title: A prospective follow-up of two 21/7 cycles followed by two extended regimen 84/7 cycles with contraceptive pills containing ethinyl estradiol and drospirenone.
abstract: BACKGROUND
  Continuous use of combined oral contraceptives is currently attracting growing interest as a means of improving menstrual related symptoms and reducing the number of bleeding days.
  
  
  OBJECTIVE
  To evaluate bleeding patterns, menstrual symptoms and quality of life with an extended 84/7 oral contraceptive regimen versus 21/7 cycles.
  
  
  METHODS
  In two consecutive run-in cycles, 30 microg ethinyl estradiol and 3 mg drospirenone tablets taken on days 1-21 were followed by a tablet-free period from days 22 to 28 of each cycle and then by two 84 day cycles of pill use with a 7 day tablet-free interval. The primary outcome was the total number of bleeding/spotting days. Secondary outcomes were severity of daily symptoms, general well-being determined by the PGWBI questionnaire, and overall treatment satisfaction.
  
  
  RESULTS
  Of the 137 women invited to participate in the study 109 (aged 18-40 years) were enrolled. The number of bleeding days decreased by about one-third from a calculated 31.8 days of bleeding under a cyclic 21/7 regimen to an expected total of 21.8 days for the extended 84/7 regimen. The incidence of menorrhagia, intermenstrual bleeding, dysmenorrhea, abdominal bloating, breast tenderness, depressive moods and irritability - when compared at enrollment and at the end of the second extended study period--was significantly lower (P < 0.005) among women on the continuous pill regimen. The median (range) global PGWBI scores were not substantially different before and after the extended use cycles: 78.2 (39.1-96.4) and 77.3 (30.9-96.4), respectively. Body weight and skin condition also remained constant. At the completion of the study: 65.5% of the women were either highly satisfied (41.4%) or satisfied (24.1%) with the extended regimen.
  
  
  CONCLUSIONS
  The extended 84/7 regimen was found to be satisfactory for the majority of participants and was associated with a decrease in the number of bleeding days and an improvement in menstrual symptoms compared to 21/7 cycles.
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel. dseidman@tau.ac.il
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Seidman
authors.forename: Arie
authors.initials: A
authors.lastname: Yeshaya
authors.forename: Amos
authors.initials: A
authors.lastname: Ber
authors.forename: Ida
authors.initials: I
authors.lastname: Amodai
authors.forename: Itzhak
authors.initials: I
authors.lastname: Feinstein
authors.forename: Israelit
authors.initials: I
authors.lastname: Finkel
authors.forename: Nina
authors.initials: N
authors.lastname: Gordon
authors.forename: Noga
authors.initials: N
authors.lastname: Porat
authors.forename: Dganit
authors.initials: D
authors.lastname: Samuel
authors.forename: Einat
authors.initials: E
authors.lastname: Shiran-Makler
authors.forename: Igal
authors.initials: I
authors.lastname: Wolman
mesh_terms: D000328:Adult; D000736:Androstenes / Q000008:administration & dosage*; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004997:Ethinyl Estradiol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008598:Menstruation / Q000187:drug effects; D008599:Menstruation Disturbances / Q000188:drug therapy; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D000736:Androstenes; D003277:Contraceptives, Oral, Combined; D000451:Mineralocorticoid Receptor Antagonists; D004997:Ethinyl Estradiol; C035144:drospirenone