Making change

Funding of Cerazette

Pharmac have proposed funding desogestrel, the progesterone only pill Cerazette.

" I would love for all wāhine to have unlimited access to Cerazette and for healthcare professionals to be confident in prescribing and recommending it.  Please read my letter as to why and sign if you agree with me by filling in the form. 

Lived experiences are so important for guiding change, please share your story if you are happy for us to share it with Pharmac"   

Dr Sam

PHARMAC
PO Box 10254
The Terrace 
Wellington 6143

13th February 2025

Tēnā koutou katoa,

Re: Consultation on Funding Cerazette (Desogestrel 75mg)

Thank you for considering the funding of Cerazette. If funded, this progestogen-only pill (POP) would significantly enhance contraceptive care and options for women in Aotearoa. Oral contraceptives not only help prevent pregnancy but also improve the quality of life for women experiencing menstrual dysfunctions such as PMS, which affects up to 80% of women of reproductive age.

Why Fund Cerazette?

Currently, there is no funded desogestrel-based POP in New Zealand, leaving many women without access to an effective and well-tolerated alternative to norethisterone-based mini-pills. 

The advantages of Cerazette include:

1. Improved Contraceptive Efficacy - Unlike traditional mini-pills that require strict adherence to a three-hour dosing window, Cerazette offers a 12-hour missed-pill window with a significantly lower failure rate.
2. Better Tolerability and Fewer Side Effects - Cerazette has fewer androgenic side effects (e.g., acne, hirsutism, mood changes) compared to norethisterone mini-pills. Additionally, it avoids estrogen-related side effects such as nausea, headaches, and increased venous thromboembolism (VTE) risk seen with combined oral contraceptives (COCPs).
3. Reliable Ovulation Suppression - Cerazette inhibits ovulation in over 97% of cycles, compared to around 50% with norethisterone mini-pills. This provides better cycle control and symptom relief for conditions like PMS, PMDD, and endometriosis.
4. Safer Option for High-Risk Groups - Desogestrel does not increase VTE risk, making it suitable for postpartum women, those with obesity, migraines with aura, or other estrogen contraindications. It is also a preferred option for women with PCOS, particularly those with a high BMI, as it can decrease testosterone levels, improving androgenic effects.
5. Accessible Alternative to LARCs - While long-acting reversible contraceptives (LARCs) are funded, barriers such as cost, procedural concerns, trauma history (including intergenerational trauma), and limited rural services make Cerazette a non-invasive and readily accessible option (6 month prescriptions available).
6. Postnatal Use - Desogestrel is safe during breastfeeding and offers better efficacy and tolerance than other POPs in the postpartum period.
7. Addressing Supply Issues - Recent supply disruptions of norethisterone 350 mcg have led to tolerance issues with alternatives (eg northinidrone) and decreased compliance among users. Cerazette would provide a reliable alternative and reduce pressure on other options.

Broader Health Benefits

Funding Cerazette would also support the management of various hormonal conditions:

• Heavy Menstrual Bleeding (HMB): Reduces menstrual flow more effectively than norethisterone mini-pills and can be doubled off-label for greater efficacy.
• PMS/PMDD: Stabilizes hormonal fluctuations by suppressing ovulation, offering relief without reliance on SSRIs or GnRH analogues.
• Endometriosis: Strong ovulation suppression reduces symptoms and disease progression while patients await specialist care or surgery.
• Perimenopause: Provides reliable contraception for women over 40 and can be used off-label (as a double dose) with estrogen therapy for endometrial protection.
• Acne: A preferable option for androgen-driven acne where COCPs are contraindicated.
• Cardiovascular Risk: A suitable and more effective option for those with a history of cardiac or stroke issues.
• Thrombogenic Effect: Studies show that POPs, including Cerazette, have no substantial effect on blood pressure and are not linked to increased risks of VTE, stroke, or myocardial infarction compared to non-users. Due to the benefits described above, it is likely to offer a more suitable option for those at higher risk on estrogen-containing pills.

Impact on Public Health and Equity

Funding Cerazette aligns with Pharmac’s commitment to equity and improved health outcomes:

• Expands contraceptive options for healthcare providers and patients.
• Reduces unintended pregnancies and their associated personal and economic costs.
• Improves access to hormonal treatments for debilitating conditions like PMDD and endometriosis, reducing reliance on specialist care or surgery, which is currently challenging to access.
• Addresses health inequities by providing accessible options for rural and low-income communities facing barriers to LARCs.

Additionally, this initiative complements Pharmac’s work in improving access to transdermal estrogen therapies by addressing the broader impact of hormonal health on mental and physical well-being, as well as workplace productivity. It also offers another teaching and community and healthcare professional education opportunity to highlight the nuances involved in hormonal health

Conclusion
  Funding Cerazette supports patient choice while addressing unmet needs in women’s healthcare. Its benefits extend beyond contraception, improving menstrual well-being and managing complex hormonal conditions effectively. We urge Pharmac to prioritize this funding decision in alignment with its principles of equity and improved health outcomes.

Ngā mihi nui,

Dr Samantha Newman

MBChB BSc (hons) DipOMG

GP with a Specialist Interest in Womens Health

Honorary Lecturer at the University of Auckland

Adjunct Research Associate Univ. Monash