Rapid Resumption of Ovulation and Menstruation Following Continuous Use of the Combination Oral Contraceptive

Abstract

Background: The return of ovulation and fertility following cyclic oral contraceptive (OC) use can be delayed in some women. The return to ovulation following long-term suppression with continuous use of the pill has not been studied. It is possible cycle suppression for many years could induce ovarian quiescence and a delay in the return to ovulation and menstruation. Objective: The purpose of this study was to evaluate the time to ovulation and menstruation following discontinuation of daily OC consumption. Materials and Methods: Three faculty, with continuous combination pill use for the prior three years or greater, prospectively stopped their pill use and underwent serial ultrasound examination, urinary LH testing to confirm ovulation, and serial serum estradiol and progesterone measurements. Result(s): Case 1 was a 42-year-old with 2 term deliveries who then took 20mcg ethinyl estradiol/100mcg levonorgestrel daily for 8 years. She ovulated 13 days following pill cessation but had an abnormally thin endometrium during the first month and bleeding did not begin until day 26. Case 2 was a 31-year-old nulligravid who took 35mcg ethinyl estradiol/1000mcg norethindrone daily for 5 and a half years. She had withdraw bleeding day 3, ovulated day 25 and had a menstrual bleed on day 33. Case 3 was a 31-year-old nulligravid who took 35mcg ethinyl estradiol/250mcg norgestimate daily for 3 years. She ovulated day 16 and had menses on day 30. Conclusion(s): There was no evidence of a significant delay in the return to ovulation or menses following years of cycle suppression and amenorrhea from continuous OC use in this small prospective study. None of these women were attempting to conceive, but it is possible conception could have occurred in the first cycle after cessation of daily OC consumption.