Desogestrel 75 mcg (the progestogen-only pill, or “mini pill”) is one of the safest contraceptive options in the UK. Because it contains no estrogen, it is suitable for many people who cannot take combined oral contraceptives.

This guide explains who can use Desogestrel, who should use it with caution, and who should avoid it, based on:

FSRH – UK Medical Eligibility Criteria (UKMEC)
NHS guidance
WHO Medical Eligibility Criteria

Table of Contents

Who Can Safely Use Desogestrel? (UKMEC 1–2)

According to FSRH and NHS guidance, most people can safely use Desogestrel, including many who cannot take estrogen-containing methods.

Breastfeeding Women

Safe from any time postpartum (often recommended from 4 weeks)
Does not reduce milk supply
A first-line postpartum option

Women With Migraine (Including Migraine With Aura)

UKMEC Category 2
Does not increase stroke risk

Smokers (Including Women Aged 35+)

No increased cardiovascular risk due to estrogen-free formulation

Women With High Blood Pressure (Controlled)

Safe in mild or well-controlled hypertension (UKMEC 2)

Women at Risk of Blood Clots (VTE)

Suitable for women with family history of VTE or superficial thrombophlebitis
Does not significantly increase VTE risk

Women With Overweight or Obesity

Safe at any BMI
No dose adjustment required

Women With Diabetes (Without Vascular Disease)

Does not significantly affect blood glucose
UKMEC 2 when vascular disease is present

Women Who Cannot Tolerate Estrogen

Useful when estrogen causes:

Migraines
Breast tenderness
Nausea
Mood changes

Women With Endometriosis

May reduce pain and bleeding
Can induce amenorrhoea

Perimenopausal Women

Suitable for women in their 40s
Can be used until age 55
Helps manage irregular bleeding

Medical Conditions Where Desogestrel Is Usually Safe (UKMEC 1–2)

The following conditions do not restrict or only minimally restrict Desogestrel use:

Anaemia
Sickle cell disease
Thalassaemia
Thyroid disorders
IBS or IBD (Crohn’s disease, ulcerative colitis)
Gallbladder disease
Benign breast disease
Uncomplicated diabetes
Varicose veins
Epilepsy (check for drug interactions)

Overall, Desogestrel is considered one of the safest hormonal contraceptives available.

Who Should Use Desogestrel With Caution? (UKMEC 2–3)

These situations require assessment rather than automatic exclusion.

Unexplained Vaginal Bleeding

Cause should be investigated before starting

Hypertension (Uncontrolled or Severe)

Severe hypertension requires clinical judgement
Controlled hypertension is usually acceptable (UKMEC 2)

History of Ectopic Pregnancy

Overall ectopic risk is reduced due to ovulation suppression
If pregnancy occurs, relative ectopic risk is higher
Careful counselling is advised

Mild or Past Liver Disease

Past or resolved liver disease may still allow use
Active or severe liver disease is contraindicated

Enzyme-Inducing Medications

These may reduce Desogestrel effectiveness:

Carbamazepine
Phenytoin
Phenobarbital
Topiramate (dose-dependent)
Rifampicin or rifabutin
St John’s Wort

Alternative or backup contraception may be required.

Who Should Not Use Desogestrel? (UKMEC 4 – Contraindications)

Very few absolute contraindications exist.

Current Breast Cancer

Progestogen-only methods are contraindicated

Severe Liver Disease

Includes:

Severe cirrhosis
Liver tumours (benign or malignant)
Acute hepatitis with significant dysfunction

Unexplained Heavy or Recurrent Vaginal Bleeding

Must be evaluated before use

Known Allergy to Desogestrel or Tablet Ingredients

Desogestrel vs Combined Pills (Eligibility Perspective)

Desogestrel is preferred over combined pills for:

Migraine with aura
Breastfeeding or postpartum use
Smoking over age 35
High BMI
High VTE risk
Hypertension
Diabetes
Estrogen intolerance

This makes Desogestrel a first-line option for many people in the UK.

Age Considerations

Adolescents (Under 18)

Safe and suitable
Useful when estrogen is unsuitable

Women Aged 40–50 (Perimenopause)

Safe until age 55
Helps regulate bleeding
Avoids estrogen-related risks

Women Over 55

Contraception can usually be stopped at age 55

Fertility After Stopping Desogestrel

Ovulation often returns within 7–14 days
No delay in fertility
Suitable for reversible contraception

Summary of Eligibility

Suitable For

Breastfeeding women
Smokers (any age)
Migraine with aura
High BMI
VTE risk
Perimenopausal women
Adolescents

Use With Caution

Enzyme-inducing medications
History of ectopic pregnancy
Controlled hypertension
Past liver disease

Avoid If

Current breast cancer
Severe liver disease
Unexplained vaginal bleeding

Clinical Summary

According to UKMEC and FSRH guidance, Desogestrel is one of the safest contraceptive options available. Its estrogen-free profile, minimal restrictions, and rapid return to fertility make it a key choice in modern UK contrac