Continuous Oral Contraceptives

Edelman, Alison; Koontz, Stephanie L.; Nichols, Mark; Jensen, Jeffrey T.

doi:10.1097/01.aog.0000199950.64545.16

Cited by 45 publications

(7 citation statements)

References 25 publications

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“…Any inconsistencies in reporting and pill use should have been distributed evenly between the groups, leading to a dilution of the effect and rejection of the hypothesis. Furthermore, our bleeding data were comparable to those reported in other studies of continuous OCP studies using a similar pill formulation, suggesting external validity to our findings [19,23]. Finally, changes in bleeding in the treatment group are unlikely to be related to the absorption of contraceptive steroid as pharmacokinetic studies have demonstrated that concomitant use of typical doses of doxycycline does not alter contraceptive steroid levels [25,26].…”

Section: Discussionsupporting

confidence: 88%

“…In a randomized study of continuous use of OCPs containing 20 mcg EE in combination with either 100 mcg of LNG or 1 mg Norethindrone acetate, the addition of 10 mcg EE to either regimen did not improve bleeding patterns [19]. …”

Section: Discussionmentioning

confidence: 99%

“…Prior studies documented a mean of 19.2 (SD 12.01) days of bleeding and spotting over the first 90 days when a 100-mcg levonorgestrel/20-mcg ethinyl estradiol pill is administered continuously [19]. The sample size (beta 0.80, alpha 0.05) was calculated to detect a 50% reduction in bleeding (e.g., from 19 days to 9 days) and accounted for a 30% dropout rate.…”

Section: Methodsmentioning

confidence: 99%

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A randomized controlled trial of subantimicrobial-dose doxycycline to prevent unscheduled bleeding with continuous oral contraceptive pill use

et al. 2012

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Background Unscheduled bleeding is the main side effect of continuous oral contraceptive pills (OCPs) and has been correlated with the up-regulation of matrix metalloprotineases (MMPs). The study objective was to determine if prophylactic administration of doxycycline (an MMP inhibitor at low subantimicrobial doses) would prevent unscheduled bleeding during the initiation of a continuous OCP. Study Design Subjects using cyclic hormonal contraceptives (combined OCPs, patch or ring) without unscheduled bleeding were switched to continuous OCPs (20 mcg ethinyl estradiol/100 mcg levonorgestrel). They were randomized to receive daily doxycycline [sustained-release subantimicrobial dose (40 mg daily)] or placebo for the first 84 days and then observed for an additional 28 days on the continuous OCP alone. The number of bleeding/spotting days and the time in days it took to achieve amenorrhea were compared using a t test. Results Sixty-five subjects were randomized. Although the use of doxycycline did not significantly decrease the number of mean bleeding/spotting days in the first 84 days of the study [doxycycline 14.75 (SE 2.30), placebo 17.78 (2.31), p=.36], women who received doxycycline had a significantly earlier onset of amenorrhea [mean last day of bleeding/spotting doxycycline 61.7 (7.7), placebo 85.2 (6.7), p=.03]. Conclusion The coadministration of subantimicrobial-dose doxycycline during initiation of continuous OCPs results in a significant reduction in the length of time needed to achieve amenorrhea.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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A randomized controlled trial of subantimicrobial-dose doxycycline to prevent unscheduled bleeding with continuous oral contraceptive pill use

et al. 2012

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“…In terms of ethinylestradiol, few patients require a pill containing more than 35 μg/d to prevent breakthrough bleeding. 87 Many clinicians advocate starting with the lowest ethinylestradiol dose to minimize risks. However, there are no data demonstrating that 10-to 20-μg/d ethinylestradiol doses are safer than 35 μg daily, and lower ethinylestradiol doses are associated with more unscheduled vaginal bleeding.…”

Section: Selecting a Contraceptive Pillmentioning

confidence: 99%

Contraception Selection, Effectiveness, and Adverse Effects

Teal

Edelman

2021

JAMA

164

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ontraception is defined as an intervention that reduces the chance of pregnancy after sexual intercourse. According to a report from 2013, an estimated 99% of women who have ever had sexual intercourse used at least 1 contraceptive method in their lifetime. 1 Approximately 88% of sexually active women not seeking pregnancy report using contraception at any given time. 2 All nonbarrier contraceptive methods require a prescription or initiation by a clinician. Therefore, contraception is a common reason women 15 to 50 years of age seek health care. 3 This review summarizes current evidence regarding efficacy, adverse effects, and optimal selection of reversible contraceptives. This review uses the terms women and men when the biological expectation for the individual is ovulation or sperm production, respectively.

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“… 67 In a different study, pills formulated with LNG had significantly less unscheduled bleeding than those formulated with norethindrone. 68 Additionally, discontinuation of the continuous CHC for 3 to 4 days in cases of bothersome unscheduled bleeding to allow for a withdrawal bleed is one option, as long as the discontinuation occurs after the first 21 days of use. 1 However, this technique is limited to once every 3 weeks, given the risk of decreasing contraceptive effectiveness.…”

Section: Combined Hormonal Contraceptivesmentioning

confidence: 99%

Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates

Villavicencio¹,

Allen²

2016

OAJC

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Approximately half (51%) of the 6.6 million pregnancies in the US each year are unintended and half of those pregnancies (54%) occur among women not using contraception. Many women discontinue their contraceptives due to method dissatisfaction. Bothersome unscheduled bleeding is one of the main reasons cited by women for stopping a birth control method. Improving counseling and management of these side effects will aide in increasing satisfaction with contraceptive methods. The following review will discuss the bleeding profiles associated with the contraceptive options available in the US. A valuable resource from the Centers for Disease Control and Prevention, the US Selected Practice Recommendations for Contraceptive Use, will be introduced. Definitions of the types of unscheduled bleeding are included, as well as strategies for treatment for each contraceptive method. The evidence whether or not anticipatory counseling increases continuation rates will also be reviewed.

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Continuous Oral Contraceptives

Abstract: I.

Cited by 45 publications

References 25 publications

A randomized controlled trial of subantimicrobial-dose doxycycline to prevent unscheduled bleeding with continuous oral contraceptive pill use

A randomized controlled trial of subantimicrobial-dose doxycycline to prevent unscheduled bleeding with continuous oral contraceptive pill use

Contraception Selection, Effectiveness, and Adverse Effects

Unscheduled bleeding and contraceptive choice: increasing satisfaction and continuation rates

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