Ring, Monthly Injectable Produce Less Menstrual Disruption than DMPA

Abstract

The main points of a study from the WHO Special Program of Research Development and Research and Training in Human Reproduction on menstrual bleeding patterns and contraceptive use are presented. 1875 users of oral contraceptives 1822 users of monthly injectables 546 users of vaginal rings and 1109 depot-medroxyprogesterone acetate (DMPA) users kept diaries of full bleeding and days of spotting during the 1st year a method was started. This information was compared with data from the 1930s and 1960s on bleeding patterns among nonusers of contraceptive methods. Monthly data were excluded in which pregnancy occurred of following a pregnancy and when there were menstrual disorders or gynecological surgery. Data were then limited to women aged 18-34 years which left 3893 woman years of menstrual cycles. The results revealed that women who used hormonal contraceptives such as the vaginal ring or monthly injectables tended to have shorter periods of menstrual bleeding and more regular predictable periods than women on longterm injectables. Most women have variable bleeding patterns during the year even when not using hormonal methods. Nonusers pill users and vaginal ring users had a median of just more than 3 bleeding or spotting day episodes during a 90-day period vs. 3 days among injectable users and <2 days for DMPA users. However when the average duration of bleeding or spotting episodes was examined the median was 4 days for pill users 5 days for vaginal ring users and 6 days for DMPA users. Menstrual cycle average length was lowest at 26 days for vaginal ring users 28 days for nonusers 29 days for injectable users and 36 days for DMPA users. The median value for difference between the longest and the shortest cycle within 12 months was around 10 days for nonusers and pill users and 24 days for injectable or vaginal ring users vs. 55 days for DMPA users. The median for the longest episode of bleeding or spotting was 5 days for pill users 7 days among nonusers monthly injectable users or vaginal ring users and 12 days among DMPA users of which 25% bled for at least 21 days and 1 in 29 bled for 55 days or more. The shortest bleeding-free intervals was the median for vaginal ring users at 21 days and longest for DMPA users at 27 days. Other methods were similar to the intervals for the vaginal ring. 25% of DMPA users had a minimum bleeding-free interval of only 2 days and 25% had an interval of at least 20 days. The myth is debunked that normal women have normal and regular cycles of 25-35 days.