Omitting the first oral contraceptive pills of the cycle does not automatically lead to ovulation

Elomaa, Kaisa; Rolland, R.; Brosens, Ivo; Moorrees, M.T.E.C.; Deprest, Jan; Tuominen, Juhani; Lähteenmäki, Pekka

doi:10.1016/s0002-9378(98)70249-2

Cited by 41 publications

(26 citation statements)

References 17 publications

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“…Our rationale for defining coitus protected by pill use as day before and day of coitus assures that not more than two consecutive days of missed pills occurred around that specific coital event. This rationale is based on the following: (1) pituitary-ovarian suppression may decline as the number of missed pills increases, especially if the OCP contains less than 30 g of estrogen [15], and (2) although ovulatory "escape" is rare even with early cycle pill omission, we believe two or more missed pills constitutes an OCP adherence pattern associated with increased risk of ovulation and pregnancy [16,17]. Contraceptive patch use was assessed, but seventeen women used the patch and only one coital event occurred among these women adding little to the analysis.…”

Section: Methodsmentioning

confidence: 99%

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Pregnancy Intentions and Contraceptive Behaviors Among Adolescent Women: A Coital Event Level Analysis

Bartz

Shew

Ofner

et al. 2007

Journal of Adolescent Health

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Section: Methodsmentioning

confidence: 99%

“…Each year almost 750,000 adolescent girls aged [15][16][17][18][19] become pregnant in the United States [1,2]. Most of these pregnancies are unplanned, accounting for about one fourth of all U.S. accidental pregnancies annually [3].…”

mentioning

confidence: 99%

Pregnancy Intentions and Contraceptive Behaviors Among Adolescent Women: A Coital Event Level Analysis

Bartz

Shew

Ofner

et al. 2007

Journal of Adolescent Health

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“…We investigated the length of the first menstrual cycles after stopping the intake of a combination OC in healthy female volunteers, in comparison with the cycle length of women who did not use an OC. Since the degree of pituitary suppression depends on the dose of ethinyl estradiol (EE) in the OC preparation, the duration until restoration of pituitary and ovarian function may differ with different preparations [13,14]. Therefore, the cycle lengths after discontinuation of OCs with different doses of EE were compared.…”

Section: Introductionmentioning

confidence: 99%

Length of the menstrual cycle after discontinuation of oral contraceptives

Duijkers

Engels

Klipping

2005

Gynecological Endocrinology

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“…First, pituitary-ovarian suppression may decline as the number of missed pills increases, especially for formulations containing less than 30 μg of estrogen [23]. Although ovulatory "escape" is rare even with early or late cycle pill omission, three or more missed pills constitutes an OCP adherence pattern associated with increased risk of ovulation and pregnancy [24,25]. Second, women who miss three or more active pills are often instructed to begin a new pill pack, to abstain from sex, or to use alternative contraceptive methods [26].…”

mentioning

confidence: 99%

Patterns of Oral Contraceptive Pill-taking and Condom Use among Adolescent Contraceptive Pill Users

Woods

Shew

et al. 2006

Journal of Adolescent Health

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Purpose-Imperfect oral contraceptive pill (OCP) regimen adherence may impair contraceptive effectiveness. The purpose of this study was to describe daily adherence patterns of OCP use, to analyze OCP protection on an event level basis, and to examine pill-taking and condom use during method transitions.Methods-Women (n = 123, ages 14-17 years) completed quarterly interviews to classify OCP method choice into four categories: stable, initiated, stopped, and discordant use. Within each OCP category, daily diaries were used to assess occurrence of coitus, condom use, and patterns of day-today OCP use (i.e., consecutive days of OCP use reported with no more than two consecutive days of nonuse). A coital event was OCP protected if pills were used on both the day of the coitus and the day preceding.Results-There were 123 participants who reported at least some OCP use in 210 diary periods (average diary length = 75.5 days). Fifty-three participants categorized as stable users reported 87 diary periods: the average interval of consecutive OCP use in this group was 32.5 days. Among stable users, only 45% of coital events were associated with both OCP and condom use. Over one-fifth of coital events in all groups were protected by no method of contraception.Conclusion-Dual use of OCP and barrier contraception remains an elusive goal. The time during OCP adoption or discontinuation is often unprotected by condoms. However, concurrent missed pills and condom nonuse increase pregnancy and infection risk even among stable OCP users. Understanding motivation for method usage may improve education and prevention techniques. KeywordsAdolescent; OCP; Condom; Coital event Oral contraceptive pills (OCP) have failure rates of less than 1% under perfect-use conditions. However, imperfect use contributes to failure rates as high as 30% [1]. Effective OCP use requires method commitment (i.e., considering one's birth control method to be OCP) as well as OCP use consistent with the method's pharmacology and mechanism of action (i.e., method adherence). Moreover, OCPs provide no protection against sexually transmitted infections *Address correspondence to: Dr. Jennifer L. Woods, [XE 070] OCP method choice is not a fixed characteristic of young women's contraceptive behavior. Over 60% of contraception users switch methods at some time point, and many discontinue a method within the first three months of use [6][7][8][9]. Variable patterns of OCP pill-taking during periods of transition into and out of OCP use may make these especially vulnerable times in terms of method adherence [10]. Condom use during transition periods is especially important for contraceptive as well as STI prevention purposes.Even among women who continue OCP use, daily OCP pill-taking can be difficult. Up to 60% of adult users report missed pill doses and up to 50% miss enough doses to place them at risk for pregnancy [11,12]. Therefore, clinicians must be aware that actual OCP usage differs from the ideal with associated perfect pill usage.Understanding the ...

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Omitting the first oral contraceptive pills of the cycle does not automatically lead to ovulation

Cited by 41 publications

References 17 publications

Pregnancy Intentions and Contraceptive Behaviors Among Adolescent Women: A Coital Event Level Analysis

Pregnancy Intentions and Contraceptive Behaviors Among Adolescent Women: A Coital Event Level Analysis

Length of the menstrual cycle after discontinuation of oral contraceptives

Patterns of Oral Contraceptive Pill-taking and Condom Use among Adolescent Contraceptive Pill Users

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