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  • Title: Pill-a-month as an oral contraceptive.
    Author: Hefnawi F, Hassanein M, Younis N.
    Journal: Egypt Popul Fam Plann Rev; 1972 Jun; 5(1):1-17. PubMed ID: 12256024.
    Abstract:
    The first 600 cases of a 1200-case study of a monthly contraceptive pill at the Family Planning Clinic at Al-Azhar University Hospital in Cairo are described. The estrogen component, Quinestrol (17 alpha ethinyl estradiol-3-cyclopentyl ether) has prolonged activity. Quingestanol acetate (3 cyclopentyl ether derivative of norethindrone acetate), the progestogen component of the pill, induces withdrawal bleeding, and regulates the cycle. In Group A (96) the first pill was given on day 25 of the cycle to get withdrawal bleeding at the supposed date of the next flow; subsequent pills were given monthly on the same day of each calendar month. In Group B (504) the first pill was given on the first day of the menstrual flow and the second pill after 3 weeks; subsequent pills were given monthly on the same day of each calendar month. Follow-up was for 6 to 12 months. The total number of cycles was 3858. The flow began 6-15 days after taking the pill in 80.4% of the cycles. Treatment cycles were significantly longer than premedication cycles. During contraception the incidence of light flow decreased from 19.6 to 4.19% and the incidence of heavy flow increased from 10 to 12.4%. The mean duration of flow rose from 4.3 to 6.4 days. Percentages of cycles experiencing intermenstrual bleeding and amenorrhea were 5 and 2.6. Dysmenorrhea increased gradually to 20% at the ninth cycle. No significant changes were found in weight, libido, or breasts. Percentages of cycles getting various side effects were nausea and vomiting (6.95), headache (4.57), fatigue (4.05), and discharge (3.02). By the fourth cycle none of the 106 women originally lactating were still doing so. Ignoring pregnancies in the first cycle, when the pill is not yet effective, the pregnancy rate was 2.8/100 woman year. Endometrial biopsies indicated an anti-ovulatory effect after the first cycle. The drop-out rate was 21.3% in the first cycle, but no cases dropped out after the eighth cycle.
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