Effects of Continuous<i>Versus</i>Cyclical Oral Contraception: A Randomized Controlled Trial

Legro, Richard S.; Pauli, Jaimey G.; Kunselman, Allen R.; Meadows, Juliana W.; Kesner, James S.; Zaino, Richard J.; Demers, Laurence M.; Gnatuk, Carol L.; Dodson, William C.

doi:10.1210/jc.2007-2287

Cited by 75 publications

(67 citation statements)

References 39 publications

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“…Therefore, more long-term multicentre studies should be performed, with careful selection of the phenotype. Finally, there is some evidence that extended-cycle EPs (vs cyclic therapy) may offer greater hormonal suppression and prevent rebound ovarian function during the pill-free interval (102). However, their efficacy in the treatment of hirsutism should be investigated.…”

Section: Normal Weight Hirsute Women With Pcosmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Treatment of hirsutism in the polycystic ovary syndrome

Pasquali

Gambineri

2014

European Journal of Endocrinology

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Hirsutism is a common medical complaint among women of reproductive age, and it affects the majority of women with the polycystic ovary syndrome (PCOS). Increased rate of androgen production and its availability in tissue represent the main pathophysiological mechanisms responsible for hirsutism. In addition, androgens may be generated de novo in the hair follicle; therefore, circulating androgen levels do not quantify the real exposure of the hair follicle to androgens, as a quota is locally generated. Hirsutism is a clinical sign and not a disease in itself; its presence does not therefore necessarily require treatment, particularly in mild-to-moderate forms, and when an affected woman does not worry about it. Physicians should decide whether hirsutism is to be treated or not by evaluating not only the severity of the phenomenon but also the subjective perception of the patient, which does not necessarily correspond to the true extent of hair growth. In any case, a physician should manage a woman with hirsutism only on the basis of a diagnosis of the underlying cause, and after a clear explanation of the efficacy of each therapeutic choice. Cosmetic procedures and pharmacological intervention are commonly used in the treatment of hirsutism and are discussed in this paper. Importantly, there are different phenotypes of women with hirsutism and PCOS that may require specific attention in the choice of treatment. In particular, when obesity is present, lifestyle intervention should be always considered, and if necessary combined with pharmacotherapy.

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Section: Normal Weight Hirsute Women With Pcosmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Treatment of hirsutism in the polycystic ovary syndrome

Pasquali

Gambineri

2014

European Journal of Endocrinology

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“…These differences approached statistical significance (p-value = 0.054), but there were no pregnancies in either group. 21 In another study (n = 641), with a continuous OC regimen compared to a cyclic OC product, one woman became pregnant on continuous OC compared to three pregnancies in the cyclic comparator group, but the significance of this difference is not clear. 22 A study (n = 1 417) was also done to compare the contraceptive efficacy, cycle control, compliance and safety of a weekly transdermal contraceptive patch and a daily OC.…”

Section: Day 28mentioning

confidence: 99%

The safety and efficacy of low-dose oral contraceptives

Westhuizen¹,

Merwe²

2011

South African Family Practice

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Oral contraceptives (OCs) are classified according to the dosage of ethinyloestradiol (EE) and type of progestogen, and whether the dosages of EE and progestogen stay the same during the cycle, or change in a phasic manner. Ultimately, there is no statistically significant difference in efficacy between high-dose and low-dose OCs. There is also no difference in efficacy between monophasic and multiphasic products, which, other than having a lower hormone content, have no benefit over monophasic products.Several medications, such as rifampicin, some of the anticonvulsants and certain human immunodeficiency virus (HIV) medications, may reduce the efficacy of OCs. Higher-dose OC preparations are recommended in patients taking these concomitant drugs.The effectiveness of OCs with typical use is largely dependent on compliance, which is influenced by bleeding patterns and side-effects. In this regard, the composition of an OC may play a significant role. The dosage of EE and type of progestogen may relate to specific non-contraceptive benefits, such as improvement in dysfunctional uterine bleeding, dysmenorrhoea, premenstrual tension, endometriosis, iron deficiency anaemia, hyperandrogenism and acne. The thirdgeneration progestogens and anti-androgens are generally regarded as more "skin friendly".The cardiovascular safety of OCs has long been controversial, and although complications such as myocardial infarction and stroke have been reduced over the years with lower EE dosages, the risk of venous thromboembolism (VTE) has not decreased consistently. In fact, some of the low-dose products containing third-generation progestogens and antiandrogens may be associated with a higher risk of VTE.Breast cancer is another controversial issue that is associated with OC use. Epidemiological studies do not report an increased risk, whereas other meta-analyses do. The risk may be amplified by genetic susceptibility, although data on the subject are not consistent.An increased risk of hepatic adenoma and cervical cancer has also been noted with OC use, but the latter seems to be dependent on persistent human papillomavirus infection. On the other hand, ovarian and endometrial cancers are reduced by the use of OCs, although genetic susceptibility may also modify the risk.As indicated by several studies on risk factors relating to the safety of contraceptives, the choice of contraceptive is more complicated in patients with certain medical conditions. This is because the physiological changes and side-effects that are associated with the method may increase the risk of morbidity or mortality in these women. Before starting on a contraceptive, the woman should undergo a risk-benefit assessment to ensure the safety of the method. This is also true for OCs, and in this regard, the latest World Health Organization (WHO) safety categories may be consulted.

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“…Patient satisfaction outcomes with regard to hormone withdrawal symptoms have been examined in extended-cycle regimens and are generally positive, with a number of studies reporting improvement in premenstrual symptoms and reduced headache 13,[43][44][45] . The Cochrane Review commented that extended-cycle regimens were better than traditional regimens in managing withdrawal New combined oral contraceptive pill regimens Read headache, genital irritation, tiredness, bloating, and menstrual pain 30 .…”

Section: Hormone Withdrawal Symptomsmentioning

confidence: 99%

“…This and other studies concluded that the degree of residual ovarian activity could be regarded as a useful measure of the effectiveness of oral contraceptives 51 . The scoring system combines ultrasound assessment of follicular size and appearance with the measurement of LH, FSH, oestradiol and progesterone levels 9,18,45 . A fascinating study into the question of missed pills and poor compliance randomised women to either a 21/7-or a 24/4 days-regimen of pills containing 20 mg EE and 3mg DRSP.…”

Section: What About Efficacy?mentioning

confidence: 99%

New regimens with combined oral contraceptive pills – moving away from traditional 21/7 cycles

Read

2010

The European Journal of Contraception & Reproductive Health

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Effects of ContinuousVersusCyclical Oral Contraception: A Randomized Controlled Trial

Abstract: Continuous oral contraception does not result in a reduction of bleeding days over a 168-d period of observation but provides greater suppression of the ovary and endometrium. These effects are associated with improved patient symptomatology.

Cited by 75 publications

References 39 publications

THERAPY OF ENDOCRINE DISEASE: Treatment of hirsutism in the polycystic ovary syndrome

THERAPY OF ENDOCRINE DISEASE: Treatment of hirsutism in the polycystic ovary syndrome

The safety and efficacy of low-dose oral contraceptives

New regimens with combined oral contraceptive pills – moving away from traditional 21/7 cycles

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