Fillers POEM

Continuous use of combined contraceptive pill minimises vaginal bleeding

BMJ 2003; 327 doi: (Published 24 July 2003) Cite this as: BMJ 2003;327:0-e

Question Does the continuous use of combined oral contraceptives lead to less vaginal bleeding without an increase in adverse effects?

Synopsis Women aged 18 to 44 years were recruited by flyer for a randomised (non-blinded) controlled trial of contraception; the flyer did not emphasise the potential for reduced bleeding. There were 79 women enrolled and randomised (allocation concealed) to continuous (that is, no weeks off hormonal treatment) or standard 28 day cycles of 20 μg ethinyl estradiol with 100 μg levonorgestrel (Alesse) for 48 weeks. Women who experienced prolonged bleeding (more than 10 days) after cycle 3 (84 days) were instructed to return to the study clinic for evaluation including pelvic examination, transvaginal ultrasonography, and endometrial biopsy. Weight and blood pressure were measured every 84 days. Median days of bleeding in the first 84 days (cycles 1-3) were 3 in the continuous group and 10 in the cyclic group (P < 0.001). By cycles 10 to 12, 72% of women in the continuous group had no bleeding or spotting. There was a small difference in systolic blood pressure between groups at study exit among women who completed the study (116 (SD 12) mm Hg standard treatment v 108 (13) continuous treatment; P = 0.02). Otherwise there were no differences between groups for changes in blood pressure or weight or haemoglobin. There were no pregnancies and no cases of endometrial hyperplasia or neoplasia.

Bottom line Within six months, most women who take combination oral contraceptive pills on a continuous basis (without skipping hormonal treatment every fourth week) will not have any vaginal bleeding that requires the use of a pad. The results are similar to those of Depo-Provera, with the advantage that treatment can be stopped quickly if desired.

Level of evidence 1b (see; individual randomised controlled trials (with narrow confidence interval).

Miller L, Hughes JP. Continuous combination oral contraceptive pills to eliminate withdrawal bleeding: a randomized trial. Obstet Gynecol 2003;101: 653-61.

©infoPOEMs 1992-2003

* Patient-Oriented Evidence that Matters. See editorial (BMJ 2002;325: 983

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