- Extended cycle combined hormonal contraceptive
Extended cycle combined hormonal contraceptives Background Birth control type Hormonal First use ? Pregnancy rates (first year) Perfect use ? Typical use ? Usage Duration effect varies Reversibility Yes User reminders varies Advantages and disadvantages STD protection No Periods Eliminates or reduces frequency Benefits Reduce menstruation related symptoms, reduce risk of anemia
Extended cycle combined oral contraceptive pills are COCPs packaged to reduce or eliminate the withdrawal bleeding that occurs once every 28 days in traditionally packaged COCPs. Extended cycle use of COCPs may also be called menstrual suppression.
Other combined hormonal contraceptives (those containing both an estrogen and a progestogen) may also be used in an extended or continuous cycle. For example, the NuvaRing vaginal ring and the contraceptive patch have been studied for extended cycle use, and the monthly combined injectable contraceptive may similarly eliminate bleeding.
Although it was evident that the pill could be used to suppress menstruation for arbitrary lengths of time, the original regimen was designed to produce withdrawal bleeding every four weeks to mimic the menstrual cycle.
Seasonale was first developed by Barr Pharmaceuticals, in collaboration with Eastern Virginia Medical School, under an agreement. The U.S. Food and Drug Administration (FDA) approved Seasonale in the United States on September 5, 2003. Barr Pharmaceuticals, its manufacturer, claimed at the time of Seasonale's approval that it would cost one dollar per pill. Seasonale is one of Barr Pharmaceuticals' 22 oral contraceptive products. Health Canada approved Seasonale in July 2007, and Paladin Labs began distributing it in Canada on January 4, 2008.
The FDA approved Lybrel for human consumption on May 22, 2007. Lybrel is currently available at pharmacies by prescription only.
When a woman takes COCPs (combined oral contraceptive pills), the hormones in the pills prevent both ovulation and shedding of the endometrium (menstruation). Traditionally, COCPs are packaged with 21 active (hormone-containing) pills and 7 placebo pills. During the week of placebo pills, withdrawal bleeding occurs and simulates an average 28-day menstrual cycle. The placebo pills are not required for pregnancy protection, and with any monophasic COCP the placebo pills may be skipped (going straight to the next pack of active pills) to prevent the withdrawal bleeding. With bi- and tri-phasic pills, skipping the placebo week results in a sudden change in hormone levels, which may cause irregular spotting or flow.
Recently, several pharmaceutical companies have gained FDA approval to package COCPs for the intended use of reducing the frequency of or completely eliminating withdrawal bleeding.
Extended or continuous use of COCPs has been used for many years to treat endometriosis, dysmenorrhea, and menstruation-associated symptoms. Some studies have suggested that women who experience premenstrual-type symptoms during the placebo (hormone-free) week of traditionally packaged COCPs may experience significantly fewer symptoms when placed on extended cycle COCP regimens.
More recently, personal preference to avoid menstruation has also become a common reason for use. Personal preference is the most common reason extended cycle or continuous use COCPs are prescribed to adolescents. The Society for Menstrual Cycle Research holds that this use of COCPs does not have sufficient safety studies to justify promotion as a lifestyle choice (as opposed to medical indications), and criticizes what it perceives as negative portrayals of normal menstrual cycles in promotional literature for extended and continuous COCP use.
Women's satisfaction with their contraception, compliance in taking the pills on time, and discontinuation rates are not significantly different between traditional and extended cycle regimens.
With all extended-cycle COCPs, breakthrough bleeding is the most common side effect, although it tends to decrease over time. In a 12-month study of a continuous COCP regimen, 59% of women experienced no bleeding in months six through twelve and 79% of women experienced no bleeding in month twelve. Extended or continuous use of COCPs or other combined hormonal contraceptives carries the same risk of side effects and medical risks as traditional COCP use.
There is no available data at this time concerning the long term effects of menstrual suppression on a woman's overall health. There exists concern in the medical field that increasing the amount of hormones typically taken by a woman may have an adverse effect on her long term health, but there is no data to confirm or disprove this.
One of the early extended-cycle COCPs, Seasonale, was marketed with the campaign, "Fewer periods. More possibilities." In December 2004, Barr Pharmaceuticals was warned by the FDA concerning these television advertisements. As the warning stated, "By omitting and minimizing the risks associated with Seasonale, the TV ad misleadingly suggests that Seasonale is safer than has been demonstrated by substantial evidence or substantial clinical experience." Although clinical studies had proven Seasonale to be effective in preventing pregnancy, the FDA felt the commercial advertisements omitted the common side effects of irregular vaginal bleeding or spotting.
Seasonale is produced by Duramed Pharmaceuticals, a subsidiary of Barr Pharmaceuticals; Barr Pharmaceuticals also produces the same medicine as a generic called Jolessa. Quasense is the generic version produced by Watson Pharmaceuticals. Seasonale contains 30 micrograms of ethinylestradiol and 150 micrograms of levonorgestrel in each active pill. Seasonale reduces the frequency of menstrual periods from thirteen per year to four per year by changing the regimen of active pills from 21 to 84. Each package has 84 active pills and seven placebo pills to be taken at the end of the active cycle.
Seasonique, also produced by Duramed Pharmaceuticals, has active pills and packaging identical to Seasonale, but replaces the placebo week with a low-dosage week of estrogen.
- ^ "Health Matters: Understanding Menstrual Suppression". Association of Reproductive Health Professionals. October 2006. http://www.arhp.org/healthmatters/UnderstandingMenstrualSuppression.cfm. Retrieved 2007-11-16.
- ^ Organon (September 15, 2005). "NuvaRing is effective and well tolerated in extended use - Most women would like to decrease their number of periods a year". http://www.organon.com/media/press_releases/2005_09_15_nuvaring_is_effective_and_well_tolerated_in_extended_use.asp. Retrieved 2008-05-04.
Miller L, Verhoeven CH, Hout J (2005). "Extended regimens of the contraceptive vaginal ring: a randomized trial". Obstet Gynecol 106 (3): 473–82. doi:10.1097/01.AOG.0000175144.08035.74 (inactive 2009-11-04). PMID 16135576.
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- Elsimar M. Coutinho; Sheldon J. Segal (1999). Is menstruation obsolete?. Oxford: Oxford University Press. ISBN 0-19-513021-9.
- Susan Rako (2006). The Blessings of the Curse: No More Periods?. Lincoln, NE: Backinprint.com. ISBN 978-0595386550.
- Susan Rako (2003). No More Periods?: The Risks of Menstrual Suppression. Harmony Books. ISBN 1400045037.
- Lybrel official site
- Seasonale and Seasonique official site
- Pro-extended cycle COCP site by Leslie Miller, M.D.
Birth control methods (G02B, G03A) Comparison Behavioral Barrier or
Anti-estrogenOrmeloxifene (Centchroman) Post-intercourse Intrauterine device Abortion Sterilization Menstrual cycle Events and phases Life stages TrackingSignsSystems SuppressionExtended cycle combined hormonal contraceptive · Lactational amenorrhea method Disorders Related events In culture and religion
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