Extended-Cycle Oral Contraception

Extended use of oral contraceptive (OC) pills can successfully suppress endometrial activity and prevent menstruation for several months. Given that missed menses in women not using hormonal contraception may be of medical concern, understanding how hormonal contraceptives eliminate these concerns is important for both patient and healthcare provider acceptance. OC withdrawal bleeding is an artificial, iatrogenic event, which results from the deliberate, periodic interruption of hormonal support of the endometrium. Historically, it was important to provide periodic bleeding to reassure OC efficacy, but today it is recognized that these bleeding episodes are medically unnecessary and cause patient discomfort and out-of-pocket expenses. Decades of experience with prolonged use of OCs have been accumulated for women with specific menstrual-related problems such as endometriosis, dysmenorrhea, and menstrual migraine headaches. Today there is a US FDA-approved product to routinely reduce the number of withdrawal periods. Clinical trials show that there is an initial increase in unscheduled bleeding and spotting days with extended-cycle OC use, but an absolute decrease in total days of bleeding and spotting from the first cycle of use. Over time, unscheduled bleeding and spotting decreases to rates found with the use of conventional-cycle regimens. Every woman who is interested in using OC pills should be offered the opportunity to choose how to use them, to determine if and when she will have withdrawal bleeding. Similar content being viewed by others Notes The use of trade names is for product identification purposes only and does not imply endorsement.

Marks L. Sexual chemistry: a history of the contraceptive pill. New Haven (CT): Yale University Press, 2001 Gladwell M. Annals of medicine. John Rock’s error. What the co-inventor of the pill didn’t know about menstruation can endanger women’s health [online]. Available from URL: http://www.gladwell.com/archive.html [Accessed 2004 Sep 16] Baerwald AR, Olatunbosun OA, Pierson RA. Ovarian follicular development is initiated during the hormone-free interval of oral contraceptive use. Contraception 2004 Nov; 70(5): 371–7 Kistner RW. Current status of the hormonal treatment of endometriosis. Clin Obstet Gynecol 1966 Jun; 9(2): 271–92 Vercellini P, Frontino G, De Giorgi O, et al. Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. Fertil Steril 2003 Sep; 80(3): 560–3 Boyle CA. Management of menstrual migraine. Neurology 1999; 53(4 Suppl. 1): S14–8 Sommerville RI, Rogers WP. The nature and action of host signals. Adv Parasitol 1987; 26: 239–93 Mattson RH, Rebar RW. Contraceptive methods for women with neurologic disorders. Am J Obstet Gynecol 1993 Jun; 168 (6 Pt 2): 2027–32 Schwallie PC, Assenzo JR. Contraceptive use: efficacy study utilizing medroxy-progesterone acetate administered as an intramuscular injection once every 90 days. Fertil Steril 1973 May; 24(5): 331–9 Sulak PJ, Scow RD, Preece C, et al. Hormone withdrawal symptoms in oral contraceptive users. Obstet Gynecol 2000 Feb; 95(2): 261–6 Sulak PJ, Kuehl TJ, Ortiz M, et al. Acceptance of altering the standard 21-day/7-day oral contraceptive regimen to delay menses and reduce hormone withdrawal symptoms. Am J Obstet Gynecol 2002 Jun; 186(6): 1142–9 Miller L, Notter KM. Menstrual reduction with extended use of combination oral contraceptive pills: randomized controlled trial. Obstet Gynecol 2001 Nov; 98 (5 Pt 1): 771–8 Miller L, Hughes JP. Continuous combination oral contraceptive pills to eliminate withdrawal bleeding: a randomized trial. Obstet Gynecol 2003 Apr; 101(4): 653–61 Kwiecien M, Edelman A, Nichols MD, et al. Bleeding patterns and patient acceptability of standard or continuous dosing regimens of a low-dose oral contraceptive: a randomized trial. Contraception 2003 Jan; 67(1): 9–13 Cote I, Jacobs P, Cumming D. Work loss associated with increased menstrual loss in the United States. Obstet Gynecol 2002 Oct; 100(4): 683–7 Davis AR, Westhoff CL. Primary dysmenorrhea in adolescent girls and treatment with oral contraceptives. J Pediatr Adolesc Gynecol 2001 Feb; 14(1): 3–8 Thomas SL, Ellertson C. Nuisance or natural and healthy: should monthly menstruation be optional for women? Lancet 2000 Mar; 355(9207): 922–4 Cote I, Jacobs P, Cumming DC. Use of health services associated with increased menstrual loss in the United States. Am J Obstet Gynecol 2003 Feb; 188(2): 343–8 Elomaa K, Rolland R, Brosens I, et al. Omitting the first oral contraceptive pills of the cycle does not automatically lead to ovulation. Am J Obstet Gynecol 1998 Jul; 179(1): 41–6 Schlaff WD, Lynch AM, Hughes HD, et al. Manipulation of the pill-free interval in oral contraceptive pill users: the effect on follicular suppression. Am J Obstet Gynecol 2004 Apr; 190(4): 943–51 Spona J, Elstein M, Feichtinger W, et al. Shorter pill-free interval in combined oral contraceptives decreases follicular development. Contraception 1996 Aug; 54(2): 71–7 Duramed Pharmaceuticals Inc. Seasonale® [prescribing information]. Pomona (NY): Duramed Pharmaceuticals Inc., 2003 Sep Profet M. Menstruation as a defense against pathogens transported by sperm. Q Rev Biol 1993 Sep; 68(3): 335–86 Coutinho EM, Segal SJ. Is menstruation obsolete? New York (NY): Oxford University Press, 1999 Brumberg JJ. The body’s new timetable: how the life course of American girls has changed. ACOG Clin Rev 1998 Sep 10; 3(5): 16, 13–5 Anderson FD, Hait H. A multicenter, randomized study of an extended cycle oral contraceptive. Contraception 2003 Aug; 68(2): 89–96 Hamerlynck JV, Vollebregt JA, Doornebos CM, et al. Postponement of withdrawal bleeding in women using low-dose combined oral contraceptives. Contraception 1987 Mar; 35(3): 199–205 Sulak PJ, Carl J, Gopalakrishnan I, et al. Outcomes of extended oral contraceptive regimens with a shortened hormone-free interval to manage breakthrough bleeding. Contraception 2004 Oct; 70(4): 281–7 Rutter W, Knight C, Vizzard J, et al. Women’s attitudes to withdrawal bleeding and their knowledge and beliefs about the oral contraceptive pill. Med J Aust 1988 Oct 17; 149(8): 417–9 den Tonkelaar I, Oddens BJ. Preferred frequency and characteristics of menstrual bleeding in relation to reproductive status, oral contraceptive use, and hormone replacement therapy use. Contraception 1999 Jun; 59(6): 357–62 Glasier AF, Smith KB, van der Spuy ZM, et al. Amenorrhea associated with contraception: an international study on acceptability. Contraception 2003 Jan; 67(1): 1–8 Association of Reproductive Health Professionals. Choosing when to menstruate: the role of extended contraception. National Survey. Harris Poll, June 14–17 and July 18–22, 2002 [online]. Available from URL: http://www.arhp.org/ healthcareproviders/visitingfacultyprograms/extended/nationalsurvey.cfm [Accessed 2004 Sep 25] Wiegratz I, Hommel HH, Zimmermann T, et al. Attitude of German women and gynecologists towards long-cycle treatment with oral contraceptives. Contraception 2004 Jan; 69(1): 37–42 Andrist LC, Arias RD, Nucatola D, et al. Women’s and providers’ attitudes toward menstrual suppression with extended use of oral contraceptives. Contraception 2004 Nov; 70(5): 359–63 Loudon NB, Foxwell M, Potts DM, et al. Acceptability of an oral contraceptive that reduces the frequency of menstruation: the tri-cycle pill regimen. BMJ 1977 Aug 20; 2(6085): 487–90 Braunstein JB, Hausfeld J, Hausfeld J, et al. Economics of reducing menstruation with trimonthly-cycle oral contraceptive therapy: comparison with standard-cycle regimens. Obstet Gynecol 2003 Oct; 102(4): 699–708 Schwartz JL, Creinin MD, Pymar HC. The trimonthly combination oral contraceptive regimen: is it cost effective? Contraception 1999 Nov; 60(5): 263–7 Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Nelson, A.L. Extended-Cycle Oral Contraception. Mol Diag Ther 4, 139–145 (2005). https://doi.org/10.2165/00024677-200504030-00002 Published: Issue date: DOI: https://doi.org/10.2165/00024677-200504030-00002