title: Menstrual bleeding patterns in untreated women and with long-acting methods of contraception. Task Force on Long-Acting Systemic Agents for Fertility Regulation.
abstract: The bleeding patterns recorded by women using one of two new types of long-acting hormonal contraception, a levonorgestrel-releasing vaginal ring or a monthly injectable, have been compared with those in an untreated group and those experienced by women using either a combined oral contraceptive (OC) or depot-medroxyprogesterone acetate (DMPA). The frequency of bleeding was very similar between the combined pill users, the ring users and the untreated women, who all recorded an average of 3.2-3.3 bleeding/spotting episodes every 90 days. Monthly injectable users had slightly fewer episodes. Women using a monthly injectable or a vaginal ring had longer bleeding/spotting episodes (5 days) than combined pill users (4 days). However, the untreated women and DMPA users had the longest episodes, averaging 6 days. The median value of the within-woman mean length of bleeding-free intervals was 20.6 days among ring users, 22.3 days in the untreated group, 23.6 days among women given a combined OC or a monthly injectable, and 27.4 days in the DMPA group. Women using any of the long-acting methods had more variable bleeding patterns than untreated women or combined pill users. Over a year of method use, however, the lengths of the bleeding-free intervals recorded by vaginal ring and monthly injectable users became more predictable. It is concluded that these newer methods do not produce the marked bleeding disturbances seen with DMPA.
authors.affiliation: Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
authors.forename: E M
authors.initials: EM
authors.lastname: Belsey
mesh_terms: D000293:Adolescent; D000328:Adult; D003274:Contraceptive Devices, Female; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D003692:Delayed-Action Preparations; D004958:Estradiol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology; D005260:Female; D006801:Humans; D007267:Injections; D016912:Levonorgestrel / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D008525:Medroxyprogesterone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology; D017258:Medroxyprogesterone Acetate; D008597:Menstrual Cycle / Q000187:drug effects* / Q000502:physiology; D013997:Time Factors
chemical_list: D003277:Contraceptives, Oral, Combined; D003692:Delayed-Action Preparations; D004958:Estradiol; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate; D008525:Medroxyprogesterone