{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:03Z","timestamp":1792787283082,"version":"4.5.0"},"reference-count":41,"publisher":"BMJ","issue":"Suppl 2","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"name":"World Health Organization Human Reproduction Programme","id":[{"id":"https:\/\/ror.org\/01f80g185","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2026,8,7]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the efficacy, safety and acceptability of quinestrol combined with quingestanol (Quin-QUIN), quinestrol combined with levonorgestrel (Quin-LNG) and quinestrol combined with norgestrel (Quin-NG) as contraceptives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Web of Science Core Collection, Embase, CENTRAL, CINAHL, CNKI, Wanfang, SinoMed and selected supplementary sources were systematically searched to identify randomised controlled trials (RCTs) and non-randomised studies of interventions related to Quin-QUIN, Quin-LNG and Quin-NG. Two investigators independently performed data extraction and risk-of-bias assessment. A random-effects model was used for the meta-analysis and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve studies (1 RCT and 11 case series) involving 5355 participants were included. Most studies were published in the 1970s. The only included RCT showed no significant difference in the risk of pregnancy (risk ratio (RR)=0.70, 95% confidence interval (CI) 0.31 to 1.55 for Quin-LNG compared with Quin-NG). Quin-LNG was associated with a lower risk of discontinuation and fewer side effects than Quin-NG. Proportion meta-analyses of the case series, all evaluating Quin-QUIN, found a pooled proportion of pregnancy of 3.6% (95% CI 2.5% to 5.0%) and a pooled discontinuation rate of 47.9% (95% CI 17.4% to 79.4%). Nausea, vomiting, dizziness and headache were the most common side effects. The certainty of evidence for most outcomes was low or very low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Available evidence is limited; the risk\u2013benefit profile of quinestrol-based once-monthly oral contraceptives remains uncertain. Their clinical use should be cautious, and high-quality studies are needed to clarify their safety and efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsrh-2026-203330","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:05:16Z","timestamp":1790179516000},"page":"s23-s32","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy, safety and acceptability of once-monthly oral contraceptives containing quinestrol and quingestanol, quinestrol and levonorgestrel or quinestrol and norgestrel: a systematic review"],"prefix":"10.1136","volume":"52","author":[{"given":"Yuanyuan","family":"Yao","sequence":"first","affiliation":[{"name":"Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China"},{"name":"Key Laboratory of Evidence Based Medicine of Gansu Province, Lanzhou, Gansu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Liu","sequence":"additional","affiliation":[{"name":"Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China"},{"name":"Institute of Health Data Science, Lanzhou University, Lanzhou, Gansu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingyi","family":"Wang","sequence":"additional","affiliation":[{"name":"Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meihua","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Public Health, Lanzhou University, Lanzhou, Gansu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huayu","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Public Health, Lanzhou University, Lanzhou, Gansu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haodong","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Lanzhou University, Lanzhou, Gansu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu","family":"Yang","sequence":"additional","affiliation":[{"name":"Women\u2019s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Santesso","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asantesana","family":"Kamuyango","sequence":"additional","affiliation":[{"name":"Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3447-244X","authenticated-orcid":false,"given":"Nancy","family":"Kidula","sequence":"additional","affiliation":[{"name":"Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4180-7858","authenticated-orcid":false,"given":"James N","family":"Kiarie","sequence":"additional","affiliation":[{"name":"Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9841-5233","authenticated-orcid":false,"given":"Yaolong","family":"Chen","sequence":"additional","affiliation":[{"name":"Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China"},{"name":"WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, Gansu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"2026092309050932000_52.Suppl_2.s23.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.xagr.2022.100132","article-title":"Facility readiness to remove subdermal contraceptive implants in 6 sub-Saharan African countries","volume":"2","author":"Senderowicz","year":"2022","journal-title":"AJOG Glob Rep"},{"key":"2026092309050932000_52.Suppl_2.s23.2","doi-asserted-by":"crossref","DOI":"10.3389\/fgwh.2024.1433189","article-title":"Understanding the perceptions and reactions to a monthly oral contraceptive capsule with end users and healthcare providers in Bangladesh, Senegal and Zimbabwe","volume":"5","author":"El-Sahn","year":"2024","journal-title":"Front Glob Womens Health"},{"key":"2026092309050932000_52.Suppl_2.s23.3","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/S0015-0282(16)36245-8","article-title":"One-pill-a-month contraceptive","volume":"18","author":"Greenblatt","year":"1967","journal-title":"Fertil Steril"},{"key":"2026092309050932000_52.Suppl_2.s23.4","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/S0015-0282(16)37203-X","article-title":"A pill-a-month contraceptive","volume":"20","author":"Maqueo-Topete","year":"1969","journal-title":"Fertil Steril"},{"key":"2026092309050932000_52.Suppl_2.s23.5","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.contraception.2007.01.007","article-title":"Once-a-month contraceptive pills in China: a review of available evidence","volume":"75","author":"Kejuan","year":"2007","journal-title":"Contraception"},{"key":"2026092309050932000_52.Suppl_2.s23.6","unstructured":"Fan HM . Studies on long-acting oral contraceptives. In: Chang CF , Griffin D , eds. Recent advances in fertility regulation. Geneva: Atar SA, 1981: 378\u201393."},{"key":"2026092309050932000_52.Suppl_2.s23.7","first-page":"11","article-title":"Clinical observation on long acting oral contraceptives levonorgestrel + quinestrol [In Chinese]","volume":"12","author":"Weng","year":"1992","journal-title":"Reprod Contracept"},{"key":"2026092309050932000_52.Suppl_2.s23.8","first-page":"1506","article-title":"Research progress on female contraceptives in clinic [in Chinese]","volume":"39","author":"Hu","year":"2020","journal-title":"Herald Med"},{"key":"2026092309050932000_52.Suppl_2.s23.9","doi-asserted-by":"crossref","DOI":"10.1016\/j.contraception.2025.110946","article-title":"Estimating emergency contraception efficacy with levonorgestrel and copper intrauterine devices","volume":"149","author":"Nourse","year":"2025","journal-title":"Contraception"},{"key":"2026092309050932000_52.Suppl_2.s23.10","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/1472-6874-14-54","article-title":"A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception","volume":"14","author":"Shohel","year":"2014","journal-title":"BMC Womens Health"},{"key":"2026092309050932000_52.Suppl_2.s23.11","first-page":"39","article-title":"The biological activities of norgestrel and its enantiomers","volume":"24","author":"Jones","year":"1979","journal-title":"Int J Fertil"},{"key":"2026092309050932000_52.Suppl_2.s23.12","first-page":"38","article-title":"A strategic assessment of the need for contraceptive introduction in Chongqing Municipality China [in Chinese]","volume":"10","author":"Fang","year":"2002","journal-title":"Chin J Fam Plan"},{"key":"2026092309050932000_52.Suppl_2.s23.13","unstructured":"Phiri P . Health experts in Zambia warn women to stay away from Chinese contraceptives. Global Press Journal; 2016. Available: https:\/\/globalpressjournal.com\/africa\/zambia\/health-experts-zambia-warn-women-stay-away-chinese-contraceptives\/ [Accessed 28 Feb 2026]."},{"key":"2026092309050932000_52.Suppl_2.s23.14","unstructured":"Motaung N . Deadly Chinese contraceptive pill floods Lesotho\u2019s black market. NewsDay; 2025. Available: https:\/\/newsdayonline.co.ls\/deadly-chinese-contraceptive-pill-floods-lesothos-black-market\/ [accessed 28 Feb 2026]"},{"key":"2026092309050932000_52.Suppl_2.s23.15","unstructured":"Musambi E . Kenya battles unsafe Chinese contraceptive pill a decade after ban. BBC News, 2022. Available: https:\/\/www.bbc.com\/news\/world-africa-63299185 [accessed 28 Feb 2026]."},{"key":"2026092309050932000_52.Suppl_2.s23.16","unstructured":"Unauthorized Chinese pill tablets on the market. National Drug Authority Uganda; 2022. Available: https:\/\/www.nda.or.ug\/wp-content\/uploads\/2022\/10\/CIRCULAR-CHINESE-PILL08347920221014101855.pdf [accessed 28 Feb 2026]"},{"key":"2026092309050932000_52.Suppl_2.s23.17","unstructured":"World Health Organization (WHO) . Medical Eligibility Criteria for Contraceptive Use. 6th Ed; 2025. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240115583 [accessed 28 Feb 2026]"},{"key":"2026092309050932000_52.Suppl_2.s23.18","unstructured":"World Health Organization (WHO) . Selected Practice Recommendations for Contraceptive Use. 4th Ed; 2025. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240115606 [accessed 28 Feb 2026]"},{"key":"2026092309050932000_52.Suppl_2.s23.19","unstructured":"World Health Organization . Essential medicines. 2024. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/essential-medicines [Accessed 28 Feb 2026]."},{"key":"2026092309050932000_52.Suppl_2.s23.20","unstructured":"Higgins JPT , Thomas J , Chandler J , et al . Cochrane Handbook for Systematic Reviews of Interventions Version 6.5 (Updated August 2024). Cochrane, 2024. Available: https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook"},{"key":"2026092309050932000_52.Suppl_2.s23.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026092309050932000_52.Suppl_2.s23.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2026092309050932000_52.Suppl_2.s23.23","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"2026092309050932000_52.Suppl_2.s23.24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjebm-2017-110853"},{"key":"2026092309050932000_52.Suppl_2.s23.25","doi-asserted-by":"crossref","unstructured":"Aromataris E , Lockwood C , Porritt K . JBI manual for evidence synthesis. JBI, 2024. Available: https:\/\/doi.org\/10.46658\/JBIMES-24-01","DOI":"10.46658\/JBIMES-24-01"},{"key":"2026092309050932000_52.Suppl_2.s23.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.026"},{"key":"2026092309050932000_52.Suppl_2.s23.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.11.026"},{"key":"2026092309050932000_52.Suppl_2.s23.28","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/0010-7824(75)90065-7","article-title":"Biochemical studies with once-a-month contraceptive pill containing quinestrol-quingestanol acetate","volume":"11","author":"Donde","year":"1975","journal-title":"Contraception"},{"key":"2026092309050932000_52.Suppl_2.s23.29","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/S0015-0282(16)39254-8","article-title":"Further experience with a once-a-month oral contraceptive: quinestrol-quingestanol","volume":"23","author":"Rubio","year":"1972","journal-title":"Fertil Steril"},{"key":"2026092309050932000_52.Suppl_2.s23.30","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/S0015-0282(16)37331-9","article-title":"Clinical study of a once-a-month oral contraceptive: quinestrol-quingestanol","volume":"21","author":"Guiloff","year":"1970","journal-title":"Fertil Steril"},{"key":"2026092309050932000_52.Suppl_2.s23.31","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/0010-7824(73)90157-1","article-title":"Life table analysis of a clinical study of a once-a-month oral steroid contraceptive: Quinestrol \u2014 Quingestanol","volume":"8","author":"Mishell","year":"1973","journal-title":"Contraception"},{"key":"2026092309050932000_52.Suppl_2.s23.32","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/0010-7824(74)90008-0","article-title":"Fertility following termination of the once-a-month oral contraceptive","volume":"10","author":"Maqueo-Topete","year":"1974","journal-title":"Contraception"},{"key":"2026092309050932000_52.Suppl_2.s23.33","first-page":"1","article-title":"Pill-a-month as an oral contraceptive","volume":"5","author":"Hefnawi","year":"1972","journal-title":"Egypt Popul Fam Plann Rev"},{"key":"2026092309050932000_52.Suppl_2.s23.34","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/0010-7824(74)90037-7","article-title":"Clinical experience in India with a once-a-month oral contraceptive pill: qingestanol and quinestrol","volume":"10","author":"Tejuja","year":"1974","journal-title":"Contraception"},{"key":"2026092309050932000_52.Suppl_2.s23.35","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/0010-7824(70)90053-3","article-title":"Clinical study of a once-a-month oral contraceptive: Quinestrol-quingestanol","volume":"1","author":"Larranaga","year":"1970","journal-title":"Contraception"},{"key":"2026092309050932000_52.Suppl_2.s23.36","first-page":"89","article-title":"Quinestrol-quingestanol combination for conception control","volume":"13","author":"Ansari","year":"1974","journal-title":"J Reprod Med"},{"key":"2026092309050932000_52.Suppl_2.s23.37","first-page":"176","article-title":"Poor acceptability of \u201cPill-a-month\u201d contraceptive. High pregnancy and drop-out rates in a small sample","volume":"22","author":"Vaidya","year":"1976","journal-title":"J Postgrad Med"},{"key":"2026092309050932000_52.Suppl_2.s23.38","first-page":"202","article-title":"A Latin American field trial with a once-a-month oral contraceptive","volume":"10","author":"Leguia","year":"1973","journal-title":"J Reprod Med"},{"key":"2026092309050932000_52.Suppl_2.s23.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.12.089"},{"key":"2026092309050932000_52.Suppl_2.s23.40","doi-asserted-by":"publisher","DOI":"10.1016\/S0010-7824(97)00157-1"},{"key":"2026092309050932000_52.Suppl_2.s23.41","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(98)70047-X"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2026-203330","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:05:32Z","timestamp":1790179532000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2026-203330"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":41,"journal-issue":{"issue":"Suppl 2","published-online":{"date-parts":[[2026,9,23]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bmjsrh-2026-203330"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2026-203330","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}