Continuous use of oral contraceptives reduces bleeding

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Continuous use of oral contraceptives reduces bleeding

J Fam Pract. 2003 August;52(8):587-604

By

Jill Lambert, MD

Warren Newton, MD, MPH

BACKGROUND: Most clinicians in the US prescribe oral contraceptives that are given cyclically for 21 days, followed by 7 days of no therapy, to mimic natural cycling, signal the absence of pregnancy, protect against endometrial cancer, and prevent irregular bleeding. This randomized controlled trial compared continuous and cyclic contraceptives with respect to bleeding pattern and side effects.
POPULATION STUDIED: The investigators recruited 79 subjects at a university-affiliated research clinic. They excluded women who intended to become pregnant, were aged <18 years or >45 years, had standard contraindications for oral contraceptives, had hemoglobin <9 g/dL, or had a diagnosis of uterine infection or cervical dysplasia.
STUDY DESIGN AND VALIDITY: After an initial 28-day run-in period, women were randomized to receive either 21-day cycles (with 7 days of placebo) or continuous treatment with a 20-μg ethinyl estradiol/100-μg levonorgestrel formulation for 1 year. Allocation was concealed, but after randomization, masking was limited due to differences in pill color.
OUTCOMES MEASURED: The primary outcome was the number of bleeding and spotting days; secondary outcomes were adherence to regimen, patient satisfaction, symptoms, and physiologic parameters such as weight and blood pressure. Cost and provider satisfaction were not addressed.
RESULTS: Study groups were similar after randomization, and the follow-up rate was >75%. Bleeding was significantly less in continuous users than in cyclic uses, with an average of 3 vs 10 days for cycles 1–3 and 0 vs 9 for cycles 10–12, respectively (all comparisons P<.001.) Spotting was significantly greater in continuous users in cycles 1–3 (median 6 vs 4 days, P<.001), but no difference was found by the end of the trial.

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Continuous use of oral contraceptives reduces bleeding

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