QS is a family planning method that:

• uses a drug called quinacrine
• permanently prevents pregnancy
• is nonsurgical
• has been used by over 100,000 women around the world

Quinacrine Sterilization (QS) is intended to prevent pregnancy. It does not protect against HIV infection (AIDS) and other sexually transmitted diseases.
QS is a sterilization procedure for women without surgery. It uses a drug called quinacrine to cause the fallopian tubes to be blocked. This method is permanent. It cannot be reversed. A woman should not agree to have this procedure done if she may want more children. The QS method is intended to prevent pregnancies permanently, but like all methods, it can fail and the women could become pregnant. SEE ALSO
Quinacrine is also known as Atabrine or Mepacrine. It was first introduced in the 1930s to prevent and treat malaria. Since then, doctors all over the world have prescribed it for millions of people who have malaria and also for treatment of giardiasis, lupus, tapeworm and other medical conditions. It is the only drug in the United States approved by the FDA (Food and Drug Administration) to treat giardiasis.
There has been a great deal of research on quinacrine over the past 65 years and it has been found to be very safe. Millions of Americans have taken as much as 36,500 to 52,000 milligrams of quinacrine by mouth each year. In some cases they have done so for years as an anti-malverdana, arial, helvetica, with few lasting side effects. The QS method requires only 504 milligrams of quinacrine to be inserted into the uterus in two doses (252 mg a dose) one month apart.
The QS method was first developed in Chile in 1977. Since then, over 100,000 women in 20 countries have used the method. Even though quinacrine is a FDA approved drug, the FDA has not yet approved its use for female sterilization. Using quinacrine for this purpose is considered an "off-label" use. The off-label use of drugs is a perfectly legal, acceptable, and common practice. Treating lupus with quinacrine is also an off-label use. Approximately 60% of all prescriptions written in the U.S. are for off-label use.
In 100,000 cases, no deaths or life threatening complications have been reported. But there may be some risks, as with almost all contraceptives. SEE ALSO, SEE ALSO, SEE ALSO. Back to top of page

How does QS act as a contraceptive?
Quinacrine in the form of seven pellets is placed high in the uterus using a modified IUD inserter. Over the course of 30 minutes, the pellets dissolve in uterine fluid. A small portion of the fluid containing quinacrine makes its way a short distance into the fallopian tubes. About 30% of the quinacrine is excreted from the vagina and the rest is quickly absorbed from the uterus through blood vessels. This takes from one to four hours. The small amount entering the fallopian tubes injures their lining several cell layers deep. We do not yet understand the mechanism of the injury, which causes inflammation. The end result is formation of scar tissue. Each tube is blocked by a plug of scar tissue near its junction with the uterus. The egg cannot pass the point of blockage and is reabsorbed just like other cells. Normal ovulation continues until menopause. Surgical sterilization also produces scar tissue as a result of injury, blocking the tubes. Back to top of page

How is Quinacrine inserted?
The quinacrine can only be inserted on the 6th through the 12th day of the menstrual period. This lessens the risk of the woman unknowingly being pregnant. It is also that part of the cycle when the height of the endometrium, which may interfere with the action of the quinacrine, is the lowest.

Before insertion, the clinician will perform a pelvic examination. Its purpose is to determine the size, shape, and position of the uterus and to be sure that there are no contraindications. An instrument called a speculum will hold the vagina open so that the cervix (the entrance to the uterus) can be seen. (The woman will probably feel pressure from the speculum throughout the insertion procedure as in a normal pelvic with a speculum.)

The cervix is then cleaned with an antiseptic solution and an instrument called a tenaculum is attached to it. This instrument assists in holding the uterus steady during insertion. Pain or a pinching sensation may be felt as the tenaculum is attached. Then the clinician will guide a narrow instrument called a sound through the opening of the cervix into the uterus. The sound measures the depth and position of the uterus. Cramping similar to menstrual cramps is expected as the sound is inserted and withdrawn.

Then the clinician will guide the inserter containing the quinacrine pellets through the vagina and the cervix into the uterus. The pellets are then placed at the top of the uterus and the inserter is withdrawn.

During insertion, some pain or cramping is to be expected. Some women may feel nauseous, weak or faint. After the inserter is removed from the cervical opening, the tenaculum and speculum will then be removed. Pain or pinching may be felt when the tenaculum is removed. Remaining lying down for a while and rising slowly usually prevents fainting. The women's experience of the QS insertion has been reported to be very similar to that of an IUD insertion. Back to top of page

Using a modified IUD inserter, the provider (a midwife, nurse or doctor) places 7 small pellets (pills) of quinacrine in the uterus.

In half an hour, the pellets dissolve and the liquid quinacrine flows into the tubes. The quinacrine causes inflammation of the lining of the fallopian tubes.

The quinacrine that does not go into the tubes is absorbed into the womb or comes out in the vagina.

Over the next 6-12 weeks, the quinacrine causes plugs of scar tissue to form at the first part of the tubes. These plugs close the tubes and block the egg’s path to the uterus.

6-12 days after the next menstrual period begins, a second insertion is performed. Back to top of page

Some women have menstrual changes after the insertions. This means that they either do not have their period or there is a change in the amount of flow of their period or the number of days it lasts. This usually lasts no more than a few months. In rare cases, it may last a year or more.

The following may occur during the insertion of the quinacrine and shortly afterwards. The experience of side effects associated with the QS insertion has been reported to be very similar to that of an IUD insertion, both in frequency and intensity.

1. Pain, usually uterine cramps, low backache, headache, dizziness, vaginal itching or irritation and fever may occur at the time of insertion or shortly afterwards and may persist. If pain is severe, becomes worse, or persists, she should contact her clinician. Pain during sex is a rare side effect that disappears within a few months. Pain during urination is also rarely reported and disappears without treatment.

2. Fainting may occur at the time of insertion.

3. A small amount of bleeding occurs following insertion in some women. If the amount of blood is more than 1 milliliter, the insertion must be repeated in the next cycle as an additional insertion. Blood in the uterus interferes with the action of the quinacrine and will increase the risk of failure.

4. Partial or total perforation of the inserter through the wall of the uterus may occur at the time of insertion with deposit of quinacrine in the abdominal cavity. Perforation could result in abdominal adhesions (scars), severe pain, and loss of contraceptive protection. Perforation and its complications may require surgery and, in very rare cases, could possibly result in serious illness or death.

5. Bleeding between menstrual periods may occur during the first two or three months after insertion. The first few menstrual periods after insertion may be heavier and longer than usual or they may be lighter and shorter. Some women will miss their period for even several months after the first insertion. If these conditions continue for longer than two or three months, a woman should consult her clinician.

6. Occasionally, women report missing a menstrual period while using QS. It is important to determine if she is pregnant; she should report this without delay to her clinician.

7.There will be a bright yellow discharge from the vagina during the first 24 hours following insertion. The bright yellow color comes from the quinacrine itself. This side effect is harmless but it does stain, as quinacrine is also a dye.

8. Severe Allergic Reaction to Quinacrine
Severe allergic reactions are known to occasionally occur with every drug used by humans. Quinacrine is no exception. Thus far, we have seen two severe allergic reactions with QS, or one per 50,000 cases. Though rare, the risk exists. Severe allergic reactions sometimes result in death.

The following adverse reactions have been reported and may be caused by QS:

• Failure of the procedure (pregnancy)


• Severe allergic reaction


• Backache


• Cervical infection


• Death


• Delayed menstruation


• Fainting and pain at the time of insertion


• Spotting between periods


• Miscarriage


• Pain and cramps


• Pelvic infection (PID), which may result in surgical removal of reproductive organs, including hysterectomy


• Hematometra, accumulation of menstrual blood in the womb, an easily-treated condition


• Perforation of the uterus (womb) or cervix (inserter passes through uterine tissue and pellets are placed in the abdomen)


• Prolonged or heavy menstrual flow


• No period


• Regret, a change of mind about the decision to terminate fertility


• Uterine synechia, adhesions between the anterior and posterior uterine walls


• Vaginal discharge, bright yellow due to the color of the quinacrine or opaque

As with other methods of contraception, tubal pregnancy (a pregnancy which occurs outside of the uterus), though rare, can still occur. Tubal pregnancy may still occur after QS, but it is not caused by this method. The tubal pregnancy rate with this method is lower than the rate in women who use no contraceptive method. Tubal pregnancies are very dangerous. In some countries, 1 out of 20 women with a tubal pregnancy dies. If a woman believes she is pregnant and has any of these signs, she should contact her provider right away:

• a missed period.
• severe pain in the lower abdominal area, or shoulder pain
• dizziness, fainting or weakness
• vaginal bleeding other than a normal menstrual period.

Ectopic pregnancy does not happen often, but it is dangerous because it develops outside the uterus. Researchers have found that the rate of ectopic pregnancy for women who have been sterilized by the QS method is lower than among fertile women who do not use contraception. But a pregnancy that occurs with QS is more likely to be ectopic than a pregnancy occurring without QS. This is true of surgical sterilization as well. The rate of ectopic pregnancy has been shown to be about 1 per 1,000 woman-years of use with QS, a similar rate is found with surgical sterilizations. If a woman has ever had an ectopic pregnancy, there is an increased risk of having another one. There is also an increased risk of an ectopic pregnancy if a woman has ever had certain types of infections. These infections include pelvic inflammatory disease (PID) or any venereal disease (VD) or sexually transmitted disease (STD) caused by, for example, gonorrhea or chlamydia.

Anytime a woman becomes pregnant there is a risk that it could be ectopic. Ectopic pregnancy can cause death, so it is very important to know the symptoms! If a woman suspects that she may be pregnant she must immediately contact her doctor or nurse and go to a hospital or clinic to find out if it is an ectopic pregnancy. Ectopic pregnancy may require surgery to save her life.

There are 13 conditions that should prevent or delay a quinacrine sterilization. These are:

• Pregnancy. The clinician must absolutely be certain that the woman is not pregnant before QS can be performed. If there is any reason to suspect pregnancy, a pregnancy test will be needed.


• Severe cervicitis


• Purulent discharge


• Active vaginal bleeding


• Tumor in the reproductive tract (fibroid, etc.).Severe uterine distortion (bicornate uterus, etc.) that will not allow proper placement of the pellets.


• Pelvic inflammatory disease (PID)


• Intermenstrual or other abnormal bleeding patterns


• Psoriasis (quinacrine may cause a severe attack of psoriasis)


• Porphyria (quinacrine may cause this condition to worsen)


• Glucose-6-phosphate dehydrogenase (G6PD) deficiency


• Use of alcohol or alcohol-containing medications


• Use of primaquine

Other conditions that should be discussed with a clinician before a QS
The conditions listed below are not necessarily contraindications, but a clinician should know if a women has had or suspects she has had:

Potential for Regret
About one woman in 100 in the U.S. regrets getting sterilized, almost always due to changing circumstances, usually divorce or remarriage. In developing countries this rate is believed to be about 1 in 1,000. QS is not reversible. Surgical sterilization is sometimes reversible. If a woman believes there is any chance that she may regret her decision, QS might not be her best option. Surgical sterilization or a temporary method would be more appropriate. Before agreeing to be sterilized a woman should be comfortable with her decision. She should ask herself these questions.

Am I sure that I never want any more children?
Would temporary methods or a surgical sterilization be better for me?
Is my family or a clinician or anyone else pressuring me to get sterilized?
Why am I choosing QS?

Available data from numerous sources have been analyzed to estimate the risk of death associated with various methods of contraception. The estimates of risk of death include the combined risk of the contraceptive method plus the risk of pregnancy or abortion in the event of method failure.

Annual Number of Birth-Related or Method-Related Deaths Associated with Control of Fertility per 100,000 Nonsterile Women, by Fertility Control Method, According to Age.

* Deaths are birth related only ** Deaths are method related or birth related

To learn about the risks and benefits of QS, a brochure has been prepared, it should be read in its entirety, and discussed with a clinician. It contains information that is vital to a woman's health. She should read the QS leaflet and also view the QS film.

If she does not understand any of the technical terms in this brochure, she should ask her clinician to explain to her satisfaction anything that is not clear.

Besides reading this brochure, it is a good idea to learn about other birth control methods. One of them may be more suitable or safer for her than QS. To make the right personal decision, she must discuss her questions about QS and other kinds of birth control with her clinician.

Under certain conditions, QS is not recommended. The risks to a woman's health may be too great.

Even if none of them applies to her, she may still experience serious problems with QS that will require immediate medical treatment. These medical problems could cause damage to her reproductive organs or, in some cases, cause death. She may have to undergo major surgery. Though absolutely necessary, prompt medical treatment may not be effective.

Read 14, 15, 16, 17, 18, 19, 20 and Warnings

Become familiar with the danger signs of QS. Always discuss these and other sections of the brochure with a clinician before making a decision.