title: Bleeding patterns after immediate vs. conventional oral contraceptive initiation: a randomized, controlled trial.
abstract: OBJECTIVE
  To compare bleeding patterns after immediate vs. conventional oral contraceptive (OC) initiation.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  University-based clinic.
  
  
  METHODS
  One hundred thirteen women initiating combination OCs.
  
  
  METHODS
  Participants received a 4-month supply of a monophasic 35-microg ethinyl E(2) (EE) OC and a bleeding diary, were randomized to immediate or conventional OC start, underwent monthly telephone follow-up, and after 90 days returned the diary and completed an exit interview.
  
  
  METHODS
  Total number of bleeding-spotting days, using the World Health Organization 90-day reference period method. Comparisons were made by trial assignment (immediate vs. conventional) and cycle day of OC initiation (day 8+ vs. days 1-7).
  
  
  RESULTS
  There was no significant difference in the number of bleeding-spotting days (mean difference: -0.5 days; 95% CI: -3.4 to 2.3) or any other bleeding parameter between the immediate and conventional starters, or days 1-7 and day 8+ starters.
  
  
  CONCLUSIONS
  Immediate start of OCs does not induce bleeding patterns different from conventional starting regimens. Concern about adverse bleeding patterns should not be considered a justification for instructing women to wait until menses before starting OCs.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University, New York, New York 10032, USA. clw3@columbia.edu
authors.forename: Carolyn
authors.initials: C
authors.lastname: Westhoff
authors.forename: Chelsea
authors.initials: C
authors.lastname: Morroni
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kerns
authors.forename: Patricia Aikins
authors.initials: PA
authors.lastname: Murphy
mesh_terms: D000328:Adult; D001824:Body Constitution; D003276:Contraceptives, Oral / Q000494:pharmacology*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008597:Menstrual Cycle / Q000187:drug effects / Q000502:physiology*; D018579:Patient Selection; D012907:Smoking; D013997:Time Factors
chemical_list: D003276:Contraceptives, Oral