What is Cilique

• Most women take Cilique to prevent an unwanted pregnancy, but it's also prescribed for women who have problems with particularly heavy, painful or irregular periods. Taking it usually results in lighter, less painful and more regular menstrual bleeding.
• Cilique is the same as other combined pills containing ethinylestradiol 35 micrograms and norgestimate 250 micrograms.

How does Cilique work

• Each Cilique tablet contains two active ingredients, ethinylestradiol 35 micrograms and norgestimate 250 micrograms. These are synthetic versions of the naturally occurring female sex hormones, oestrogen and progesterone.
• Combined pills like Cilique over-ride your natural menstrual cycle and work mainly by stopping your ovaries from releasing an egg each month (ovulation). They also increase the thickness of the natural mucus at the neck of the womb, making it more difficult for sperm to cross from the vagina into the womb, as well as thinning the womb lining (endometrium), making it more difficult for any successfully fertilised eggs to implant there.
• You take one pill every day for three weeks, then have a week break before starting the next packet. During your pill-free week the levels of hormones in your blood fall and you'll usually get a withdrawal bleed that's like your period.

Key facts about Cilique

• Cilique is most often prescribed for young women who don't have any major health issues. It's not suitable for women who have an increased risk of getting a blood clot, including women over 35 who smoke.
• Cilique is more than 99% effective when taken correctly, but missing pills, vomiting, diarrhoea and taking certain other medicines can make it less effective.
• Cilique won't protect you against sexually transmitted infections; you'll still need to use condoms for that.
• The most common side effects of Cilique include headaches, feeling sick, breast tenderness and mood changes.
• Breakthrough bleeding, spotting and missed periods can be common in the first few months. See your doctor if this persists. If you don't have a period for two consecutive months, do a pregnancy test before starting the next month's packet of pills.
• Blood clots are a rare but serious side effect of the pill.
• If you are concerned or have any questions, talk to your doctor, nurse, pharmacist or local family planning centre.

Who shouldn't take Cilique

Cilique is not suitable for everyone. You shouldn't take it if you:

• are over 35 and you smoke, or you stopped smoking less than a year ago
• are very overweight (BMI more than 35)
• have ever had a blood clot in your leg (deep vein thrombosis) or lungs (pulmonary embolism)
• have ever had a heart attack, angina, stroke or mini-stroke
• have very high blood pressure (hypertension) or vascular disease
• have heart valve disease or an irregular heartbeat called atrial fibrillation
• have a blood disorder that increases your risk of blood clots, eg antiphospholipid syndrome or factor V Leiden
• have severe diabetes with complications affecting the eyes, kidneys or nerves
• suffer from migraines with aura
• have breast cancer now or have had it in the last five years
• have liver disease, eg liver cancer, severe cirrhosis
• have gallbladder disease
• have ever had jaundice, itching, a hearing disorder called otosclerosis, or a rash called pemphigoid gestationis, when pregnant or when taking the pill before
• have a rare metabolic disorder called porphyria.

If two or more of these apply your doctor will usually recommend that you don't take Cilique:

• You are 35 years or older.
• You smoke.
• You are overweight.
• You have high cholesterol levels.
• You have high blood pressure (hypertension).
• You have diabetes.
• Your parent, brother or sister had a heart attack, stroke or blood clot in the leg (deep vein thrombosis) or lungs (pulmonary embolism) before the age of 45.
• You use a wheelchair.
• You have a long-term condition called systemic lupus erythematosus (SLE).
• You have Crohn's disease or ulcerative colitis.
• You have a history of migraines.
• You have an undiagnosed breast lump or gene mutations that are associated with an increased risk of breast cancer, eg BRCA1.

Can I take Cilique if I'm breastfeeding

• The combined pill is not the preferred method of contraception for women who are breastfeeding, because the oestrogen in it can reduce the amount of breast milk you produce. If you do decide you want to take it you shouldn't start it until at least six weeks after the birth, when breastfeeding is fully established.

How do I take Cilique

• Cilique tablets come in a calendar pack marked with days of the week. You take one pill at the same time every day for 21 days and then have a seven day break.
• During your seven day break you'll usually get a withdrawal bleed that is similar to your normal period. Start your next pack after the seven pill-free days are up, even if you are still bleeding.
• If you want to delay your period you can take two packets back to back without a break. Have your seven day break at the end of the two packets and you should get your period then.
• You'll 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).

When can I start taking Cilique

• You can start taking Cilique at any time in your menstrual cycle.
• If you start it on day 1 to 5 of your period you'll be protected from pregnancy straight away and don't need to use any extra contraception. BUT, if you have a short menstrual cycle (if you get your period every 23 days or less), starting on days 2 to 5 may not protect you straight away, and you should use extra contraception for the first seven days.
• If you start taking Cilique at any other time in your cycle, you'll need to use extra contraception, eg condoms (or not have sex) for the first seven days of pill taking.

If you're starting Cilique after having a baby

• If you have given birth and are not breastfeeding, it may be possible to start taking Cilique on day 21 after the birth, but check with your doctor. This will protect you from pregnancy immediately so you don't need to use extra contraception. If you start Cilique more than 21 days after giving birth, use extra contraception for the first seven days of pill taking.
• If you're starting Cilique after a miscarriage or abortion
• If you start taking Cilique up to five days after a miscarriage or abortion you'll be protected against pregnancy straight away. If you start taking it more than five days after the miscarriage or abortion, use extra contraception for the first seven days of pill taking.

What should I do if I miss a pill of Cilique

If you forget to take your pill at your usual time, take it as soon as you remember. A missed pill is one that is 24 hours or more late. If you miss a pill, follow the instructions below.

One pill missed:

If you forget to take ONE pill, or start your new pack one day late, take the pill you missed as soon as possible, even if this means taking two pills at the same time. Then continue taking the rest of the pack as normal. You'll still be protected against pregnancy and you don't need to use extra contraception.

Two or more pills missed:

If you forget to take TWO or more pills, or start your new pack two or more days late, you won't be protected. Take the last pill you missed as soon as possible, even if this means taking two pills at the same time. Leave out the other missed ones. 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 the pills you missed were in the last week of your pack, finish the pack as usual but then start a new pack straight away without a break. This means skipping your pill-free week.

If you had unprotected sex in the seven days before you missed pills, you may need to take the morning after pill. Get advice from your doctor, pharmacist or local family planning clinic.

If you struggle to remember to start your next pack on time you might find an every day pill like Microgynon 30 ED is better for you.

What if I have vomiting or diarrhoea

If you vomit within two hours of taking a pill, you should take another one as soon as you feel well enough. Take your next pill at your usual time. You should still be protected from pregnancy. However, if you keep vomiting for more than 24 hours, this may make your pill less effective. Keep taking your pill at your normal time, but treat each day that you're sick as if you had forgotten to take a pill and follow the missed pill instructions above.

If you have very severe diarrhoea for more than 24 hours, this can also make your pill less effective. Keep taking your pill at your normal time, but treat each day that you have severe diarrhoea as if you had forgotten to take a pill and follow the missed pill instructions above.

Can I take other medicines with Cilique

Before you start taking Cilique, make sure you tell your doctor or pharmacist if you're already taking any other medicines, because some medicines can make Cilique less effective at preventing pregnancy. For instance, if you regularly take any of the medicines below Cilique probably won't work for you, so you'll usually need to use a different form of contraception:

• certain antiepileptic medicines, such as carbamazepine, oxcarbazepine, perampanel, phenobarbital, primidone, phenytoin or topiramate
• some medicines for HIV, such as cobicistat, efavirenz, nevirapine or ritonavir
• the antifungal griseofulvin
• modafinil for narcolepsy
• the antibiotics rifabutin or rifampicin for tuberculosis
• the herbal remedy St John's wort (Hypericum perforatum).
• If you're prescribed a short course (up to two months) of any of these medicines while you're taking Cilique this can also make it less effective, and your doctor will usually recommend that you temporarily use a different form of contraception. If you want to keep taking Cilique, talk to your doctor about what to do. You'll also need to use an extra method of contraception (eg condoms) for as long as you take the extra medicine and for at least four weeks after stopping it.

Cilique is not usually recommended if you're taking the antiepileptic medicine lamotrigine.

While you're taking Cilique it's a good idea to check with your doctor or pharmacist before you take any other new medicines.

Antibiotics (other than rifampicin or rifabutin) won't make Cilique less effective, unless they give you diarrhoea or make you sick. If this happens, follow the instructions for diarrhoea and vomiting described above.

The same applies for any other medicine that makes you vomit or gives you diarrhoea - common culprits include laxatives and the weight loss medicine orlistat (brand names Alli and Xenical).

The morning-after pill ellaOne (containing ulipristal) can make Cilique less effective. If you take this type of emergency contraception while taking Cilique you should use extra contraception, such as condoms, for 14 days after taking it.

Common side effects include:

• Feeling sick.
• Abdominal pain.
• Headache.
• Breast pain or tenderness.
• Slight bleeding or spotting between periods in the first few months.
• Lighter periods or sometimes stopping of periods.
• Mood changes. However, there's no evidence that the pill causes depression.
• Fluid retention. However, there's no evidence the pill causes weight gain.

Other possible side effects include:

• Change in libido.
• Rise in blood pressure.
• Skin reactions.
• Increased risk of getting a blood clot in an artery, which could cause a stroke or a heart attack.
• Increased risk of getting a blood clot in a vein, such as a deep vein thrombosis (clot in the leg) or pulmonary embolism (clot in the lungs). 

The risk of blood clots is also increased if you're travelling for long periods of time where you will be sat still (over three hours). Ask your doctor or pharmacist for advice on using travel stockings, calf exercises or aspirin.

Stop taking Cilique and see a doctor immediately if you get symptoms of a blood clot such as: stabbing pains and/or unusual swelling in one leg, pain on breathing or coughing, coughing up blood, sudden breathlessness, sudden severe chest pain, migraine or severe headache, sudden disturbance in vision, hearing or speech, sudden weakness or numbness on one side of the body, or if you collapse.

As with other hormonal contraceptives, it's possible that taking the combined pill may slightly increase your risk of being diagnosed with breast cancer. Research into this is still ongoing, but the risk doesn't go up the longer you take the pill, and goes back to normal ten years after you stop taking the pill.

Women who take the pill for longer than five years may also have a small increase in the risk of being diagnosed with cervical cancer, which again goes back to normal ten years after you stop taking it.

You should discuss the risks and benefits of the pill (which include reduced risks of cancer of the ovary, womb and colon) with your doctor before you start taking it.

Read the leaflet that comes with your pills, or talk to your doctor, nurse or pharmacist if you want any more information about the possible side effects or risks of Cilique.

What if I get pregnant while taking Cilique

It's extremely unlikely that you'll get pregnant if you take Cilique correctly every day. But, if this does happen, there's no evidence that the pills you have taken will harm the baby.

References:

https://www.knowyourcontraceptives.ie/patient-cilique/#toggle-id-6 
https://www.medicines.ie/medicines/cilique-250-35-microgram-tablets-34636/patient-info
https://www.medicines.org.uk/emc/product/2011/smpc