Extended regimens of combined hormonal contraception to reduce symptoms related to withdrawal bleeding and the hormone-free interval: A systematic review of randomised and observational studies

AbstractMany studies have described the features of menstrually related migraines but there is a lack of knowledge regarding the features of migraine in combined hormonal contraceptive users (CHC). Hormone-withdrawal migraines in the pill-free period could differ from those in the natural cycle. Gynaecologic comorbidities, like dysmenorrhea and endometriosis, but also depression or a family history might modify the course of migraine. A better understanding of migraine features linked to special hormonal situations could improve treatment. For this prospective cohort study, we conducted telephone interviews with women using a CHC and reporting withdrawal migraine to collect information on migraine frequency, intensity, triggers, symptoms, pain medication, gynaecologic history and comorbidities (n = 48). A subset of women agreed to also document their migraines in prospective diaries. The mean number of migraine days per cycle was 4.2 (± 2.7). Around 50% of these migraines occurred during the hormone-free interval. Migraine frequency was significantly higher in women who suffered from migraine before CHC start (5.0 ± 3.1) (n = 22) in comparison to those with migraine onset after CHC start (3.5 ± 2.1) (n = 26). Menstrually related attacks were described as more painful (57.5%), especially in women with migraine onset before CHC use (72%) (p < 0.02). Comorbidities were rare, except dysmenorrhea. The majority of migraine attacks in CHC users occur during the hormone-free interval. Similar as in the natural cycle, hormone-withdrawal migraines in CHC users are very intense and the response to acute medication is less good, especially in those women, who developed migraine before CHC use.

Download Full-text

Safety and Efficacy of Levonorgestrel 0.10 mg and Ethinyl Estradiol 0.02 mg plus Ethinyl Estradiol 0.01 mg in an Extended-Cycle Oral Contraceptive Regimen

Clinical Medicine Insights Therapeutics ◽

10.4137/cmt.s4661 ◽

2010 ◽

Vol 2 ◽

pp. CMT.S4661

Author(s):

Radhika Rible ◽

Ram Parvataneni ◽

Angela Chen

Keyword(s):

Oral Contraceptive ◽

Ethinyl Estradiol ◽

Hormonal Contraception ◽

Pivotal Trial ◽

Combined Oral Contraceptive ◽

Free Interval ◽

Effective Option ◽

Effective Contraception ◽

Combined Hormonal Contraception ◽

Extended Cycle

Extended-cycle combined hormonal contraception has become a common practice among women seeking effective contraception and menstrual regulation. Extended cycle regimens have the benefit of decreasing scheduled bleeding as compared to traditional combined oral contraceptive (COC) regimens containing 21 days of hormones followed by a 7-day hormone-free interval (HFI) by reducing the frequency of the HFI. The newest FDA approved product in this family of contraceptive regimens is a 91-day COC regimen containing 0.02 mg ethinyl estradiol (EE) and 0.1 mg levonorgestrel (LNG) for 84 days followed by a 7-day interval with 0.01 mg EE. This regimen has been evaluated in one pivotal trial and demonstrated to have efficacy and a side effect profile similar to the other currently available FDA approved 91-day extended-cycle regimens. This is the first 91-day regimen formulated with 0.02 mg EE and offers women an effective option for contraception and menstrual cycle control.

Download Full-text

Managing the side effects of contraception

Practice Nursing ◽

10.12968/pnur.2021.32.6.226 ◽

2021 ◽

Vol 32 (6) ◽

pp. 226-231

Author(s):

Katie Boog

Keyword(s):

Side Effects ◽

Hormonal Contraception ◽

Oral Contraceptive Pill ◽

Common Reason ◽

Evidence Based ◽

Contraceptive Methods ◽

Mood Change ◽

Combined Oral Contraceptive ◽

Free Interval ◽

Combined Hormonal Contraception

Side effects are the most common reason for the discontinuation of contraceptive methods. Dr Katie Boog summarises the available evidence on how to manage them Although often transient, side effects are the most common reason for individuals to discontinue contraception. The evidence to prove causality is limited, as is evidence-based guidance on how to manage these side effects. This article summarises the available evidence. For individuals who have new or worsening acne on progestogen-only contraception (POC), switching to combined hormonal contraception (CHC) is likely to improve their skin. Continuous or extended CHC use may be beneficial for individuals with premenstrual mood change, and for those who experience headaches in the hormone-free interval. Unpredictable bleeding patterns on POC are common. Injectable users can try reducing the interval between injections to 10 weeks. Implant, injectable or intrauterine system users can be offered a 3-month trial of a combined oral contraceptive pill (COC). CHC and POP users with unpredictable bleeding may benefit from switching to an alternative preparation.

Download Full-text

Combined hormonal contraception and bone health: a systematic review

Contraception ◽

10.1016/j.contraception.2006.01.003 ◽

2006 ◽

Vol 73 (5) ◽

pp. 445-469 ◽

Cited By ~ 53

Author(s):

Summer L. Martins ◽

Kathryn M. Curtis ◽

Anna F. Glasier

Keyword(s):

Systematic Review ◽

Bone Health ◽

Hormonal Contraception ◽

Combined Hormonal Contraception

Download Full-text

Treatment of unscheduled bleeding in women using extended- or continuous-use combined hormonal contraception: a systematic review

Contraception ◽

10.1016/j.contraception.2012.08.005 ◽

2013 ◽

Vol 87 (5) ◽

pp. 567-575 ◽

Cited By ~ 7

Author(s):

Emily M. Godfrey ◽

Maura K. Whiteman ◽

Kathryn M. Curtis

Keyword(s):

Systematic Review ◽

Hormonal Contraception ◽

Combined Hormonal Contraception ◽

Unscheduled Bleeding ◽

Continuous Use

Download Full-text

Managing the side effects of contraception

Journal of Prescribing Practice ◽

10.12968/jprp.2021.3.5.184 ◽

2021 ◽

Vol 3 (5) ◽

pp. 184-188

Author(s):

Katie Boog

Keyword(s):

Oral Contraceptive ◽

Side Effects ◽

Hormonal Contraception ◽

Oral Contraceptive Pill ◽

Evidence Based ◽

Mood Change ◽

Contraceptive Pill ◽

Combined Oral Contraceptive ◽

Free Interval ◽

Combined Hormonal Contraception

Although often transient, side effects are the most common reason for individuals to discontinue contraception. The evidence to prove causality is limited, as is evidence-based guidance on how to manage these side effects. This article summarises the available evidence. For individuals who have new or worsening acne on progestogen-only contraception (POC), switching to combined hormonal contraception (CHC) is likely to improve their skin. Continuous or extended CHC use may be beneficial for individuals with premenstrual mood change, and for those who experience headaches in the hormone-free interval. Unpredictable bleeding patterns on POC are common. Injectable users can try reducing the interval between injections to 10 weeks. Implant, injectable or Intrauterine system users can be offered a 3-month trial of a combined oral contraceptive pill (COC). CHC and POP users with unpredictable bleeding may benefit from switching to an alternative preparation.

Download Full-text

The association between dietary inflammatory index and risk of central obesity in adults: An updated systematic review and meta-analysis

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000648 ◽

2020 ◽

Vol 90 (5-6) ◽

pp. 535-552 ◽

Cited By ~ 2

Author(s):

Mahdieh Abbasalizad Farhangi ◽

Mahdi Vajdi

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Central Obesity ◽

Assessment Tool ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Dietary Factors ◽

Cross Sectional ◽

Inflammatory Status ◽

Obesity Indices

Abstract. Backgrounds: Central obesity, as a pivotal component of metabolic syndrome is associated with numerous co-morbidities. Dietary factors influence central obesity by increased inflammatory status. However, recent studies didn’t evaluate the association between central obesity and dietary inflammation index (DII®) that give score to dietary factors according to their inflammatory potential. In the current systematic review and meta-analysis, we summarized the studies that investigated the association between DII® with central obesity indices in the general populations. Methods: In a systematic search from PubMed, SCOPUS, Web of Sciences and Cochrane electronic databases, we collected relevant studies written in English and published until 30 October 2019. The population of included studies were apparently healthy subjects or individuals with obesity or obesity-related diseases. Observational studies that evaluated the association between DII® and indices of central obesity including WC or WHR were included. Results: Totally thirty-two studies were included; thirty studies were cross-sectional and two were cohort studies with 103071 participants. Meta-analysis of observational studies showed that higher DII® scores were associated with 1.81 cm increase in WC (Pooled weighted mean difference (WMD) = 1.813; CI: 0.785–2.841; p = 0.001). Also, a non-significant increase in the odds of having higher WC (OR = 1.162; CI: 0.95–1.43; p = 0.154) in the highest DII category was also observed. In subgroup analysis, the continent, dietary assessment tool and gender were the heterogeneity sources. Conclusion: The findings proposed that adherence to diets with high DII® scores was associated with increased WC. Further studies with interventional designs are necessary to elucidate the causality inference between DII® and central obesity indices.

Download Full-text

Place of progestogenic oral contraceptives in gynecological practice

Medical alphabet ◽

10.33667/2078-5631-2019-1-1(376)-19-26 ◽

2019 ◽

Vol 1 (1) ◽

pp. 19-26

Author(s):

I. V. Kuznetsova

Keyword(s):

Venous Thrombosis ◽

Oral Contraceptives ◽

Hormonal Contraception ◽

Review Of The Literature ◽

Safety Issues ◽

Routes Of Administration ◽

Positive Effects ◽

Combined Hormonal Contraception

The review of the literature presents data on the possible risks of using combined hormonal contraception and the possibilities of prescribing purely progestogenic contraception as an alternative to the use of combined means. Progestogen contraceptives include a group of agents with different routes of administration, doses and characteristics of progestins, which have a number of differences in the ratio of benefits and risks, availability, reversibility and other properties of contraception. Particular attention is paid to purely progestogenic tablets containing desogestrel, as a means equivalent in effectiveness to combination contraceptives, but safer. Safety issues are considered in the context of the use of breastfeeding women, as well as from the standpoint of the risk of arterial and venous thrombosis. The issues of non-contraceptive positive effects of purely progestogenic contraceptives are covered.

Download Full-text