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Extended and Continuous Combined Contraceptive Regimens for Menstrual Suppression
Author(s) -
Jacobson Janet C.,
Likis Frances E.,
Murphy Patricia Aikins
Publication year - 2012
Publication title -
journal of midwifery and women's health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.543
H-Index - 62
eISSN - 1542-2011
pISSN - 1526-9523
DOI - 10.1111/j.1542-2011.2012.00250.x
Subject(s) - vaginal ring , medicine , pill , progestin , family planning , gestodene , placebo , menstrual cycle , regimen , estrogen , gynecology , population , obstetrics , hormone , pharmacology , research methodology , alternative medicine , environmental health , pathology
Many women have medical indications for menstrual suppression or a personal preference to reduce or eliminate monthly bleeding, which can be achieved with extended and continuous regimens of combined estrogen and progestin contraceptives. Combined contraceptives are traditionally administered in a 28‐day cycle, with 21 days of a contraceptive pill, vaginal ring, or transdermal patch followed by a hormone‐free interval that is usually 7 days. During the hormone‐free interval, women either take a placebo pill or do not use their combined contraceptive method. Hormone‐related symptoms are significantly worse during the hormone‐free interval than the days when the contraceptive is used. Alterations of the standard 28‐day cyclic regimen for menstrual suppression include decreasing the frequency of the hormone‐free interval, thus extending the time between withdrawal bleeding episodes (extended use), and eliminating the hormone‐free interval altogether (continuous use). This article reviews menstrual suppression indications and physiology. Research demonstrating that the effectiveness, safety, and side effects of oral, vaginal, and transdermal extended and continuous regimens are comparable to cyclic regimens is summarized. Findings from studies of women's and health care providers’ attitudes toward menstrual suppression also are reviewed. Important topics to include in evidence‐based counseling for extended and continuous combined contraceptive use are presented.