Historical review of the combined oral contraceptive pill and injectable progestogens.

This paper traces the history of the combined oral contraceptive (OC) pill and injectable progestogens. Around the 1920s-30s experiments on rabbits demonstrated that transplantation of ovaries and injection of ovarian extracts could reduce fertility. This breakthrough was followed by the synthesis of progesterone and the formation of the first contraceptive pharmaceutical company Syntex. In 1949 an orally active progestogen norethisterone was synthesized while private individuals funded research on the development of an OC. During the trials for the efficacy of progestogen researchers found that best results were obtained when combined with a controlled amount of estrogen. From this evolved Envoid the first combined OC pill containing 9.85 mg of norethynodrel and 0.15 mg of mestranol. In 1960 Envoid was granted a license by the US Food and Drug Administration (FDA). The OC pill revolutionized family planning and was able to address the concerns of women regarding fertility control; however several controversies arose after the promotion of OCs. One controversy was the approval of the FDA for promoting Depo-Provera as a contraceptive method. The OC pill then suffered a backlash and was linked to increased risk of breast cancer and venous thromboembolism. Towards the end of the century positive publicity and review of new methods were required to restore the faith of women in hormonal contraceptives.