Randomized trial of the effect of tailored versus standard use of the combined oral contraceptive pill on continuation rates at 1 year

FSRH Guideline (January 2019, amended October 2023) Combined Hormonal Contraception

“…A UK trial56 randomised 503 women to use 30 μg EE/LNG COC either as a 21/7 regimen or as a regimen in which pills were taken consecutively until a 3-day bleed triggered a 3-day break in pill-taking. Of the 252 women using the tailored regimen, 179 women were followed up at 12 months; 54% were continuing the tailored regimen.…”

Evolution of extended use of the combined oral contraceptive pill

“…The withdrawal bleed that occurs in the HFI seems to ‘discourage’ further irregular bleeding when the pill is restarted, leading to the desired combination of fewer withdrawal bleeds and less irregular bleeding. A recent RCT of standard versus tailored COC use revealed no significant difference in continuation or satisfaction rates at 1 year between the two regimens 30. While a significant minority of women expressed a preference for regular menstrual periods in the recruitment phase, a qualitative sub-study noted high satisfaction with the reduced bleeding and relief over the medical sanctioning of extended pill use on the one hand, but a dislike of the unpredictability of bleeding and the worry that amenorrhoea might imply pregnancy on the other 88.…”

“…Numerous studies have aimed to determine more precisely the effects of extended COC use, in attempts to improve both contraceptive choice and continuation rates 12 30…”

Counselling to include tailored use of combined oral contraception in clinical practice: an evaluation

“…These tools that had been used for the tailored versus standard contraceptive pill use trial6 were combined, modified and validated to produce a Script for use by healthcare professionals (HCPs) and an Advice Sheet (see online supplementary appendix 1) for patients to provide information on tailored COC use. Questionnaires were also developed to obtain information from both the HCP and the patient immediately after the initial consultation (HCP and patient baseline questionnaires), and again from the patient after 8 weeks—either by telephone, email or in person at their follow-up visit (follow-up questionnaire).…”

“…We did a randomised controlled trial of tailored versus standard use to compare COC continuation rates at 1 year and user experience 6. In those women familiar with standard use of the COC at trial recruitment (83%, n=417), switching to tailored COC use or continuing with standard use were both associated with high COC continuation rates and high satisfaction with contraceptive regimen and bleeding pattern.…”