of the natural hormone progesterone [1.2.3]. It is used as a hormonal contraceptive, often in the form of a progestin-only pill (POP), commonly referred to as the "mini-pill" [1.2.3]. Unlike combined oral contraceptives, POPs do not contain estrogen. Desogestrel primarily works by preventing ovulation, the release of an egg from the ovary [1.2.4]. It also thickens cervical mucus, making it more difficult for sperm to reach an egg, and can thin the lining of the uterus [1.2.4, 1.7.1]. Due to its estrogen-free formulation, it is often considered an option for women who cannot take estrogen, such as those who are breastfeeding or have a higher risk of blood clots [1.9.1, 1.2.4].
Long-Term Effect on Bone Mineral Density (BMD)
The impact of hormonal contraceptives on bone health is a significant area of study, particularly for long-term users. Research into desogestrel's effect on bone mineral density (BMD) has yielded mixed results. One study noted that users of desogestrel pills experienced a loss in bone mineral density of approximately 2% between 12 and 24 months of use; however, this loss was not deemed statistically significant over the full 24-month period when compared to a control group [1.3.1, 1.3.3]. In contrast, other progestin-only methods like the depot medroxyprogesterone acetate (DMPA) injection have been more clearly associated with significant BMD loss [1.3.1, 1.3.3, 1.3.5]. A 2025 review indicated that hormonal implant users do not seem to experience bone mineral density loss [1.3.6]. The general consensus suggests that while some changes may occur, desogestrel's impact on BMD is not as pronounced as that of some other progestogens, but it remains a point of consideration for long-term users.
Association with Cancer Risk
The relationship between hormonal contraceptives and cancer risk is complex and often a primary concern for long-term use.
Brain Tumors (Meningioma): A recent study published in June 2025 in The BMJ found that prolonged use of desogestrel (continuously for five years or more) is associated with a small increased risk of developing intracranial meningioma, a typically non-cancerous brain tumor [1.2.2, 1.4.1, 1.4.3]. The researchers stressed that the absolute risk is low, with an estimated one case of meningioma requiring surgery for every 67,300 women using desogestrel [1.2.2, 1.4.3]. The risk was found to disappear one year after discontinuing the medication [1.2.2, 1.4.3]. The study found no similar risk associated with levonorgestrel, another common progestin [1.4.3].
Breast and Reproductive Cancers: Epidemiological studies on oral contraceptives have examined the risk of breast, endometrial, and ovarian cancer. While some studies have suggested a slight increase in breast cancer risk for current users of combined oral contraceptives, this excess risk appears to diminish over time after stopping the pill and disappears by 10 years post-cessation [1.2.6]. Research specifically on progestin-only pills is less extensive, but it's a critical area of ongoing investigation.
Cardiovascular and Metabolic Health Over Time
Cardiovascular effects are a well-documented consideration with hormonal contraception, though the risk profile varies between different formulations.
- Venous Thromboembolism (VTE): Third-generation progestins, including desogestrel, have been associated with a higher risk of VTE (blood clots in veins) compared to some older, second-generation progestins [1.2.6]. However, the overall risk remains low, and progestin-only contraceptives are generally considered to have a lower VTE risk than combined pills containing estrogen [1.5.3, 1.9.1].
- Myocardial Infarction (MI): A meta-analysis of observational studies suggests there is no increased risk of myocardial infarction (heart attack) with the use of progestin-only contraceptives [1.5.2].
- Blood Pressure and Metabolism: Desogestrel-containing oral contraceptives do not appear to negatively influence the blood pressure of young, healthy women [1.5.5]. However, progestogens can increase insulin secretion and create some insulin resistance, which means diabetic and prediabetic women should be monitored closely while taking them [1.2.6].
| Feature | Desogestrel (POP) | Combined Oral Pill (COC) | Copper IUD (Non-Hormonal) |
|---|---|---|---|
| Hormones | Progestin-only [1.2.3] | Estrogen and Progestin [1.2.4] | None [1.2.4] |
| VTE Risk | Lower risk than COCs [1.5.3] | Higher risk than POPs [1.2.6] | No hormonal-related risk |
| Typical Use Efficacy | ~92% effective [1.9.5] | ~92% effective | >99% effective |
| Effect on Menstruation | Can cause irregular bleeding or stop periods [1.2.3] | Typically regulates periods [1.2.6] | Can cause heavier, more painful periods |
Long-Term Impact on Mood and Mental Health
Changes in mood are a commonly reported side effect of hormonal contraception [1.6.1]. For desogestrel, these can include mood alterations, depressed mood, anxiety, and decreased libido [1.2.3, 1.6.1, 1.6.2]. A review of user experiences shows that while some individuals tolerate it well, a significant portion reports negative mood changes as a reason for discontinuation [1.8.1, 1.8.5]. One report noted a potential link between desogestrel use and panic attacks, though this is based on spontaneous reports and not conclusive studies [1.6.2]. It's crucial for individuals with a history of mood disorders to discuss these risks with their healthcare provider, as they may be more susceptible to these side effects [1.6.4].
Return to Fertility After Discontinuation
For many, a key long-term question is whether contraceptive use will affect future fertility. Studies show that the use of oral contraceptives, including progestin-only pills, does not negatively impact long-term fertility [1.7.3]. Fertility typically returns relatively quickly after stopping desogestrel. While it varies, many women can expect to ovulate within the first few months after discontinuing the pill [1.7.1, 1.7.4]. One study noted that for oral contraceptives in general, it may take about three menstrual cycles for fertility to return to normal, a delay shorter than that seen with injectable contraceptives [1.7.5]. The 12-month conception rate for women who stop progestin-only pills is comparable to those who stop using non-hormonal methods like condoms [1.7.2].
Conclusion
The long-term effects of desogestrel are multifaceted. While it is an effective contraceptive, particularly for those who need to avoid estrogen, long-term use requires careful consideration of potential risks and benefits. Key long-term considerations include a small, but documented, increased risk of meningioma with use over five years, which reverses upon discontinuation [1.4.3]. Its impact on bone density appears less significant than other progestogens, and the risk of heart attack is not shown to be increased [1.3.1, 1.5.2]. However, the potential for mood changes is a significant factor for many users [1.6.1]. Encouragingly, there appears to be no lasting impact on fertility after stopping the medication [1.7.3]. As with any medication, a thorough discussion with a healthcare provider is essential to weigh the individual benefits against the potential long-term risks.
For more information from an authoritative source, you can visit the NHS page on the progestogen-only pill.
