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  • Title: Women's attitudes to withdrawal bleeding and their knowledge and beliefs about the oral contraceptive pill.
    Author: Rutter W, Knight C, Vizzard J, Mira M, Abraham S.
    Journal: Med J Aust; 1988 Oct 17; 149(8):417-9. PubMed ID: 3173203.
    Abstract:
    One hundred and fifty-eight attenders at general practices and family-planning clinics, and 20 young female doctors volunteered to complete a questionnaire about how women take the oral contraceptive pill, their knowledge of the Pill and their attitudes to withdrawal bleeding. Forty-three per cent of female patients has used the Pill to alter the time of withdrawal bleeding. Twenty-two per cent of female patients had taken the Pill daily for more than six weeks on at least one occasion and all reported positive experiences. However, 83% of female patients believed that it was necessary to bleed monthly when taking the Pill and 69% of the female patients believed that continuous use of active medication is undesirable. The over-all knowledge of the Pill was poor and 43% of female patients did not know what to do if they missed two consecutive Pills. Female doctors were better informed but had similar attitudes about the Pill to those of other women. Forty-six per cent of the female patients and 55% of young female doctors would chose to bleed at intervals of three months or greater if they could determine their own Pill regimen. Australian women's oral contraceptive (OC)-related behavioral practices and attitudes toward withdrawal bleeding were assessed in a questionnaire administered to 158 pill users (recruited either from general practice or family planning clinics) and 20 female physicians. The patients, the majority of whom were 20-29 years of age, had been taking the pill for an average of 5.3 years. 83% of the patients and 60% of the physicians believed a monthly bleed was essential for normal body functions. When given the hypothetical option of choosing how often they would bleed, 54% of patients and 45% of physicians still opted for monthly withdrawal bleedings. However, 43% of all female patients and 45% of physicians indicated they had used OCs to alter the time of withdrawal bleeding on at least 1 occasion, generally to prevent bleeding for special occasions or on holidays. These OC "manipulators" were more likely to be taking a monophasic than triphasic OC, to state that they did not always take the pill as directed, to believe that it was not physiologically essential to bleed every month, and to prefer a pill regimen that resulted in less frequent bleeding. Overall, knowledge of the mechanisms of OC use was poor among the female acceptors. 43% of female patients did not know what to do if they missed 2 consecutive pills. Few patients were aware that the pill functions by suppressing the release of endogenous estrogen and progesterone and that withdrawal bleeding is not menstruation. In general, the findings of this study suggest that there are many misconceptions that must be overcome before women would be willing to accept an OC regimen associated with a withdrawal bleed at intervals of 2-3 months.
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