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John Rock 



This is rather easily controlled by increasing the dosage. If the daily dose 

 is 10 mg, a per diem increase of 5 mg usually stops the bleeding. We have seen 

 that such staining occurs more often in the early than in the later cycles of 

 treatment. This is clearly shown in Table II. A contributory factor in this 

 connection may be the patient's tendency in earlier cycles to fail to adhere to 

 the regimen as prescribed. However, it must be remembered, in considering 

 these tabulated figures, that some of the women who have this early bleeding 

 drop out of the treated group; this naturally leaves a lower average number 

 of affected patients in the later cycles. 



Table 12. 



Fertility Control with Enovid: Incidence of Amenorrhea in 

 Various Cycles of Medication 



3. Amenorrhea: ''Occult regression of the endometrium." One interesting 

 observation, so-called "occult regression of the endometrium", sometimes 

 incorrectly termed "silent menstruation", shows that menstruation is not in 

 essence a breakdown, but only a regression of the endometrium. This may 

 be complete, yet without bleeding. The sudden occurrence of amenorrhea 

 after perhaps a number of regular cycles during treatment usually disturbs 

 the patient. When menstruation fails to appear after she stops the medication 

 as prescribed, she believes she must be pregnant, but she is not. The tempera- 

 ture graph descends to the premedication level. Then, after about 10 to 20 

 days, without intervening catamenia, ovulation will again take place. 



Hence patients who are using these steroids for contraceptive purposes 

 must fix the regimen entirely on the occurrence of menstruation. If this does 

 not follow within 6 days after the end of one cycle of medication, pill-taking 

 must be resumed by the 10th day at the latest, or ovulation is very likely soon 

 to occur. The incidence of this interesting and physiologically instructive 

 phenomenon is suggested in Table 12. It happens, in fact, on the average in 

 less than 2% of all cycles (30). 



