Contraception without bleeding: Women’s attitudes
A. Szarewski
Cancer Research UK Centre for Epidemiology, Mathematics and
Statistics, Wolfson Institute of Preventive Medicine, London, United Kingdom
It has been believed for several decades, that women are worried
if they do not see a monthly bleed: indeed, the combined oral contraceptive
regimen, which provides a monthly withdrawal bleed, was specifically designed
with that consideration in mind. Surveys in the 1970s and 80s tended to uphold
this view. However, even in the late 1970s, Loudon et al demonstrated that a
tri-cycle pill regimen was acceptable to the majority of women. Interestingly,
the women were more positive about it than their providers, a difference which
often persists to this day. Studies of extended cycle regimens in the 1980s and
1990s mostly support the acceptability of reduced bleed regimens. It is
interesting that the more recent the survey or study, the greater the proportion
of women who find no bleed or reduced bleed regimens acceptable, or even
preferable to monthly cycles. This may reflect greater understanding of female
reproductive physiology in the populations, coupled with the increasing role of
women in the workplace, where monthly cycle may be a nuisance. There continue to
be cultural differences, but it would appear these are decreasing. Further
research is required in this area, particularly outside family planning clinic
settings. It is also likely that a more positive attitude on the part of
providers would help to dispel women’s anxieties: there is now some evidence
this is occurring.
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