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Which Oral Contraceptive is Better: Monthly Cycle or Extended Cycle?

A recent study in the United States compared the benefits experienced by women using two different forms of combined oral contraceptive pills.

The introduction of combined oral contraceptive pills in the sixties provided couples with a new option to consider in family planning and gave women greater flexibility in making life choices. Oral contraceptives supply daily doses of hormones to the body. Some provide a medication-free week to allow bleeding similar to menstruation. Monthly-cycle combined oral contraceptives induce this bleeding every month. Extended-cycle combined oral contraceptives reduce the bleeding to four times a year (every three months) or less. Some studies have shown that women in the United States and Europe would rather have fewer bleeding episodes in a year.

In a study recently published in BMC Women’s Health, researchers analyzed data from the 2013 National Health and Wellness Survey to compare the benefits of two different forms of combined oral contraceptive pills. This survey is conducted in several countries, but the study focused on participants from the United States.

For the study, they compared women using extended-cycle oral contraceptive pills with women who use monthly-cycle combined oral contraceptive pills. Premenopausal women between the ages of 18 and 50 years, without a hysterectomy and currently on a combined oral contraceptive were chosen for the analysis. Of the 3,876 women surveyed, 260 women used extended-cycle combined oral contraceptive pills while 3,616 women used monthly-cycle combined oral contraceptive pills. The outcomes measured include menstrual-cycle related symptoms such as menstrual pain and heavy bleeding, medication satisfaction, and medication adherence.

The results show that the women on extended-cycle combined oral contraceptive pills were more satisfied with their medication and more adherent to their regimen. These participants also had fewer reports of heavy bleeding. Incidents of bloating, irritability, and tiredness were more common in participants on extended oral contraceptives.

The analysis performed did not consider the different types of hormones available in different brands of these medications. This could be an important factor in determining if the results obtained are the effect of a drug class. The study supports the use of extended-cycle combined oral contraceptive pills in women of reproductive age.  This regimen provides fewer bleeding episodes and is a more convenient and preferred option for a lot of women.

Written by Anuolu Bank-Oni, Pharm.D, CDE, BCGP

Reference: Nappi R.E et al. Real-world experience of women using extended-cycle vs monthly-cycle combined oral contraception in the United States: the National Health and Wellness Survey. BMC Women’s Health (2018) 18:22 DOI 10.1186/s12905-017-0508-6

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