Ormeloxifene (Centchroman)
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Direct answer
Ormeloxifene, also called centchroman and marketed in India as Saheli, is a non-steroidal oral contraceptive taken once a week. It acts as a selective oestrogen receptor modulator and is a chroman (benzopyran) derivative rather than a steroid hormone. The standard regimen is 30 mg twice a week for the first 12 weeks, then 30 mg once a week on a fixed day, and pregnancy must be excluded before starting.
What you must remember
- Origin: Developed at the Central Drug Research Institute, Lucknow, and used in India as a weekly non-steroidal contraceptive.
- Drug class: A non-steroidal selective oestrogen receptor modulator, unlike the steroidal combined oral pill.
- Dose: 30 mg twice weekly for the first 12 weeks, then 30 mg once weekly on a fixed day; the weekly maintenance schedule is the feature most often tested.
- Mechanism: Thought to act mainly through endometrial and tubal effects, with less consistent suppression of ovulation than combined pills.
- Side effects: Menstrual irregularity, leucorrhoea, nausea, headache and dizziness are the commonest; pruritus is reported less often.
- Precautions: Pregnancy must be excluded before starting, and unexplained vaginal bleeding should be evaluated first.
How ormeloxifene compares with the combined oral pill
Centchroman is most often compared with the daily combined pill, because the two differ in class, schedule and main mechanism. Comparing them clarifies both the mechanism and the counselling points.
| Feature | Ormeloxifene | Combined oral pill |
|---|---|---|
| Chemical class | Non-steroidal SERM | Steroidal oestrogen and progestogen |
| Schedule | 30 mg twice weekly for 12 weeks, then weekly | One tablet daily |
| Main mechanism | Endometrial and tubal effects | Suppression of ovulation |
| Bleeding pattern | Irregularity is common | Usually more regular |
| Typical side effects | Irregular bleeding, leucorrhoea | Nausea, breast tenderness, headache |
The weekly schedule suits women who find daily pills hard to remember, but irregular bleeding is a common counselling issue. Because its main action is not simple ovulation suppression, the exam answer should not describe it as a copy of the combined pill.
Adherence is easiest when the weekly dose is tied to a fixed routine, such as the same day each week. Missed doses should be managed as per the product schedule and local guidance rather than improvised.
Where the exam tries to catch you
Centchroman questions usually test its class, its schedule and the pre-treatment checks.
- Trap: Classifying ormeloxifene as a steroidal pill like the combined oral contraceptive Correct: It is a non-steroidal selective oestrogen receptor modulator, a chroman derivative.
- Trap: Prescribing it as a daily tablet Correct: After a twice-weekly loading phase of 12 weeks, the maintenance dose is 30 mg once a week on a fixed day.
- Trap: Starting it without excluding pregnancy Correct: It is an antifertility agent, so pregnancy must be ruled out before the first dose.
Frequently asked questions
What is the standard dose of ormeloxifene?
The standard dose is 30 mg twice a week for the first 12 weeks, then 30 mg once a week on the same day. Starting and missed-dose instructions follow the product schedule and local guidance. The weekly maintenance schedule is the feature most often tested in exams.
Is ormeloxifene a steroid hormone?
No, ormeloxifene is a non-steroidal selective oestrogen receptor modulator. It is a chroman (benzopyran) derivative, pharmacologically a SERM like tamoxifen and raloxifene, which is why it is not classed with steroidal combined pills. This distinction is a commonly tested point.
What are the commonest side effects of ormeloxifene?
The commonest side effects are menstrual irregularity, leucorrhoea, nausea, headache and dizziness. Pruritus is reported less often. Women should be counselled in advance that some change in bleeding pattern is expected.
Why must pregnancy be excluded before starting ormeloxifene?
Ormeloxifene is an antifertility agent, so its use is inappropriate during pregnancy. A pregnancy test before starting protects both the woman and any pregnancy. Unexplained bleeding should also be evaluated before treatment begins.