Postponement of withdrawal bleeding in women using low-dose combined oral contraceptives

Abstract

Postponement of menses is widely practised by women using oral contraceptives. One-hundred volunteers, consisting of three groups of women, each group using a different extensively used contraceptive regimen, were tested and compared. The test period consisted mainly of a double (monophasics) or extended (triphasics) pill cycle without a tablet-free interval. Based on daily records of vaginal bleedings as well as on the results of a questionnaire, it could be concluded that postponement of the withdrawal bleeding for twenty extra days was generally effective; the occurrence of the bleedings was related to the duration of postponement of menses and to the contraceptive regimen that was used. However, the introduction of a seven-week cycle pill is not yet a promising alternative since the majority of the volunteers preferred the inconvenience of a monthly withdrawal bleeding.

PIP: Women who already were using 1 of the 3 most widely prescribed combined oral contraceptives (OCs) for more than 6 months without experiencing any pill-related problems were asked to participate in an investigation to determine what would be the percentage of regular users of low-dose combined OCs that could effectively postpone the withdrawal bleeding for 21 days (20 in case of triphasic preparation) by skipping the tablet-free interval. It was assumed that if 1 or more bleeding days occurred in the total period of tablet intake, the woman would consider the attempt to have failed. 100 women who responded to announcements in daily newspapers, student weeklys, and information boards at universities in Amsterdam fulfilled the inclusion criteria. The women were asked to maintain a daily record of vaginal bleedings on a specially designed card where a distinction was made between "spotting" and "bleeding." The total study period lasted 12 weeks. It started with the tablet-free interval after a preceding pill cycle, followed by 42 days of daily tablet intake and a 7-day tablet-free interval, and was completed by a regular 21-day tablet cycle and a 7-day tablet-free period. For the triphasic levonorgestrel-containing pill, the scheme was somewhat more complicated. In the 1st 21 days of the 2 consecutive OC cycles, spotting and bleeding episodes were rare. After day 21, there was a rapid increase in the number of women with bleeding episodes in the group using the extended triphasic regimen. This was observed also in women using the consecutive monophasic regimens but to a considerably smaller degree. The difference between the triphasic and the monophasic preparations in the extended cycle (day 21-42) was statistically significant. No statistical difference was observed when spotting included. The extended period of tablet intake was followed by a withdrawal bleeding in the 7-day tablet-free interval in all but 1 case; this woman remained amenorrheic until the next tablet-free interval. The bleeding pattern in the cycle following the prolonged tablet cycle showed minimal irregular bleeding, followed by a normal withdrawal bleeding. 98 women completed a questionnaire on side effects and acceptability of the regimen. Of the 56 women who experienced a bleeding or a period of spotting during the extended period of pill intake, 16 considered the method to be acceptable despite the bleeding or spotting. Of these 16 women, 13 experienced spotting only. 48 of the 98 women would favor a bleeding at 3 or 6 months only, while for the other half this was unacceptable of the 98 women would desire total amenorrhea, if possible.