Contraception without bleeding – Existing options
B. Pinter
Dept. of Ob/Gyn, University Medical Center, Ljubljana,
Slovenia
Introduction
Extended cycles, using oral contraceptives, have been used to
treat endometriosis and other menstrual disorders (menorrhagia, dysmenorrhea) or
to treat conditions that are known to be exacerbated cyclically (migraine,
epilepsy, irritable bowel syndrome and psychiatric symptoms). In addition,
extended cycles decrease blood loss during withdrawal bleedings and may provide
more effective protection from pregnancy.
Existing options
A variety of different extended cycle regimens are existing in
oral contraceptive use (Cochrane Database of Systematic Reviews): 42/7 regimen
(49-day cycle: 6 weeks of continuous use, 1 pill-free week), 63/7 regimen
(70-day cycle: 9 weeks of continuous use, 1 pill-free week), 84/7 regimen
(91-day cycle: 12 weeks of continuous use, 1 pill-free week), 161/7 regimen
(168-day cycle: 23 weeks of continuous use, 1 pill-free week) or 329/7 regimen
(336-day cycle: 47 weeks of continuous use, 1 pill-free week). Monophasic pill
containing 30 mcg or 20 mcg of etinilestradiol are prescribed (the first birth
control pill FDA approved for extended cycling was Seasonale), with comparable
efficacy.
Study on extended use of transdermal contraceptive patch (12
weeks of continuous use, 1 patch-free week) has shown that this regimen may be
useful alternative regimen, too. Extended regimens were studied also for
contraceptive vaginal ring (NuvaRing). Comparison among 28-day cycle, 49-day
cycle, 91-day cycle and 364-day cycle (51 weeks of continuous use, 1 ring-free
week) showed comparable efficacy of regimens, but spotting days increased with
postponement of the withdrawal bleeding. In addition, the studies on extended
use of progesterone-releasing vaginal ring in nursing women are going on.
Contraception without bleeding can be achieved also with depo
injectables, implants and levonorgestrel releasing IUS, if breakthrough bleeding
and spotting do not exceed amenorrhoic effects.
Conclusions
Contraception without bleeding in extended contraceptive use is
a reasonable approach in hormonal contraception.