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.