11 May Cerelle Vs Cerazette: The Contraceptive Monopoly
By Hannah Crowe
Morgan was 20 days into her new mini-pill prescription when her panic attacks appeared. Her skin was breaking out, her anxiety was overwhelming, and the only thing she could think might be causing this was her new contraceptive, except it wasn’t really new – it was the same as her old pill, it just had a different name. She went to her GP and was declined her old contraceptive, but was offered antidepressants for her psychological symptoms instead.
During this time, many other women were experiencing the same symptoms as Morgan. In 2013, in a bid to save money for the NHS, Clinical Commissioning Groups across the UK made the decision to stop purchasing a branded mini-pill called Cerazette, a single hormone contraceptive with the active ingredient of Desogestrel 75mg. GP’s were no longer allowed to prescribe this pill, and instead, a generic was introduced. At half the price, Cerelle was an appealing alternative, with the same active ingredient. No new clinical trials were needed on the drug, since the NHS knew how Desogestrel worked. Guidelines from studies completed on Cerazette were looked at in order to predict how Cerelle would behave, and since the identical medication was safe, the general consensus was that Cerelle would be too.
Measures were put in place to dry out the supply of Cerazette in pharmacies. Women were told their pill had been discontinued, and the NHS would no longer provide it free of charge. They were switched to Cerelle with a brief explanation that both pills were identical, this one was just cheaper to supply. With many women thinking nothing of the change, away they went with their old contraception with a new name. The advice was to take it as you would your old pill, without missing any days.
Within a week of switching from a pill she had been on for 6 years, Millie Sansoye noticed a difference in her skin, the heaviness of her periods and her facial hair. Her acne free complexion had disappeared, and Millie’s face had broken out.
Her hair became greasy due to a seemingly overnight change in skin types, and she started to get dark facial hair on her chin and above her upper lip. She noticed the skin under her eyebrows was flaking and falling off.
“It was awful and I was so self conscious. I think I put on weight because despite going to the gym more and eating my normal amount, nothing was budging. But the spots and hair were the worst symptoms.”
Millie wasn’t alone in her ordeal. “Oh, it’s just the new name for Cerazette!” Christina was told by her GP. She had been on Cerazette for 10 years, with no problems. “I was taking Cerelle for 2 months before it flipped my life upside down. I was miserable, had constant PMS (Premenstrual Syndrome), anxiety, panic attacks, mood swings and acne. The only thing different was my pill.”
Without a proper explanation as to what was going on with their bodies, women were flocking to female-oriented forums in an attempt at figuring out why these changes were taking place.
After trawling through Mumsnet, Reddit and tens of blog entries on Cerelle, there were at least 140 women who had all experienced a variety of horrifying symptoms after switching specifically from Cerazette to Cerelle. Some of the worst and most common were anxiety attacks, extremely heavy vaginal bleeding and hormonal, cystic acne. Other symptoms ranged from mood swings, weight gain and depression to insomnia and lack of libido. Believe it or not, all of the above are the most common symptoms experienced when taking a hormonal contraceptive – the problem is that they shouldn’t be flaring up with the “same” medication which in its previous branded form, caused no adverse effects. It’s unlikely that 140 women from internet forums alone is a coincidence, and as not every female in the UK is active online, the estimates on how many women this has impacted are high.
So what exactly is a generic medicine? Generic versions of drugs are thought to save billions of pounds a year for healthcare providers, and are accepted as safe. In the same way buying a pack of Ibuprofen for £1.10 will save you money by not going with the branded Nurofen for £2.89, Cerelle costs the NHS a mere £1.95 for three months, rather than £9.95 for three months of Cerazette. Annually, £16 billion is spent on drugs by the NHS, and in an austere economy, it makes sense to use generic drugs where appropriate.
Sadly, most women were not told they had been switched without their consent to a different contraceptive. The GMC (General Medical Council) stated the following when questioned on whether any guidelines existed for prescribing generic medicine.
“There is nothing in our guidelines that explicitly state GP’s should let patients know when they’re being switched to a generic version of their existing medicine, but we do advise honesty and transparency with patients and follow ups to see how a new medicine is working for the patient.”
In doing this, GP’s weren’t technically breaking any rules or acting outside of the guidelines prescribed by the GMC, who regulate and oversee the work of doctors and nurses in the UK. However, there is agreement among medical professionals that generic drugs can indeed cause different symptoms when taken instead of a branded medication that the body is used to, particularly when that medication has been taken for several years. Although rare, there are documented cases of this happening. Generics are not required to be tested on a large number of people the same way a branded drug is, which is where these side effects would be noticed. This is why it’s vital for GP’s to tell patients that they are being switched, and why it is concerning that the GMC do not have guidelines to enforce this. In an MHRA report on Cerelle for the British government, it is stated on page 9 that no new trials were conducted.
Speaking to Huff Post, Michael White, Doctor of Pharmacy and Head of the Department of Pharmacy Practice at the University of Connecticut, was asked why patients may have a different experience with a generic.
“Some patients will tolerate a brand name medication but when they switch medications, they do not do as well. The reason may be that that while the blood concentrations of the brand name medication are very similar, what the tablets are made out of can vary.”
It is plausible that this could be one of the reasons behind the side effects, as the only two differences in the ingredients of the medication are in the core of the tablet. Cerelle contains potato starch, whereas Cerazette uses Maize starch.
After enduring months of hell on Cerelle, Millie went to her GP and demanded to be prescribed Cerazette again. Expecting to be told no, she was surprised when her GP agreed, and said: “I don’t know why but so many people keep coming to me, saying that Cerelle is giving them bad side effects that they never had on Cerazette.” Leaving with her old prescription and a feeling of relief that this wasn’t just affecting her, Millie said trying to find a pharmacy that stocked her old pill was like finding a needle in a haystack.
Since small amounts of Cerazette were drip fed to certain pharmacies to make it difficult to access, Millie had to ring around before she found somewhere that stocked it.
Within weeks, Millie’s skin had cleared up, her bleeding had stopped and her confidence returned. Christina’s experience was the same, and after begging to be given Cerazette back, her livelihood increased dramatically in the space of a week, and the horrors of Cerelle had disappeared.
A member of the King’s College Faculty of Life Sciences and Medicine who wished to remain anonymous, said it was likely this was a negative placebo effect, known as a “nocebo”. If this was true, the women affected would have needed to be told about possible changes in symptoms and the chances of negative side effects. However, the issue is actually, they were told nothing at all – therefore this theory isn’t that strong. Another indication that this was not a nocebo effect, is that the women on forums were writing about symptoms they had experienced years prior, that they dealt with on their own. It wasn’t until several years later that they collectively discussed their symptoms, which they were no longer experiencing as they had either changed back to Cerazette, or had switched to a different contraceptive. The NHS were also approached for comment, but at the time of publication had not responded.
After arguing with her GP three times about switching back to her old pill, Morgan was forced to purchase Cerazette at full price from an online pharmacy. “I feel 10 times better since I changed back to Cerazette.” It cost her £40, but she says it was absolutely worth it.
Doctors refusing to accept that women know their bodies better than anyone else is nothing new. Women can be made to feel like hypochondriacs, and in many cases symptoms that are not physical can be overlooked. This is the result of centuries of negative stereotypes that portray women as overly emotional and hysterical, and the healthcare industry is certainly not exempt from this crux. These testimonies are a miserable example of the horrors of contraception that women have endured for decades, and although we have evolved massively since the first pill of the 60’s, there is a lot of work to be done to ensure that doctors listen to what women are telling them about their own bodies.
If you are someone who has been affected by a change to Cerelle, you are still able to request Cerazette, and doctors must prescribe it to you if you demand it. If they say no, ask for their denial of the contraceptive to be recorded in your medical notes.
