Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception

Edelman, Alison; Micks, Elizabeth; Gallo, Maria F; Jensen, Jeffrey T.; Grimes, David A.

doi:10.1002/14651858.cd004695.pub3

Cited by 131 publications

(109 citation statements)

References 63 publications

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“…Moreover, the few studies that have assessed women's experiences have been limited in scope and have most often used adherence to COCPs as a 'proxy' measure of satisfaction (Edelman et al, 2010). The findings of this exploratory study provide more detailed information about women's actual experiences of tailored COCP use.…”

Section: Discussionmentioning

confidence: 96%

“…There have also been many more studies of women's attitudes toward hypothetical use of extended-use pill regimes (Den Tonkelaar and Oddens, 1999;Glasier et al, 2003Glasier et al, , 2008Andrist et al, 2004) than of their actual use of continuous COCPs. In a Cochrane review of use of extendedcycle versus standard use of COCPs, the authors concluded that further research on women's satisfaction and menstrual-associated symptoms was needed (Edelman et al, 2010). Qualitative research is important to better understand contraceptive use behaviors and the barriers or problems related to extended-use contraceptive methods (Sundstrom, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Women's experiences with tailored use of a combined oral contraceptive: a qualitative study

et al. 2013

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what is known already: While many studies have investigated views toward extended use of COCPs, little research has examined women's actual experiences with these regimens. study design, size, duration: This was a semi-structured qualitative interview study that was part of a larger randomized trial of a standard (21 daily pills followed by a 7-day pill-free interval) versus a tailored regimen (daily pills until 3-consecutive-day bleeding triggers a 3-day pill-free interval) of Microgynon 30w mcg (Ethinyl estradiol 30 mcg, Levonorgestrel 150 mcg).participants/materials, settings, methods: Interviews were conducted with 26 women (17 in the tailored group and 9 who switched their assigned treatment group) . Data were analyzed using thematic analysis.main results and the role of chance: Women discussed positive changes associated with tailored use of COCPs, as well as some negative consequences. The major themes identified in the interview data were: ease of tailored regimen; changes in cycle-related symptoms; adjustment to reduced/absent bleeding and unpredictability about bleeding.limitations, reasons for caution: The sample comprised mainly young, nulliparous women. The majority of women were using COCPs at the start of the study.wider implications of the findings: Clinicians discussing extended-use regimes with patients should mention that women may need time to adjust to an extended-use regime. Future research should attempt to identify predictors of response to extended use of COCPs.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Women's experiences with tailored use of a combined oral contraceptive: a qualitative study

et al. 2013

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“…Some studies suggest that menstrual symptoms of headaches, genital irritation, tiredness, bloating, and menstrual pain may be less in extended-cycle regimens. 24 …”

Section: Combined Oral Contraceptivesmentioning

confidence: 99%

Menstrual Management for Adolescents With Disabilities

Quint¹,

O’Brien²,

Gynecology³

2016

Pediatrics

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The onset of menses for adolescents with physical or intellectual disabilities can affect their independence and add additional concerns for families at home, in schools, and in other settings. The pediatrician is the primary health care provider to explore and assist with the pubertal transition and menstrual management. Menstrual management of both normal and abnormal cycles may be requested to minimize hygiene issues, premenstrual symptoms, dysmenorrhea, heavy or irregular bleeding, contraception, and conditions exacerbated by the menstrual cycle. Several options are available for menstrual management, depending on the outcome that is desired, ranging from cycle regulation to complete amenorrhea. The use of medications or the request for surgeries to help with the menstrual cycles in teenagers with disabilities has medical, social, legal, and ethical implications. This clinical report is designed to help guide pediatricians in assisting adolescent females with intellectual and/or physical disabilities and their families in making decisions related to successfully navigating menarche and subsequent menstrual cycles.

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“…17 Oral contraceptive pills reduce menstrual blood flow 35% to 69%. 17 Bleeding patterns appear to be improved with continuous as opposed to cyclic administration, 18 and with pills containing more than 20 mg of ethinyl estradiol vs pills with 20 mg or less. 19 In a randomized trial of continuous administration, combined oral contraceptives containing 1 mg of norethindrone resulted in fewer days of bleeding and spotting than preparations containing 0.1 mg of levonorgestrel.…”

Section: Hormonal Management Of Hmb In Women With Bleeding Disordersmentioning

confidence: 99%

Heavy menstrual bleeding: work-up and management

James

2016

Hematology

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Heavy menstrual bleeding (HMB), which is the preferred term for menorrhagia, affects~90% of women with an underlying bleeding disorder and~70% of women on anticoagulation. HMB can be predicted on the basis of clots of ‡1 inch diameter, low ferritin, and "flooding" (a change of pad or tampon more frequently than hourly). The goal of the work-up is to determine whether there is a uterine/endometrial cause, a disorder of ovulation, or a disorder of coagulation. HMB manifest by flooding and/or prolonged menses, or HMB accompanied by a personal or family history of bleeding is very suggestive of a bleeding disorder and should prompt a referral to a hematologist. The evaluation will include the patient's history, pelvic examination, and/or pelvic imaging, and a laboratory assessment for anemia, ovulatory dysfunction, underlying bleeding disorder, and in the case of the patient on anticoagulation, assessment for over anticoagulation. The goal of treatment is to reduce HMB. Not only will the treatment strategy depend on whether there is ovulatory dysfunction, uterine pathology, or an abnormality of coagulation, the treatment strategy will also depend on the age of the patient and her desire for immediate or long-term fertility. Hemostatic therapy for HMB may serve as an alternative to hormonal or surgical therapy, and may even be life-saving when used to correct an abnormality of coagulation. Learning Objectives• Identify 3 clinical features that correlate with true HMB • Name the first-line therapies for HMB Heavy menstrual bleeding (HMB), which is the preferred term for menorrhagia, affects~90% of women with an underlying bleeding disorder 1 and~70% of women on anticoagulation. [2][3][4][5] It is a condition hematologists are expected to understand and, in some cases, to help manage. This paper will describe normal menstruation, define HMB, summarize the causes of HMB, describe the gynecologic and hematologic evaluation of HMB, and discuss the hormonal, surgical, and hemostatic management of HMB. Normal menstruationThe following description of normal menstruation applies to all reproductive-age women, including adolescents. If fertilization (pregnancy) does not occur, the menstrual cycle begins with the sloughing or shedding of the lining of the uterus (ie, the endometrium). Then, under the influence of estrogen from ovarian follicles, the endometrium increases in thickness due to the development of glands and blood vessels. Approximately mid-cycle (in a normal cycle), ovulation occurs. The dominant ovarian follicle undergoes a process described as luteinization, becomes a corpus luteum, and secretes progesterone. Under the influence of progesterone, the endometrial glands mature and become secretory. In the absence of fertilization, the endometrial vessels constrict and the newly developed portion of the endometrium, including the new glands and blood vessels, becomes ischemic and starts to slough, thereby beginning another cycle (Figure 1).

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Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception

Cited by 131 publications

References 63 publications

Women's experiences with tailored use of a combined oral contraceptive: a qualitative study

Women's experiences with tailored use of a combined oral contraceptive: a qualitative study

Menstrual Management for Adolescents With Disabilities

Heavy menstrual bleeding: work-up and management

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