These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: Menstrual impact of contraception.
    Author: Stubblefield PG.
    Journal: Am J Obstet Gynecol; 1994 May; 170(5 Pt 2):1513-22. PubMed ID: 8178900.
    Abstract:
    Persistent bleeding is a common reason for the discontinuation of contraception. Standard terminology for describing bleeding patterns by reference period is presented. Observed bleeding patterns with oral contraceptives, depot medroxyprogesterone acetate, the levonorgestrel subdermal implant, and intrauterine devices are described. Bleeding days are least with oral contraceptives that are highest in progestin and estrogen potency and dose, but the ratio of the two steroids is also important. Published studies suggest that oral contraceptives containing new nonandrogenic progestins have bleeding patterns as acceptable as older low estrogen formulations. Approaches to the evaluation and treatment of intermenstrual bleeding with contraceptive methods are reviewed. Patient education on expected bleeding patterns is essential to compliance and continuation. Many women discontinue hormonal contraceptives because of persistent bleeding. Discontinuation can result in unwanted pregnancy. Hormonal contraceptives may have 2 effects on the menstrual cycle: continued cyclic bleeding or partial or complete suppression of the normal cycle. Oral contraceptives (OCs) suppress the normal ovarian cycle with an artificial cycle caused by withdrawal of the hormones on day 21. Progestin-only OCs, subdermal implants, injectable steroids, and the levonorgestrel-releasing IUD cause partial or complete suppression of the normal cycle. OCs with the highest progestin and estrogen potency and dose are associated with the least number of bleeding days. The ratio of the 2 steroids may affect bleeding. For example, an increase in either steroid appears to decrease breakthrough bleeding (BTB). In some women, BTB or spotting is associated with OC use. Clinical trials of OCs do not use standard terminology and definitions, making it difficult to analyze bleeding patterns. OCs with the new nonandrogenic progestins and low-estrogen doses tend to effect acceptable bleeding patterns similar to those of the older low-dose estrogen OCs. Among Norplant users experiencing persistent bleeding, levonorgestrel (0.03 mg 2 times/day for 20 days), ethinyl estradiol (0.05 mg/day for 20 days), and ibuprofen (800 mg 3 times/day for 5 days) reduce bleeding days and episodes of treatment. Some possible regimens to treat persistent bleeding in OC users include 7 day courses of estrogen (0.02 mg ethinyl estradiol or 2.5 mg conjugated equine estrogens). When BTB occurs in an OC user who has previously had normal menstrual cycles, providers should consider causes other than OCs, such as trauma-vaginal laceration, cervical lesion, endometrial lesion, fallopian tube cancer, and pregnancy. They should deliver good patient education on bleeding patterns to achieve good compliance and continuation.
    [Abstract] [Full Text] [Related] [New Search]