Avoiding menstruation: a review of health and lifestyle issues

This article (1) reviews the decades-long history of short-term dosing regimens delaying the onset of expected, spontaneous menses or withdrawal bleeding in oral contraceptive users up to 20 days; (2) outlines treatment schedules that suppress menstrual bleeding for several months; and (3) evaluates the recently approved extended dosing regimen of 3 months' duration. For single-term postponement of normal menses, estrogen-progestogen combinations can be employed, starting about 7 days after ovulation. Oral contraceptive users can skip the 7-day pill-free period and continue with the active pills in the next package. The main focus of this review is the development of extended dosing schedules that result in cycles lasting 7 weeks up to several months and reduce the number of periods of bleeding and menstrual discomfort. Recently a dosing schedule was introduced into clinical use consisting of ethinyl estradiol, 30 microg, plus levonorgestrel, 150 microg/d, for 84 days, followed by 7 days of placebo. The pregnancy rate was < 1% for compliant women and 1.5% for all participants. A monophasic 21 + 7-day combination using the same daily doses had slightly higher pregnancy rates. The discontinuation rate for unscheduled bleeding and spotting was higher with extended dosing than with the conventional, 21 + 7 schedule.