Understanding Zoely's Unique Hormone Profile
Zoely is a monophasic combined oral contraceptive, meaning all 24 active pills in the blister pack contain the same dose of hormones: nomegestrol acetate (a progestogen) and estradiol (an estrogen). It is the inclusion of estradiol, which is chemically identical to the estrogen produced naturally by the body, that sets it apart from the majority of other COCs. Following the 24 active pills, the pack includes four placebo pills.
The progestogen in Zoely, nomegestrol acetate, is a 19-norprogestin derivative with high selectivity for progesterone receptors. This differs from the progestogens used in many other pills, which are derived from testosterone. This unique combination and dosing schedule influence its side effect profile, bleeding patterns, and suitability for individual users.
The Most Similar Alternative: Qlaira
Qlaira is another combined pill that contains estradiol rather than ethinylestradiol. This makes it the most structurally similar alternative to Zoely in terms of its estrogen component. However, the dosing and progestogen are different. Instead of a monophasic (constant dose) schedule, Qlaira is quadriphasic, meaning it provides four different hormone levels throughout its 26 active pills and includes a two-day placebo interval. The progestogen in Qlaira is dienogest, not nomegestrol acetate.
Comparing Qlaira and Zoely:
- Hormone Type: Both use estradiol, which can make them potentially better for women sensitive to the synthetic ethinylestradiol found in other pills.
- Dosing Regimen: Zoely is monophasic (constant dose) with 24 active pills, while Qlaira is quadriphasic (varying dose) with 26 active pills.
- Inactive Pills: Zoely includes four placebo pills, while Qlaira has only two.
- Bleeding Pattern: Due to their different dosing schedules, the bleeding patterns can differ. Some women may experience lighter or absent withdrawal bleeds on Zoely compared to other pills, while Qlaira may be better for those with mood swings linked to hormone fluctuations.
Alternatives with Synthetic Estrogen (Ethinylestradiol)
Most combined oral contraceptives on the market contain a synthetic estrogen called ethinylestradiol. The choice between brands typically depends on the type and dose of the progestogen. If you are looking for an alternative to Zoely and are not specifically seeking an estradiol-based pill, many COCs are available. The side effect profile can vary significantly between brands.
Examples of combined pills with ethinylestradiol:
- Yasmin / Yaz: These contain the progestin drospirenone, which has diuretic properties that can help with bloating. Comparative studies show Zoely and Yasmin have similar efficacy, but some studies noted higher instances of acne and weight gain with Zoely.
- Microgynon: A monophasic pill containing levonorgestrel. It is a popular and well-established alternative.
- Mercilon: A low-dose monophasic pill containing desogestrel.
- Cilique: A monophasic pill with norgestimate and ethinyl estradiol, often prescribed to help with acne.
Progestogen-Only Pills (POPs) or 'Mini-Pill'
For women who cannot or prefer not to take estrogen, progestogen-only pills are a suitable alternative. These pills do not contain estrogen and work primarily by thickening cervical mucus and, in some cases, suppressing ovulation.
Common POPs include:
- Cerazette or Cerelle: These brands contain the progestogen desogestrel and offer a 12-hour window for missed pills.
- Slynd: Contains the progestogen drospirenone and provides a longer 24-hour window for a missed pill.
Other Long-Acting Reversible Contraceptives (LARCs)
Beyond daily pills, other highly effective options exist. LARCs can be especially beneficial for those who have experienced persistent side effects with oral contraceptives or prefer a longer-term solution.
Types of LARCs:
- Hormonal IUD: Examples like Mirena release progestin directly into the uterus for a period of years.
- Contraceptive Implant: A small rod inserted under the skin that releases progestin and can last for several years.
- Contraceptive Injection: Administered every few months.
Comparison of Zoely and Common Alternatives
| Feature | Zoely | Qlaira | Yasmin | Microgynon | Cerazette (POP) |
|---|---|---|---|---|---|
| Estrogen Type | Estradiol | Estradiol | Ethinylestradiol | Ethinylestradiol | None |
| Progestogen Type | Nomegestrol Acetate | Dienogest | Drospirenone | Levonorgestrel | Desogestrel |
| Dosing Regimen | Monophasic (24/4) | Quadriphasic (26/2) | Monophasic (21/7) | Monophasic (21/7) | Monophasic (28/0) |
| Hormone Type | Body-identical | Body-identical | Synthetic | Synthetic | Progestogen-only |
| Common Side Effects | Acne, weight gain, irregular bleeding | Mood-related side effects | Bloating (can help), blood clot risk | Standard COC side effects | Irregular bleeding, mood changes |
Making the Right Choice
Choosing a contraceptive pill is a personal decision that depends on many factors, including your individual health, your body's sensitivity to hormones, and your preferences regarding dosing and side effects. Because each contraceptive has a different hormonal composition, a pill that is suitable for one person may not be for another. It is crucial to have an open discussion with a healthcare professional about your options. They can evaluate your medical history and help you find the contraceptive that best fits your needs and minimizes potential side effects. For instance, if you reacted negatively to ethinylestradiol in the past, an estradiol-based pill like Qlaira or even a progestogen-only pill might be a better fit. Conversely, if the nomegestrol acetate in Zoely caused unwanted side effects, a combined pill with a different progestogen might be more tolerable.
Conclusion
While no single contraceptive pill is an exact twin of Zoely, Qlaira is the most similar in that it also uses a body-identical estradiol as its estrogen component. However, the difference in progestogen (dienogest vs. nomegestrol acetate) and its quadriphasic dosing schedule make it a distinct alternative. For those not specifically looking for an estradiol-based pill, a wide array of combined oral contraceptives are available that use synthetic ethinylestradiol and various progestins. These offer different side effect profiles and dosing regimens, with examples including Yasmin and Microgynon. For individuals needing to avoid estrogen altogether, progestogen-only pills or long-acting reversible contraceptives are also viable options. The best way to identify the most suitable alternative is through a thorough consultation with your doctor to discuss your health needs and concerns.
For more information on the efficacy and side effects of Zoely compared to other combined contraceptives, including detailed clinical study findings, you can consult the original European Medicines Agency report on Zoely.
Keypoints
- Unique Composition: Zoely contains the progestogen nomegestrol acetate and the body-identical estrogen estradiol, unlike most combined pills that use synthetic ethinylestradiol.
- Closest Alternative: Qlaira is the most similar alternative as it also contains estradiol, but it has a varying hormone dose (quadriphasic) and only two placebo days.
- Standard COCs: Most combined pills, such as Yasmin and Microgynon, use synthetic ethinylestradiol and different types of progestins. These may have different side effect profiles.
- Estrogen-Free Options: Progestogen-only pills (mini-pills) like Cerazette or Slynd are alternatives for those who cannot tolerate estrogen.
- Alternative Delivery: Non-pill options, including injections, implants, and IUDs, are also available for those seeking a different contraceptive method.
- Medical Consultation is Key: Because individual tolerance varies, a healthcare provider can help determine the best contraceptive based on a person's medical history and needs.
- Dosing Differences: The number of active versus placebo pills differs between Zoely (24/4), Qlaira (26/2), and standard COCs (21/7), affecting withdrawal bleeding patterns.
FAQs
Q: Why is Zoely's hormone composition considered different? A: Zoely's unique feature is its use of estradiol, a body-identical estrogen, combined with nomegestrol acetate. The majority of combined pills contain a synthetic estrogen called ethinylestradiol, which is structurally different.
Q: What are the main differences between Zoely and Qlaira? A: Both use estradiol, but Qlaira is quadriphasic (varying hormone doses) with 26 active pills and 2 inactive pills, while Zoely is monophasic (constant dose) with 24 active pills and 4 inactive pills. They also contain different progestogens.
Q: Is Yasmin a good alternative to Zoely? A: Yasmin is a combined pill containing a synthetic estrogen and a different progestogen (drospirenone). While effective, studies showed Zoely users reported more instances of acne and weight gain than Yasmin users. Yasmin's progestin may help with bloating.
Q: Are there any progestogen-only pills similar to Zoely? A: No, progestogen-only pills (POPs) do not contain estrogen at all, making them fundamentally different from Zoely. However, they are a suitable alternative for individuals who need to avoid estrogen.
Q: How does the dosing regimen affect the user? A: The number of active and inactive pills can influence withdrawal bleeding patterns. Zoely's 24/4 regimen often results in lighter or absent withdrawal bleeds compared to the standard 21/7 schedule of many other combined pills.
Q: Can I just switch from Zoely to a different pill on my own? A: No, you should always consult a healthcare professional before switching contraceptives. They can properly assess your health and recommend the best alternative, considering potential side effects and interactions.
Q: Are estradiol-based pills like Zoely and Qlaira safer than those with synthetic estrogen? A: It has been postulated that combined oral contraceptives (COCs) containing synthetic estradiol, which is structurally identical to endogenous oestrogen, are potentially safer and better tolerated than those containing ethinylestradiol, the synthetic oestrogen most commonly used in COCs. However, the published studies on Zoely did not address whether it is safer, particularly regarding the risk of thromboembolism. All hormonal contraceptives carry some risks, and a doctor can provide guidance on your individual risk profile.
Citations
- National Institutes of Health (NIH) | (.gov). (2017). Nomegestrol acetate/17-beta estradiol: a review of efficacy, safety, and patient acceptability. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC5683186/.
- European Medicines Agency (EMA). (2025). Zoely. Retrieved from https://www.ema.europa.eu/en/medicines/human/EPAR/zoely.
- The Pharmaceutical Journal. (2014). Zoely not recommended over established combined oral contraceptives. Retrieved from https://pharmaceutical-journal.com/article/news/zoely-not-recommended-over-established-combined-oral-contraceptives.
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- Drug and Therapeutics Bulletin. (2014). Zoely: a new combined oral contraceptive. Retrieved from https://dtb.bmj.com/content/52/8/90.
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- Treated UK. (2024). What Is The Best Contraceptive For Perimenopause?. Retrieved from https://uk.treated.com/blog/female-health/contraception/best-contraceptive-perimenopause.
- Australian Broadcasting Corporation. (2025). When birth control has unwanted side effects, what are your options?. Retrieved from https://www.abc.net.au/news/2025-03-02/when-birth-control-has-side-effects-what-are-your-options/104978082.
- The Pharmaceutical Journal. (2014). Zoely not recommended over established combined oral contraceptives. Retrieved from https://pharmaceutical-journal.com/article/news/zoely-not-recommended-over-established-combined-oral-contraceptives.
- Menopause Matters. (2016). Zoely to switch cycle off in early peri. Retrieved from https://www.menopausematters.co.uk/forum/index.php?topic=33225.0.
- The Pharmaceutical Journal. (2014). Zoely not recommended over established combined oral contraceptives. Retrieved from https://pharmaceutical-journal.com/article/news/zoely-not-recommended-over-established-combined-oral-contraceptives.
