title: Extended regimen combined oral contraception: A review of evolving concepts and acceptance by women and clinicians.
abstract: OBJECTIVE
  The clinical utility of extended regimen combined oral contraceptives (COCs) is increasingly being recognised. Our objective was to understand the attitudes of women and clinicians about the use of these regimens. We present the rationale for extended regimen COCs from a historical perspective, and trace their evolution and growing popularity in light of their clinical benefits. We conclude by offering potential strategies for counselling women about extended regimen COC options.
  
  
  METHODS
  We conducted a MEDLINE search to identify and summarise studies of extended regimen COCs, focusing on attitudes of women and clinicians regarding efficacy, safety/tolerability and fewer scheduled bleeding episodes and other potential benefits.
  
  
  RESULTS
  The body of contemporary literature on extended regimen COCs suggests that their contraceptive efficacy is comparable to that of conventional 28-day (i.e., 21/7) regimens. For women seeking contraception that allows infrequent scheduled bleeding episodes, particularly those who suffer from hormone withdrawal symptoms and cyclical symptoms (e.g., headache, mood changes, dysmenorrhoea, heavy menstrual bleeding), extended regimen COCs are an effective and safe option. Although satisfaction with extended regimen COCs in clinical trials is high, misperceptions about continuous hormone use may still limit the widespread acceptance of this approach.
  
  
  CONCLUSIONS
  Despite the widespread acceptance among clinicians of extended regimen COCs as an effective and safe contraceptive option, these regimens are underused, likely due to a lack of awareness about their availability and utility among women. Improved patient education and counselling regarding the safety and benefits of extended regimen COCs may help women make more informed contraceptive choices.
authors.affiliation: a Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Department of Obstetrics and Gynaecology , IRCCS San Matteo Foundation, University of Pavia , Pavia , Italy.
authors.forename: Rossella E
authors.initials: RE
authors.lastname: Nappi
authors.affiliation: b Department of Obstetrics and Gynecology , University of Florida College of Medicine-Jacksonville , Jacksonville , FL , USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kaunitz
authors.affiliation: c Department of Obstetrics and Gynaecology , Basel University Hospital , Basel , Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Bitzer
mesh_terms: D001291:Attitude of Health Personnel; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage*; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008598:Menstruation; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction
chemical_list: D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal
keywords: Bleeding; Clinician attitudes; Combined hormonal contraception; Menstrual suppression; Oral contraceptives; Patient satisfaction