Continuous Use Of Oral Contraceptives Research Articles

Nutraceutical Treatment of Patients with Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is a common cause of infertility, requiring antioestrogen and, possibly, gonadotropin treatment for the induction of ovulation. However, patients suffering from this disease need long-term treatment since PCOS is associated with an increased risk of metabolic syndrome, hyperinsulinemia, oxidative stress, inflammation, cardiovascular disease, and cancer. Allopathic treatment includes the continuous use of oral contraceptives, preferentially with complementary anti-androgen activity, and metformin. However, these treatments only partially correct all aspects of the disease, while carrying potential adverse effects per se. Complementary and alternative medicine (CAM) offers opportunities for treatment through the use of nutraceuticals containing plant extracts, minerals, and vitamins with antioxidant, anti-inflammatory, and adaptogen capacity, as well as for correcting insulin resistance. Here we justify the formulation of the nutraceutical QALY® (Jona Pharma, Elversele, Belgium) that is composed of Ubiquinone Q10, the vitamins B9 and B12, the salts of zinc and selenium, the biomass of Haematococcus pluvialis, and the extracts of Mediterranean pine bark and of Rhodiola rosea. This can be complemented by phytotherapy with the extract of Momordica charantia plus alfa lipoic acid (Momordica plus®).

Oral contraceptive use and anterior cruciate ligament injury: comparison of active comparator new user cohort and case-control study designs

BackgroundThis study further investigates a protective association between oral contraceptive (OC) use and anterior cruciate ligament (ACL) injury noted in prior case-control studies.MethodsActive comparator new user cohort analysis of women aged 13–45 years in the United States from the IBM MarketScan Commercial Claims and Encounters database who newly-initiated low-dose OCs (exposed) or underwent intrauterine device (IUD) insertion (comparison group) from 2000 to 2014. Women were followed for ACL injury starting 90 days after OC initiation or IUD insertion until OC or IUD discontinuation or end of continuous enrollment. Adjusted hazard ratios (adjHR) and 95% confidence intervals (CI) were estimated controlling for age. Secondary analysis replicated previously-published case-control studies assessing “ever” versus “never” OC use over 1- and 5-year periods among women who underwent ACL reconstruction compared to age-matched controls.ResultsIn the cohort analysis, 2,370,286 women initiated OCs and 621,798 underwent IUD insertion. There were 3571 (0.15%) ACL injuries during an average 370.6 days of continuous OC use and 1620 (0.26%) during an average 590.5 days of IUD use. No difference in risk of ACL injury was observed between OC initiators and IUD users (adjHR = 0.95; 95%CI 0.89, 1.01). The case-control analysis replicated the slight protective association observed in prior studies over a 5-year period (OR = 0.90; 95%CI 0.85, 0.94).ConclusionsThis cohort study suggests no association between OC use and ACL injury, while the case-control study suggested bias from uncontrolled confounding and selection factors may have influenced previous findings that suggested a protective association between OC use and ACL injury.

Hormonal Contraceptive Use, Menstrual Dysfunctions, and Self-Reported Side Effects in Elite Athletes in Denmark.

To identify the prevalence of hormonal contraceptive (HC) use, menstrual cycle disturbances, and self-perceived physical and emotional symptoms related to the menstrual cycle/pill cycle in elite female athletes. One hundred eighty-six Danish elite female athletes completed an online questionnaire to assess menstrual status and history, use of HCs, and self-perceived physical and emotional symptoms related to the menstrual cycle or HC use. Fifty-seven percent of elite female athletes in Denmark use HC, with 74% using combined HCs and 26% using progestin only. Sixty percent of oral contraceptive users reported having manipulated their menstrual cycle by continuous oral contraceptive use. Forty-nine percent of non-HC users had a regular menstrual cycle, while 51% experienced menstrual disturbances, with 1 athlete being primary amenorrheic and 13 athletes having secondary amenorrhea. Menstrual disturbances were experienced by a larger proportion of endurance athletes (69%) compared with athletes performing power and technical disciplines. In endurance athletes amenorrhea was associated with a higher cardiovascular training volume (P < .001). Negative symptoms related to the menstrual/pill cycle were reported by both HC and non-HC users, whereas positive physical symptoms were experienced more often among the non-HC (14%) versus HC users (2%) (P < .01). Notably, 13% of the athletes reported that negative symptoms sometimes/always caused them to not participate in or complete the scheduled training. HC use is common among elite athletes, and continuation of HC is used to manipulate the menstrual cycle in relation to sport competitions. HC use does not abolish dysmenorrhea, but it may reduce emotional-related side effects. Menstrual disturbances are frequent in endurance athletes and are associated with cardiovascular training volume.

Oral contraceptives use and development of obesity in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) Project.

The use of oral contraceptives (OC) has been suggested to represent a potential risk factor for the development of obesity. However, the available literature assessing the relationship between OC use and the development of obesity is still scarce and characterised by controversial heterogeneity. We prospectively evaluated the association between the use of OC and the development of obesity in female participants of a middle-aged and free-living cohort. The study population included 4920 female Spanish university graduates, initially nonobese women, with mean age (standard deviation) 28.2 (5.4) years. The study population was followed up for a mean of 8.6 (3.7) years. Self-reported use of OC and body mass index were assessed at baseline and biennially during follow-up. We used generalized estimating equation models to evaluate the association between exposure to OC and the development of obesity. After adjusting for potential confounders, baseline OC use was associated with higher odds of new-onset obesity during the full follow-up period (multivariable-adjusted odds ratio [OR] = 1.78; 95% Confidence Interval [CI]: 1.01-3.15). The continued use of OC for periods of time longer than 2 years was significantly associated with a higher risk of developing obesity (OR = 2.82, 95% CI: 1.17-6.82). According to our prospective cohort study, OC use is significantly associated with higher odds of obesity development, especially when the use of OC is steady and extends over periods of more than 2 years.

Continuous oral contraceptives versus long-term pituitary desensitization prior to IVF/ICSI in moderate to severe endometriosis: study protocol of a non-inferiority randomized controlled trial.

STUDY QUESTIONSThe primary objective is to investigate if continuous use of oral contraceptives is non-inferior compared to long-term pituitary desensitization with a GnRH agonist prior to IVF/ICSI in patients with moderate to severe endometriosis with regard to treatment efficacy. Secondary objectives concern treatment safety and cost-effectiveness.WHAT IS KNOWN ALREADYLong-term pituitary desensitization with a GnRH agonist for 3–6 months prior to IVF/ICSI improves clinical pregnancy rates in women suffering from endometriosis. However, discussion about this treatment strategy exists because of its uncomfortable side effects. Alternatively, IVF/ICSI pre-treatment with continuously administered oral contraceptives may offer fewer side-effects and lower (in)direct costs, as well as encouraging IVF outcomes in women with endometriosis. To date, these two different IVF/ICSI pre-treatment strategies in women with endometriosis have not been directly compared.STUDY DESIGN, SIZE, DURATIONAn open-label, parallel two-arm randomized controlled multicenter trial is planned, including patients with moderate to severe endometriosis. To demonstrate an absolute difference of 13% (delta of 10% with non-inferiority margin of 3%) with a power of 80% 137 patients per group are sufficient. Taking into account a withdrawal of patients of 10% and a cancelation rate of embryo transfer after ovarian pick up of 10% (for instance due to fertilization failure), the sample size calculation is rounded off to 165 patients per group; 330 patients in total will be included. After informed consent, eligible patients will be randomly allocated to the intervention or reference group by using web based block randomization stratified per centre. Study inclusion is expected to be complete in 3–5 years.PARTICIPANTS/MATERIALS, SETTING, METHODSThe research population consists of patients with moderate to severe endometriosis (ASRM III/IV) who are scheduled for their first, second or third IVF/ICSI treatment attempt. Women aged over 41 years, younger than 18 years, with a known contraindication for the use of oral contraceptives and/or GnRH agonists or with severe male factor infertility will be excluded from participation. After informed consent patients are allocated to the intervention group (one-phase oral contraceptive continuously during three subsequent months) or the reference group (three Leuprorelin 3.75 mg i.m./s.c. depot injections during three subsequent months). Tibolon 2.5 mg can be given daily as add-back therapy in the reference group. After 3 months of pre-treatment the IVF/ICSI stimulation phase will be started. The primary outcome is live birth rate after fresh embryo transfer. Secondary outcomes are cumulative live birth rate after one IVF/ICSI treatment cycle (including fresh and frozen embryo transfers up to 15 months after randomization), ongoing pregnancy rate and time to pregnancy. In addition, treatment outcome parameters, adverse events, side-effects during the first 3 months, complications, recurrence of endometriosis (complaints), quality of life, patient preferences, safety and costs effectiveness will be reported. Measurements will be performed at baseline and at 3, 6, 9, 12 and 15 months after randomization.STUDY FUNDING/COMPETING INTEREST(s)All authors have no conflict of interest related to this manuscript. The department of reproductive medicine of the Amsterdam UMC location VUmc has received several research and educational grants from Guerbet, Merck and Ferring not related to the submitted work.TRIAL REGISTRATION NUMBERThe trial is registered as the COPIE trial (Continuous use of Oral contraceptives as an alternative for long-term Pituitary desensitization with a GnRH agonist prior to IVF/ICSI in Endometriosis patients) in the Dutch Trial Register (Ref. No. NTR6357, http://www.trialregister.nl).TRIAL REGISTRATION DATE16 March 2017.DATE OF FIRST PATIENT’S ENROLMENTEnrollment is planned for November 2018.

Using social media to educate women and healthcare providers on endometriosis: preliminary results.

Objective:This study aimed to evaluate the performance of our Facebook fan page and compare it to similar pages.Methods: The authors reviewed page-specific metrics provided by Facebook, including number of fans, their age and sex, and country of origin; number of views, likes, and shares tied to our posts. A search for similar fan pages using keyword "endometriosis" found pages in Portuguese, English, and Spanish. They were analyzed for country of origin, authors, number of fans and posts, and were compared to our page.Results: Our fan page went online on April 2016 and 127 posts have been published up to December 2017. Most of its 1746 fans (89% women; 11% men) were Brazilians (n=1677). Our audience comprised primarily women aged 25-34 (39%) and 35-44 (30%) years. The most viewed posts discussed thrombosis and oral contraceptives (n =11078); continuous use of oral contraceptives (n=6448); deep endometriosis (n=4425); intrauterine levonorgestrel system (n=4045); IVF and endometriosis (n=2885); and endometriosis and cancer (n=2431). Our search found 399 Facebook pages from 44 different countries. The United States (n=81), Brazil (n=49), and the United Kingdom (n=46) topped the list of countries hosting pages, while most of the fan pages were written in English. The majority of the pages were active and 20% claimed they were based on science. Physicians administered four of the 10 most popular pages. Page heterogeneity prevented comparisons between them.Conclusion:Men and women have visited our Facebook fan page to obtain information on endometriosis. The pages found in our search were exceedingly heterogeneous and were not compared. Developing pages with sound information is an important step toward educating individuals about endometriosis and helping them make informed choices on available treatments.

Abstract #909: The Effect of Continuous Use of Oral Contraceptives on Serum Levels of Antimüllerian Hormone and Implications for Preserving Ovarian Reserve from Damage from Chemotherapy

Abstract #909: The Effect of Continuous Use of Oral Contraceptives on Serum Levels of Antimüllerian Hormone and Implications for Preserving Ovarian Reserve from Damage from Chemotherapy

Effect of Long-Term Use of Hormones on Endometriomas

Surgery remains the standard treatment for endometriomas larger than 3 cm. Three to six months of hormonal treatment administered preoperatively does not facilitate surgery; additionally, treatment taken postoperatively delays but does not prevent endometrioma recurrence and thus does not offer substantial long-term advantages. Nevertheless, postoperative long-term continuous use of oral contraceptives results in a 90 % reduction in cyst recurrence compared with no treatment. The possible mechanisms of action of oral contraceptives in preventing endometrioma recurrence include hypomenorrhea, ovulation inhibition and improvement of progesterone resistance. Further studies are needed to assess whether long-term use of oral contraceptives might be effective in the treatment and prevention of endometriomas without surgery.

Budd-Chiari Syndrome as a Manifestation of Antiphospholipid Antibody Syndrome during Oral Contraceptive Therapy: More to Think About

The association of Budd-Chiari Syndrome (BCS) and Antiphospholipid Antibody Syndrome (APS) has been previously described in literature. We report the case of a 46-year-old woman who was admitted to our Unit of Hepatology for upper abdominal quadrant pain, asthenia and edema of the left upper arm. Her familiar history told about predisposition to Systemic Lupus Erythematosus (SLE) whereas her personal story showed a continuous use of oral contraceptives during the six years preceding diagnosis and the absence of episodes of obstetric complications. At the admission, a Doppler Ultrasound examination showed complete thrombosis of venous axis of the left upper arm and thrombosis of subclavian artery (with the aspect of “subclavian steal syndrome”). Abdominal ultrasonography revealed hepatic lesions (characterized by an abdominal Computed Tomography as ischemic injuries) at seventh and eighth segments and the presence of significant amount of ascites. Abdominal and thoracic Computed Tomography confirmed pleural effusion and pointed out a radiologic pattern of Budd-Chiari Syndrome. To verify the presence of concomitant pericardial effusion, an echocardiogram was performed. It allowed reaching the diagnosis of polyserositis. In order to investigate all potential causes of thrombotic diathesis, specific laboratory tests were performed. Normal level of protein C, S and antithrombin II, absence of JAK-2 mutation and negativity of Ham’s test were observed. Positivity was found for anti-SSA (60 kDa) and for antibodies routinely tested for Antiphospholipid Antibody Syndrome (APS), i.e. Lupus-Anticoagulant, Anticardiolipin and Beta2- Glycoprotein I. After the introduction of oral anticoagulant and diuretics a significant improvement of clinical condition of the patient was reached. To conclude, the exact role of oral contraceptives as triggering factor of an undetected APS need to be emphasize, as well as the potentiality of this disease to evolve in a “ to happen” SLE in patients with positive familiarity for autoimmune diseases.

Continuous use of oral contraceptives: an overview of effects and side‐effects

To describe the effects and side-effects of the continuous use of oral contraceptives. A review of articles concerning oral contraceptives taken continuously or in cycles with hormones taken for more than 21 days per cycle. We searched publications in PubMed and Embase. Randomized controlled trials were selected if possible, otherwise case-control studies or cohort studies with controls were chosen. A level of evidence as described by the Centre for Evidence Based Medicine (Oxford University, Oxford, UK) was assigned to all selected studies. Clinical and paraclinical effects and side-effects of oral contraceptives administered continuously. The studies suggest that the endometrium is inactive during continuous use of oral contraceptives and the risk of endometrial hyperplasia is not increased. Numbers of bleeding days are halved with continuous use; however, spotting and irregular bleeding are more often seen in the beginning of use, decreasing with time. Hemostatic parameters and serum lipid and carbohydrate profiles in continuous and conventional users do not differ. Menstrual cycle-related symptoms are relieved better by continuous treatment. After surgery for endometriosis, the effect of continuously used oral contraceptives on the risk of recurrence of pain has been found to be less than that of gonadotropin-releasing hormone (GnRH) analogues, but better than the rate seen during conventional cyclic use. Oral contraceptives taken continuously or in long cycles seem to offer benefits with regard to menstrual symptoms and the recurrence of symptoms related to endometriosis. Long-term studies, comprising large groups of women, are lacking.

Interpretation of Single and Serial Measures of HE4 and CA125 in Asymptomatic Women at High Risk for Ovarian Cancer

Human epididymis protein 4 (HE4) is approved for clinical use with CA125 to predict epithelial ovarian cancer in women with a pelvic mass or in remission after chemotherapy. Previously reported reference ranges for HE4 are inconsistent. We report positivity thresholds yielding 90%, 95%, 98%, and 99% specificity for age-defined populations of healthy women for HE4, CA125, and Risk of Ovarian Malignancy Algorithm (ROMA), a weighted average of HE4 and CA125. HE4 and CA125 were measured in 1,780 samples from 778 healthy women aged >25 years with a documented deleterious mutation, or aged >35 years with a significant family history. Effects on marker levels of a woman's age, ethnicity, and epidemiologic characteristics were estimated, as were the population-specific means, variances, and within- and between-woman variances used to generate longitudinal screening algorithms for these markers. CA125 levels were lower with Black ethnicity (P = 0.008). Smoking was associated with higher HE4 (P = 0.007) and ROMA (P < 0.019). Continuous oral contraceptive use decreased levels of CA125 (P = 0.041), and ROMA (P = 0.12). CA125 was lower in women age ≥55, and HE4 increased with age (P < 0.01), particularly among women age ≥55. Because of the strong effect of age on HE4, thresholds for HE4 are best defined for women of specific ages. Age-specific population thresholds for HE4 for 95% specificity ranged from 41.4 pmol/L for women age 30 to 82.1 pmol/L for women age 80. Incorporation of serial marker values from screening history reduces personalized thresholds for CA125 and HE4 but is inappropriate for ROMA.

Young women's continued use of oral contraceptives over other hormonal methods: findings from a qualitative study

BackgroundLong-acting reversible contraceptives (LARC) have become more commonly promoted in the UK, but most young women still rely on the contraceptive pill. Here, we describe young women's accounts of hormonal...

Young Women's Attitudes Toward Continuous Use of Oral Contraceptives: The Effect of Priming Positive Attitudes Toward Menstruation on Women's Willingness to Suppress Menstruation

The present study investigated American women's attitudes toward menstrual suppression and the effect of priming attitudes toward menstruation on women's willingness to suppress menstruation. One hundred college women randomly were assigned to either a positive priming group or a negative priming group. The positive priming group first completed the menstrual joy questionnaire (MJQ) followed by a willingness to suppress menstruation (WSM) questionnaire, the beliefs and attitudes toward menstruation (BATM) questionnaire, the menstrual distress questionnaire (MDQ), and a demographic questionnaire. The negative priming group completed, in the following order: the MDQ, WSM, BATM, MJQ, and demographics. Priming affected women's reports of positive cycle-related changes on the MDQ, but not women's willingness to suppress menstruation. Higher scores on the MJQ, positive attitudes toward menstrual suppression, and previous oral contraceptive (OC) use were predictors of women's willingness to suppress menstruation. Women's primary source of information about menstrual suppression was “media,” and their primary concern was “safety.” Thus, researchers should continue to investigate the long-term effects of continuous OC use and to analyze information about menstrual suppression in the popular press.

The Clinical Rationale for Menses-Free Contraception

The impact of monthly menstruation may range from a minor inconvenience for some women to a major health concern for those who suffer from menstrual disorders and health conditions that are aggravated during their menstrual cycle. Oral contraceptives (OCs) have been used safely in continuous regimens for the treatment of menstrual disorders in some women and for others who choose to extend their 28-day menstrual cycle to accommodate major life events. There is no physiological requirement for the monthly hormone withdrawal bleed that is experienced by women taking cyclic OCs or for a menstrual period in women who do not desire to (or cannot) become pregnant. Thus, the use of continuous or extended-cycle OC regimens that eliminate the menstrual cycle represents a viable and attractive option for many women. The availability of more choices for menstrual suppression, such as continuous use of OCs, will improve the quality of life for many women who suffer from menstrual-related disorders and provide greater convenience for women with busy and active lifestyles.

Communicating with Patients about Extended-cycle and Continuous Use of Oral Contraceptives

Oral contraceptives (OCs) have been the gold standard for contraception in the United States since their introduction in 1960. They are used for both their contraceptive and noncontraceptive benefits. Although the traditional dosing regimen, 21 active pills and 7 placebo pills, (21/7), reduces many symptoms women suffer with spontaneous cycles, hormone withdrawal symptoms often occur during the 7-day hormone-free interval. New contraceptives are available that decrease the number of hormone-free days each cycle or that increase the time between hormone-free intervals. These changes in packaging are expected to decrease the periodic hormone fluctuations experienced by OC users. Because routine use of extended-cycle/continuous OCs is relatively new and differs from what women have been told for years about the importance of monthly bleeding, women have many questions about and even significant reluctance to using these methods. Numerous studies have shown that extended-cycle and continuous OC use are safe and effective. Total bleeding episodes are reduced, as are problems with bloating and dysmenorrhea. Women usually experience more unscheduled spotting and bleeding in the initial cycles, but those problems decrease with longer use. Amenorrhea may be beneficial and suit the lifestyles of many women. Counseling women about all their contraceptive options and the variety of ways that OCs can be taken may increase women's commitment to correct use and increase efficacy. Good clinician-patient communication, which includes creating an open dialogue with the patient to discuss her individual risks and benefits, should lead to more successful contraceptive utilization.

Ovarian follicular dynamics during conventional vs. continuous oral contraceptive use

Objectives The purpose of this study was to characterize ovarian follicular and endometrial development during conventional vs. continuous oral contraceptive (OC) dosing regimens, to explore follicular development during the hormone-free interval (HFI) and to examine follicular development following OC discontinuation. Study Methods A randomized clinical trial involving 36 clinically normal healthy women between the ages of 18 and 35 years (24.4±3.9, SEM). Transvaginal ultrasonography and blood sampling were done to ascertain ovarian function. Results Fewer follicles >4 mm developed during continuous vs. conventional OC use (p=.006). No dominant follicles developed during continuous OC use vs. eight dominant follicles (16.1±3.3 mm) during the conventional OC regimen. Two of eight (25%) dominant follicles ovulated. All dominant follicles began development during the HFI. Following discontinuation of OC use, ovulation took approximately 5 days longer when compared to natural cycles. Conclusion Continuous OC regimens more effectively prevent dominant follicle development and breakthrough ovulation. The slight delay in time to ovulation following OC discontinuation and natural cycles could be attributed to suppression of follicle wave activity.

Ovarian Follicular Dynamics During Conventional Versus Continuous Oral Contraceptive Use

To characterize ovarian follicular and endometrial development during conventional versus continuous oral contraceptive (OC) dosing regimens and to examine follicular development following OC discontinuation.

Effect of the menstrual cycle and oral contraceptives on cyclooxygenase-2 expression in the endometrium

Objective. To compare the expression of cyclooxygenase-2 (COX-2) and proliferation markers (Ki-67) in the endometrium of patients with ovulatory cycles with those in the endometrium of patients using oral contraceptives.Patients and methods. Endometrial biopsies from 104 premenopausal patients with regular ovulatory cycles (n = 90) or using an oral contraceptive (n = 14) were selected for this study. Using immunohistochemical methods, both COX-2 (Novocastra clone 4H12) and Ki-67 (Dako clone MIB-1) expression were determined in the endometrium during the various phases of the menstrual cycle or following the use of oral contraceptives.Results. COX-2 expression in the glandular epithelium was maximal during menstruation, the late proliferative phase and the early luteal phase, and minimal during the late luteal phase. However, in the surface epithelium, COX-2 expression remained strongly positive throughout the luteal phase. Ki-67 positivity increased during the proliferative phase and diminished during the luteal phase in the glands. In contraceptive users, both Ki-67 and COX-2 expression in the endometrium was low.Conclusion. The increased expression of COX-2 during menstruation and at mid-cycle is eliminated by the continuous use of oral contraceptives. This may be the rationale for their therapeutic action in the treatment of dysmenorrhea and bleeding.

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

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.

Attitude of German women and gynecologists towards long-cycle treatment with oral contraceptives

Long-cycle regimens with continuous use of oral contraceptives (OCs) for 3 or 6 months followed by a hormone-free interval of 7 days may reduce or prevent cycle-dependent and menses-related complaints. A representative survey carried out with 1195 German women in different age groups revealed that only 26–35% of the women aged between 15 and 49 years preferred monthly bleeding, while 37–46% wished to never bleed. The reasons for the refusal of regular menstruations were fewer severe menstrual complaints, better hygiene, higher quality of life, and less blood loss. Among the women who preferred regular withdrawal bleeding during the use of OCs, the main reasons were fear of pregnancy, infertility and adverse effects, and that menstruations were natural. Between 32% and 54% of the women would suppress menstruation sporadically and 11–14% for a longer period of time. After continuous treatment with a combination of 30 μg ethinyl estradiol and 2 mg dienogest for 6 months, the majority of women preferred the long-cycle regimen as compared to the conventional OC regimen despite a higher rate of irregular bleeding. Bleeding occurred primarily in first-time users of OC, particularly during the administration of the second OC pack. A survey carried out with German gynecologists revealed that most physicians prescribed extended OC cycles primarily for medical reasons, e.g., dysmenorrhea, hypermenorrhea, endometriosis and premenstrual dysphoric disorder. The gynecologists preferred a regimen with three packs of extended use of OCs.