Cilest tablets are a type of hormonal contraception commonly known as 'the pill' or combined oral contraceptive pill. Cilest tablets contain two active ingredients, ethinylestradiol and norgestimate. These are synthetic versions of the naturally occurring female sex hormones, oestrogen and progesterone. Ethinylestradiol is a synthetic version of oestrogen and norgestimate is a synthetic form of progesterone.
Combined oral contraceptives like Cilest work by over-riding the normal menstrual cycle. In a woman's normal menstrual cycle, levels of the sex hormones change throughout each month. The hormones cause an egg to be released from the ovaries (ovulation) and prepare the lining of the womb for a possible pregnancy. At the end of each cycle, if the egg has not been fertilised the levels of the hormones fall, causing the womb lining to be shed as a monthly period.
The daily dose of hormones taken in the pill work mainly by tricking your body into thinking that ovulation has already happened. This prevents an egg from ripening and being released from the ovaries each month.
The hormones also increase the thickness of the natural mucus at the neck of the womb, which makes it more difficult for sperm to cross from the vagina into the womb and reach an egg. They also change the quality of the womb lining (endometrium), making it less likely that a fertilised egg can implant there.
Taking the contraceptive pill usually results in lighter, less painful and more regular menstrual bleeding. This means it is sometimes also prescribed for women who have problems with particularly heavy, painful or irregular periods.
Cilest is a monophasic pill. This means that each tablet has the same dose of hormones in it. One tablet is taken every day for 21 days and you then have a seven day break from pill-taking. During your seven day break, the levels of the hormones in your blood drop, which results in a withdrawal bleed that is similar to your normal period. You start the next pack after the seven pill-free days are up, even if you are still bleeding.
The tablets come in a calendar pack marked with days of the week to help you remember to take a pill every day for three weeks, followed by a week off. You will still be protected against pregnancy in your pill-free week, provided you took all the pills correctly, you start the next packet on time and nothing else happened that could make the pill less effective (eg sickness, diarrhoea, or taking certain other medicines - see below).
Ideally, you should start taking this pill on day one of your menstrual cycle (the first day of your period). This will protect you from pregnancy immediately and you won't need to use any additional methods of contraception. If necessary, you can also start taking it up to day five of your cycle without needing to use additional contraception when you start. However, if you have a short menstrual cycle (with your period coming every 23 days or less), starting as late as the fifth day of your cycle may not provide you with immediate contraceptive protection. You should talk to your doctor or nurse about this and whether you need to use an additional contraceptive method for the first seven days.
You can also start taking this pill at any other time in your cycle if your doctor is reasonably sure that you are not pregnant. However, if you start taking this pill at any other time in your cycle, you won't be protected from pregnancy straight away and you will need to use additional contraception, eg condoms (or not have sex) for the first seven days of pill taking.
If you have given birth and are not breastfeeding, you can start taking this pill on day 21 after the birth. You will be protected against pregnancy immediately and do not need to use extra contraception. If you start taking it later than 21 days after giving birth, you will need to use extra contraception for the first seven days.
If you are starting this pill immediately after a miscarriage or abortion at under 24 weeks, you will protected against pregnancy immediately. If you start taking it more than seven days after the miscarriage or abortion, you should use extra contraception for the first seven days of pill taking.
You should try and take your pill at the same time every day to help you remember to take it.
If you forget to take ONE pill, or start your new pack one day late, you should take the pill you missed as soon as possible, then continue taking the rest of the pack as normal. You will still be protected against pregnancy and you don't need to use extra contraception.
If you forget to take TWO or more pills, or start your new pack two or more days late, you won't be protected against pregnancy. You should take the last pill you missed as soon as possible, forget the other missed ones and then continue to take your pills, one every day, as normal. You should either not have sex, or use an extra barrier method of contraception, eg condoms, for the next seven days.
If you had unprotected sex in the seven days before you missed pills, you may need emergency contraception (the morning after pill). Ask for medical advice.
If there are fewer than seven pills left in your pack after your last missed pill, you should finish the pack and then start a new pack straight away without a break. This means skipping your pill-free week.
If there are seven or more pills left in your pack after your last missed pill, you should finish the pack and have your seven day break as usual before starting the next pack.
If you are confused about any of this, you can get individual advice for your circumstances from your doctor, pharmacist, local family planning clinic, or by calling the fpa helpline on 0845 122 8690.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. See also the warnings above. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start taking this contraceptive. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to ensure that the combination is safe.
The following medicines speed up the breakdown of the hormones in this contraceptive by the liver, which makes it less effective at preventing pregnancy:
If you regularly take any of these medicines they are likely to make this contraceptive ineffective at preventing pregnancy. It is important that you talk to your doctor about this. Your doctor may recommend that you use a different form of contraception altogether. However, if you want to use the pill (and you are not taking rifampicin or rifabutin - see below), your doctor can prescribe you an additional pill to take in combination with this one, which would give you a higher dose of hormones. (This is unlicensed). If you do this, your doctor will also ask you to take three packets back to back without a break, have only a four day pill-free break and then take three packets back to back again. (This is called tricycling and is also unlicensed.) The purpose of this is to reduce the number and duration of hormone free periods in which ovulation could happen and thus minimise the chances of the pill failing.
If you are prescribed a short course (up to two months) of any of the above medicines they will also make this contraceptive less effective. Your doctor may recommend that you temporarily use a different form of contraception to prevent pregnancy. However, if you want to keep taking this pill, your doctor will probably advise you to take three packets back to back without a break, then have only a four day pill-free break, then take three packets back to back again. (This is called tricycling and is unlicensed.) You will also need to use an additional method of contraception (eg condoms), while you are doing this, for as long as you take the liver-affecting medicine and for at least four weeks after stopping it. Alternatively, your doctor could prescribe an additional pill to take in combination with this one, as above. Discuss your options with your doctor.
If you are prescribed rifampicin or rifabutin, an alternative method of contraception will always be recommended, because these two antibiotics make the pill so ineffective.
In the past, if you were prescribed an antibiotic other than rifampicin or rifabutin (eg amoxicillin, erythromycin, doxycycline) while taking the pill, the advice used to be that you use an extra method of contraception (eg condoms) while you were taking the antibiotic and for seven days after finishing the course. However, this advice has now changed. You no longer need to use an extra method of contraception with the pill while you take a course of antibiotics. This change in advice comes because to date there is no evidence to prove that antibiotics (other than rifampicin or rifabutin) affect the pill. This is the latest guidance from the Faculty of Sexual & Reproductive Healthcare. However, if you experience vomiting or diarrhoea as a result of taking an antibiotic you should follow the instructions for vomiting and diarrhoea described in the warning section above.
The emergency contraceptive ulipristal (Ellaone) has the potential to make the pill less effective. If you take Ellaone as an emergency contraceptive while you are taking Cilest, you should use an additional method of contraception such as condoms for 14 days after you take it.
The weight loss medicine orlistat (bought without a prescription as Alli and prescribed as Xenical) can cause severe diarrhoea. If you take either of these medicines while taking Cilest and get diarrhoea that lasts for more than 24 hours, you should follow the instructions for missed pills described above.
The pill may antagonise the blood sugar lowering effect of medicines for diabetes. If you have diabetes you should monitor your blood sugar and seek advice from your doctor or pharmacist if your blood sugar control seems to be altered after starting this contraceptive.
The pill may antagonise the effect of medicines used to lower high blood pressure. Your blood pressure will usually be checked periodically while you are taking the pill, but this is particularly important if you are also taking medicines for high blood pressure.
The pill may also antagonise the fluid-losing effect of diuretic medicines.
If you have an underactive thyroid gland (hypothyroidism) you may need an increased dose of your thyroid hormones while taking the pill. Your thyroid hormone levels should be regularly checked.
The pill may decrease the amount of the antiepileptic medicine lamotrigine in the blood. As this could increase the risk of seizures coming back or getting worse, the pill may not be recommended for women who take lamotrigine on its own for epilepsy.
The pill may increase the blood levels of the following medicines and this could possibly increase the risk of their side effects:
There are currently no other contraceptives in the UK that contain this combination of hormones.