Communicating with patients about extended-cycle and continuous use of oral contraceptives.
Oral contraceptives (OCs) have been the gold standard for contraception in the United States since their introduction in 1960. They are used for both their contraceptive and noncontraceptive benefits. Although the traditional dosing regimen, 21 active pills and 7 placebo pills, (21/7), reduces many symptoms women suffer with spontaneous cycles, hormone withdrawal symptoms often occur during the 7-day hormone-free interval. New contraceptives are available that decrease the number of hormone-free days each cycle or that increase the time between hormone-free intervals. These changes in packaging are expected to decrease the periodic hormone fluctuations experienced by OC users. Because routine use of extended-cycle/continuous OCs is relatively new and differs from what women have been told for years about the importance of monthly bleeding, women have many questions about and even significant reluctance to using these methods. Numerous studies have shown that extended-cycle and continuous OC use are safe and effective. Total bleeding episodes are reduced, as are problems with bloating and dysmenorrhea. Women usually experience more unscheduled spotting and bleeding in the initial cycles, but those problems decrease with longer use. Amenorrhea may be beneficial and suit the lifestyles of many women. Counseling women about all their contraceptive options and the variety of ways that OCs can be taken may increase women's commitment to correct use and increase efficacy. Good clinician-patient communication, which includes creating an open dialogue with the patient to discuss her individual risks and benefits, should lead to more successful contraceptive utilization.
Nelson
Anita L
AL
Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Torrance, California 90509-2910, USA. AnitaLNelson@earthlink.net
D000568:Amenorrhea / Q000139:chemically induced; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D003376:Counseling / Q000458:organization & administration*; D004305:Dose-Response Relationship, Drug; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008597:Menstrual Cycle / Q000187:drug effects*; D008598:Menstruation / Q000187:drug effects; D010349:Patient Compliance; D011369:Professional-Patient Relations; D016387:Women's Health
D003278:Contraceptives, Oral, Hormonal