title: Expert opinion on a flexible extended regimen of drospirenone/ethinyl estradiol contraceptive.
abstract: BACKGROUND
  Oral contraceptives are often prescribed in extended or continuous forms in order to manage menstrual bleeding and menstrual-related side effects. However, with extended regimens, unscheduled intracycle bleeding can become problematic. Flexible extended dosing of a contraceptive containing drospirenone (DRSP) and ethinyl estradiol (EE) was designed to improve bleeding profiles during extended cycles through active management of bleeding symptoms.
  
  
  METHODS
  We examine the rationale for flexible extended dosing as well as review the dosing regimen. We will focus on the findings of the two most important clinical trials regarding flexible extended DRSP/EE (3 mg/20 μg), including the bleeding profiles of women in those trials. Pharmacology, mechanisms of action, efficacy as well as safety of DRSP containing pills will also be reviewed.
  
  
  CONCLUSIONS
  Flexible extended dosing of DRSP/EE (3 mg/20 μg) has similar pharmacokinetics and contraceptive efficacy of both conventional and fixed extended regimens. However, it has the added benefit of fewer days of bleeding/spotting compared to conventional and fixed extended regimens.
authors.affiliation: Oregon Health and Science University, Department of Obstetrics and Gynecology , SW Sam Jackson Park Road, Mailcode: L466, 3181 Portland, OR 97239 , USA +1 503 494 2685 ; +1 503 494 2391 ; hanl@ohsu.edu.
authors.forename: Leo
authors.initials: L
authors.lastname: Han
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Jensen
mesh_terms: D000736:Androstenes / Q000008:administration & dosage / Q000009:adverse effects; D002986:Clinical Trials as Topic; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008598:Menstruation
chemical_list: D000736:Androstenes; D003277:Contraceptives, Oral, Combined; C534342:drospirenone and ethinyl estradiol combination; D004997:Ethinyl Estradiol
keywords: Flexyess; combined oral contraceptive; cycle regulation; drospirenone; ethinyl estradiol; flexible extended regimen; menstrual bleeding; oral contraceptive pills