title: Randomized comparison of bleeding patterns in women using a combined contraceptive vaginal ring or a low-dose combined oral contraceptive on a menstrually signaled regimen.
abstract: OBJECTIVE
  To compare bleeding patterns for 12 months continuous use of a contraceptive ring [contraceptive vaginal ring (CVR)] and pill [combined oral contraceptive (COC)] on a menstrually signaled regimen and the effectiveness of 4 days "treatment withdrawal" to stop bleeding.
  
  
  METHODS
  Women, 66 to each group, were randomized to continuous use of a CVR (15 mcg ethinyl estradiol/150 mcg etonogestrel) or a low-dose pill (20 mcg ethinyl estradiol/100 mcg levonorgestrel) for 360 days on a menstrually signaled regimen. Bleeding/spotting days, daily use of ring or pill, was recorded. Endpoint was the total number of bleeding/spotting days for each method over four 90-day reference periods (RP) plus the analysis of bleeding patterns using modified World Health Organization criteria.
  
  
  RESULTS
  There was a reduction in the mean (±S.D.) number of bleeding/spotting days from RP1 (CVR 14.2±10; pill 16.6±10.9) to RP4 (CVR 8.8±9.6; pill 8.8±9.1). Fifteen percent of CVR and 4% COC users experienced amenorrhea or infrequent bleeding throughout the study. Amenorrhea increased over time (RP1 vs. RP4: CVR 10% vs. 21% and COC 2% vs. 30%). Compliance with the menstrually signaled regimen was poor. Ceasing hormones for 4 days stopped a bleeding episode within 5 days in the majority of episodes and many stopped spontaneously.
  
  
  CONCLUSIONS
  Bleeding patterns with continuous use of the CVR and COC are similar and improve over 1 year of use. The unpredictability, but short duration, of bleeding episodes should be stressed during counseling.
  
  
  CONCLUSIONS
  This information for clinicians and women about breakthrough bleeding patterns with use of a CVR or combined pill over 12 months using a menstrually signaled regimen will give women an indication of what to expect with continuous use.
authors.affiliation: Sydney Centre for Reproductive Health Research, Family Planning New South Wales, NSW 2131, Australia; University of Sydney, NSW 2006, Australia. Electronic address: edithw@fpnsw.org.au.
authors.forename: Edith
authors.initials: E
authors.lastname: Weisberg
authors.affiliation: Clinic for Reproductive Endocrinology, Department Gynaecology, University Hospital, 8006 Zürich, Switzerland.
authors.forename: Gabriele S
authors.initials: GS
authors.lastname: Merki-Feld
authors.affiliation: Sydney Centre for Reproductive Health Research, Family Planning New South Wales, NSW 2131, Australia; University of Sydney, NSW 2006, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: McGeechan
authors.affiliation: Sydney Centre for Reproductive Health Research, Family Planning New South Wales, NSW 2131, Australia; University of Sydney, NSW 2006, Australia.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects*; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects*; D017135:Desogestrel / Q000008:administration & dosage / Q000009:adverse effects; D004338:Drug Combinations; D016903:Drug Monitoring; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects*; D016912:Levonorgestrel / Q000008:administration & dosage / Q000009:adverse effects; D055118:Medication Adherence; D008595:Menorrhagia / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D008597:Menstrual Cycle / Q000187:drug effects*; D008796:Metrorrhagia / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D009517:New South Wales; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D012648:Self Care; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined; D004338:Drug Combinations; C072593:ethinyl estradiol, levonorgestrel drug combination; C044815:etonogestrel; D004997:Ethinyl Estradiol; D016912:Levonorgestrel; D017135:Desogestrel
keywords: Compliance; Convenience; Duration; Frequent bleeding/spotting