title: Acceptance of altering the standard 21-day/7-day oral contraceptive regimen to delay menses and reduce hormone withdrawal symptoms.
abstract: OBJECTIVE
  Measure acceptance and use of extending the number of active oral contraceptive (OC) pills beyond 21 days and/or shortening the hormone-free interval to reduce the frequency and severity of hormone withdrawal symptoms.
  
  
  METHODS
  A retrospective review was performed of patients on OCs with unwanted hormone withdrawal symptoms who were counseled by one osbtetrician-gynecologist (P. J. S.) on altering their standard 21/7 regimen. All patients used a monophasic 30 to 35 microg pill and underwent an initial counseling visit between December 1993 and October 2000.
  
  
  RESULTS
  Of 318 patients counseled on "extending the number of active pills," 292 (92%) had documented follow-up after the initial counseling session. The primary reason for extending the number of active pills was to decrease symptoms of headache (35%), dysmenorrhea (21%), hypermenorrhea (19%), and premenstrual symptoms (13%). The remaining 12% of patients cited convenience, endometriosis, and other reasons such as menstrual-associated acne. Twenty-five (9%) of 292 chose not to extend, with a preference for monthly menses as the most common reason (40%) followed by a concern that symptoms were not severe enough to warrant extension (32%). Of 267 patients who initiated an extended regimen, 57 discontinued OCs, 38 returned to a standard regimen, and 172 were extending use at the time of last follow-up. Using survival analysis methods, at 5 years 46% +/- 5% (mean +/- SE) of patients continued an extended OC pattern. The regimen of OC use by patients continuing an extended pattern was 12 +/- 12 (mean +/- SD) weeks of active pills (median of 9 weeks and range to 104 weeks) with pill-free interval of 6 +/- 2 days (median of 5 days and range of 0-7 days).
  
  
  CONCLUSIONS
  The majority of patients with hormone withdrawal symptoms on OCs will initiate a regimen of extending active pills, often with a shortened hormone-free interval to reduce frequency and severity of associated symptoms.
authors.affiliation: Department of Obstetrics and Gynecology, Scott & White Clinic, Texas A&M University System Health Science Center College of Medicine, Temple 76058, USA. psulak@swmail.sw.org
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Sulak
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kuehl
authors.forename: Mirian
authors.initials: M
authors.lastname: Ortiz
authors.forename: Bobby L
authors.initials: BL
authors.lastname: Shull
mesh_terms: D000328:Adult; D003276:Contraceptives, Oral / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008598:Menstruation / Q000187:drug effects*; D008599:Menstruation Disturbances / Q000188:drug therapy / Q000503:physiopathology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*
chemical_list: D003276:Contraceptives, Oral