title: Evolution of extended use of the combined oral contraceptive pill.
abstract: BACKGROUND
  Extended use of the combined oral contraceptive pill (COC), defined as taking active pills for at least 28&emsp14;days, has been used in order to avoid bleeding at important times and to treat gynaecological conditions such as endometriosis. We examined the main issues involved in extended use of the COC and how it has evolved from being one of medicine's best-kept secrets to becoming more widely accepted by women and the medical community.
  
  
  METHODS
  Literature review, using Medline, Embase, Pubmed, CINHAL Plus, the Cochrane Database of Systematic Reviews and the Ovid database for all relevant clinical trials, systematic reviews, meta-analyses, literature reviews, scientific papers and individual opinions between 1950 and October 2013.
  
  
  RESULTS
  Accumulating evidence supports various forms of extended pill use as suitable alternatives to the standard (21/7) regimen. In terms of user preference, much hinges on whether women wish to reduce the frequency or duration of scheduled bleeding on the combined pill. Available data on the safety of extended pill regimens do not give cause for concern, but longer term data should be collected.
  
  
  CONCLUSIONS
  Information for women considering extended COC regimens should keep pace with research findings to ensure that women and clinicians are better informed about the choices available.
authors.affiliation: Specialist Registrar in Obstetrics & Gynaecology, Sexual and Reproductive Health Research Group, Institute for Women's Health, University College London, London, UK.
authors.forename: Sabeena
authors.initials: S
authors.lastname: Panicker
authors.forename: Sue
authors.initials: S
authors.lastname: Mann
authors.forename: Jill
authors.initials: J
authors.lastname: Shawe
authors.forename: Judith
authors.initials: J
authors.lastname: Stephenson
mesh_terms: D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004717:Endometrium / Q000187:drug effects; D005260:Female; D006801:Humans; D055118:Medication Adherence; D008598:Menstruation / Q000187:drug effects; D008599:Menstruation Disturbances / Q000517:prevention & control; D013997:Time Factors
chemical_list: D003277:Contraceptives, Oral, Combined
keywords: bleeding patterns; continuous use; extended use; fertility; menstruation; oral contraceptives