Technical Update on Centchroman (Non-hormonal Oral Contraceptive)

It is a selective estrogen receptor modulator (SERM) that exerts anti-estrogenic effects on the uterus, preventing implantation of the zygote. Centchroman has weak estrogenic action on bones but strong anti-estrogenic action on the uterus and breasts. The pill is safe for breastfeeding mothers soon after childbirth. Its primary side effect is the prolongation of the menstrual cycle, which occurs in approximately 8% of cases, usually within the first three months of use. Centchroman also makes periods lighter and can be beneficial for anemic women. It can be used safely in conditions where hormonal contraceptives are not advised. Centchroman's contraceptive effectiveness is reported to be 1-2 pregnancies per 100 women. The pill works by creating asynchrony between the developing zygote and endometrial maturation, preventing implantation of the zygote. The recommended dosage schedule for Centchroman is as follows: for the first three months, one pill (30 mg) is taken twice a week, followed by once a week thereafter. Starting from the fourth month, the pill is taken once a week on the first pill day and should be continued on the weekly schedule regardless of the menstrual cycle. For initiation, the first pill is taken on the first day of the period (first day of bleeding), and the second pill is taken three days later. To increase compliance with Centchroman use, healthcare providers should assure clients that they can return to the health facility at any time if a problem arises. Clients should be encouraged to return to the health facility before the packet finishes and discuss ways to remember taking the pill daily in case they might forget. Clients should also be informed about side effects, such as delayed and scanty periods, and reassured that these side effects are not harmful and usually become less or stop after the initial months of use. In cases where a pill is missed, clients should take a pill as soon as possible after it is missed. If a pill is missed by less than 7 days, the normal schedule should be continued, and a backup method (condom) should be used until the next period starts. If a pill is missed by more than 7 days, the client needs to start taking it all over again like a new user, taking two pills a week for three months and then once a week. If periods are delayed by more than 15 days, pregnancy should be ruled out. Centchroman should be avoided in certain conditions, including polycystic ovarian disease, cervical hyperplasia, recent history of jaundice or liver disease, severe allergic state, and chronic illness, such as tuberculosis or renal disease.