Cycle characteristics after discontinuation of oral contraceptives

Abstract

Nearly 60% of the women between 20 and 40 years of age who do not want to conceive choose oral contraceptives (OCs) for contraception in Germany. In an ongoing prospective study on the use of natural family planning in Germany, 175 women have been observed for 3,048 cycles immediately after having discontinued OCs (post-pill group). They were compared to a control group of 284 women observed for 6,251 cycles, who had never taken OCs. Both groups were comparable in age and sociodemographic characteristics. After discontinuing OCs, 57.9% of all first cycles were ovulatory with sufficient luteal phases. However, for the total post-pill group the cycle length was significantly prolonged up to the ninth cycle. A significantly higher number of luteal phases were insufficient in the post-pill group. Major cycle disturbances (cycle length > 35 days or luteal phase of < 10 days of elevated basal body temperature or anovulatory cycles) were significantly more frequent in the post-pill group up to the seventh cycle. Cycle disturbances after discontinuing OCs were reversible but the time of regeneration took up to 9 months (significant) or even longer (not significant). These results will help to counsel couples who wish to conceive after discontinuing OCs or who want to continue contraception with alternative methods.

Length of the menstrual cycle after discontinuation of oral contraceptives

“…The fact that the first posttreatment cycle was significantly longer in the youngest age group could indicate that an effect of OC treatment on cycle duration was present in young women but disappeared with increasing age. This possibility cannot explain the difference between our results and those by Gnoth and colleagues [12], however, because the mean age of the OC users in that study was higher than in our study (26.3 vs. 23.7 years). The shorter duration of the first post-pill cycle compared with the second cycle in the 25-29-year group is unexpected and it is hard to give an explanation for this finding, especially since the results in the highest age groups were not in agreement with this result in the 25-29-year group.…”

“…Gnoth and associates [12] performed a large prospective study on the use of natural family planning. Characteristics of 3048 cycles in 175 women who discontinued OC use were compared with those of 6251 control cycles in 284 women who had never taken OCs.…”

“…In more recent studies with lower-dose OCs a rapid return of ovulation after cessation of OC intake was reported, but data on the day of ovulation or the next menstruation were not given [7][8][9] or only the duration until the first ovulation was investigated [10,11]. Recently, a large prospective study reported the characteristics of multiple cycles after discontinuation of OCs in 175 women, in comparison with a control group of 284 non-OC users [12]. In the post-pill group the cycle length was significantly prolonged up to the ninth cycle.…”

Implications of cycle length immediately after discontinuation of combined oral contraceptives on use of the Standard Days Method

“…Gnoth et al [14] reported longer menstrual cycles for up to 9 cycles post-COC use, which they attributed to later ovulation and longer follicular phases. They followed 175 women for up to 1 year (3048 cycles) immediately after COC discontinuation and compared their cycles with those of 284 women (6251 cycles) who had never used COC.…”

Usefulness of Monitoring Fertility from Menarche

“…They also have lower monthly conception rates during the first 3 months off the pill, and a somewhat lower percentage from the fourth to the tenth month after discontinuation of the pill. [56][57][58] In conclusion, although usually used for fertility awareness, cycle charting provides women with information about their cycle pattern and ovarian function. Klaus and Martin 41 showed that ethnically and socioeconomically diverse perimenarchal girls can be taught to recognize their cervical mucus patterns and distinguish anovulatory from ovulatory cycles.…”