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This longitudinal study investigated 1) differences in self-reported cycle-related symptom severity and recovery measures (sleep quality, readiness to train, resting heart rate) between pre-bleeding, bleeding, and non-bleeding days in athletes using/not using hormonal contraception (HC); 2) associations between symptom severity and recovery measures. Fifty-eight female endurance athletes recorded recovery measures, perceived symptom severity, and menstruation/withdrawal (bleeding) days for one year. Athletes were grouped as: intrauterine system (IUS)-, implant-, progestin-only oral contraceptive (POC)-, combined oral contraceptive (COC)- and non-HC users. All groups reported higher symptom severity during bleeding compared to pre-bleeding and non-bleeding days (both p < .001), while implant users reported less severe symptoms than IUS (p < .001) and non-HC users (p = .008). Perceived sleep quality was lower during pre-bleeding compared to bleeding days (p < .001) for all groups. However, IUS users reported higher sleep quality (p = .039) and physical readiness-to-train (p = .010) than non-HC users. Symptom severity was negatively associated with sleep quality and physical readiness-to-train (both p < .050). Pre-bleeding days and cycle-related symptom severity were found to negatively influence self-reported recovery measures in both HC- and non-HC users. Therefore, athletes and their support staff are advised to prioritize symptom management and the adjustment of recovery strategies on an individual basis throughout the athletes’ cycles. [ABSTRACT FROM AUTHOR]

Our objective was to evaluate the safety and efficacy of direct initiation of gonadotropin ovarian stimulation without prior withdrawal bleeding in anovulatory clomiphene citrate (CC) resistant polycystic ovarian syndrome (PCOS) patients. Eighteen PCOS patients underwent ovulation induction with CC using a stair-step regimen. Patients who failed to respond to the maximal dose of CC initiated gonadotropin stimulation without inducing withdrawal bleeding, using the chronic low dose regimen. The primary outcome measure was the time to ovulation from the beginning of CC treatment until the day of ovulatory trigger. This was compared with the time to ovulation calculated according to the traditional approach, which includes inducing progesterone withdrawal bleeding between each CC dose increment and before gonadotropin therapy. The time to ovulation in the study group was 67.0 ± 6.8 days. The estimated time to ovulation according to the traditional approach was approximately 110 days. The clinical pregnancy rate was 44% (8/18), and all pregnancies were singletons. One patient miscarried; hence the live birth rate was 38.9% (7/18). Direct initiation of gonadotropin therapy without prior induction of withdrawal bleeding in clomiphene resistant PCOS patients results in considerable reduction of the time to ovulation and is both safe and efficacious. [ABSTRACT FROM AUTHOR]

Objectives: To obtain more precise and detailed information regarding the bleeding patterns of nomegestrol acetate (NOMAC)/17β-estradiol (E2) and drospirenone/ethinyl estradiol (DRSP/EE) and to identify whether baseline demographic characteristics were associated with unscheduled bleeding, absent scheduled bleeding, or amenorrhea.Study Design: This analysis pooled results from two pivotal open-label, randomized trials that compared bleeding patterns of NOMAC/E2 and DRSP/EE. In the two studies 4317 women aged 18-50 years from 24 countries across the Americas, Europe, and Asia underwent treatment.Results: 2835 women taking NOMAC/E2 (2.5 mg/1.5 mg) in a 24/4-day regimen and 938 women taking DRSP/EE (3 mg/30 μg) in a 21/7-day regimen had at least 1 evaluable cycle for vaginal bleeding analyses. The frequency of absent scheduled bleeding was higher (p<.0001) for women using NOMAC/E2 than DRSP/EE across all 11 cycles (cycles 2-12), ranging between 17.6% and 31.6% and between 3.4% and 5.8%, respectively. For women who had absent scheduled bleeding in cycles 2, 3, or 4 the incidence of absent scheduled bleeding in subsequent cycles was high and ranged between approximately 50%-60% for NOMAC/E2 and approximately 40%-50% for DRSP/EE. Amenorrhea increased over time with both regimens, being higher with NOMAC/E2. Both absent scheduled bleeding and amenorrhea with NOMAC/E2 were more common in older women, overweight women, switchers, and smokers; unscheduled bleeding was more common in starters, but had no association with age, body mass index, and smoking.Conclusions: NOMAC/E2 is associated with a higher prevalence of absent scheduled bleeding compared with DRSP/EE. Absent scheduled bleeding and amenorrhea were associated with age, body weight, switching and smoking. Unscheduled bleeding was more common in starters.Implications: Information about the factors associated with bleeding patterns may help clinicians provide guidance to women considering use of the NOMAC/E2 oral contraceptive. [ABSTRACT FROM AUTHOR]

Background: Although most low-dose combined oral contraceptives (COCs) include 7-day hormone-free intervals (HFIs), these COCs could incompletely suppress ovarian activity.Objectives: To review the impact of HFIs on ovarian suppression and tolerability, and evaluate the utility of COCs without traditional 7-day HFIs.Search Strategy: PubMed was searched for clinical studies published in English between January 1980 and April 2015 on the impact of HFIs and HFI modifications in COCs.Selection Criteria: Articles assessing contraceptive efficacy or tolerability as the primary focus were included.Data Collection and Analysis: Abstracts of 319 articles were screened.Results: Analysis of the 161 articles selected revealed that suppression of ovarian activity with low-dose COCs with 7-day HFIs is suboptimal. Loss of ovarian suppression during 7-day HFIs is commonly associated with follicular development, and most dominant follicles appear during this period. By contrast, increased ovarian suppression was noted in regimens that shortened or eliminated the HFI, or that substituted low-dose ethinyl estradiol for the HFI.Conclusions: Extended regimens with modified HFIs may provide greater ovarian suppression with the potential for increased contraceptive effectiveness. Additional research is needed to evaluate whether COC regimens that include 10μg ethinyl estradiol instead of an HFI may improve tolerability. [ABSTRACT FROM AUTHOR]

Objective To assess whether continuous and extended regimens (CRs/ERs) of combined hormonal contraceptives (CHCs) improve symptoms related to withdrawal bleeding or the hormone-free interval and to compare the efficacy, safety, and cost of CRs/ERs to those of conventional 28-day regimens. Study design A literature search of the PubMed database was conducted for randomised clinical trials (RCTs) and observational studies published in any language between 2006 and 2013. Results Sixteen RCTs and 14 observational studies evaluated issues related to our objectives. CRs/ERs, whose efficacy and safety were comparable to those described for conventional regimens, were preferred due to their improvement of symptoms related to withdrawal bleeding or the hormone-free interval and the lower costs resulting from the reduced incidence of these symptoms. Conclusion The contraceptive efficacy and safety of CR/ER use of CHCs is at least equal to that of 28-days conventional regimens, and this use may have some cost savings. CRs/ERs are recommended for women willing to take a CHC for treatment of symptoms related to withdrawal bleeding or the hormone-free interval. [ABSTRACT FROM AUTHOR]

Résumé: La contraception hormonale étendue permet de réduire la fréquence des règles en diminuant le nombre de jours d’arrêt d’une pilule, ou en réduisant la fréquence des séquences d’arrêts. Il existe différents régimes étendus/continus avec des cycles allant de 49jours à 365jours. Les études existantes retrouvent dans l’ensemble une réduction de la fréquence des hémorragies de privation provoquées, mais une augmentation des saignements imprévus et des spottings, qui diminue avec le temps. La contraception étendue pourrait réduire certains symptômes menstruels (ménorragies ou dysménorrhée) ou liés aux cycles comme les migraines. Cet article fait la revue des études existantes concernant la position des patientes et des professionnels de santé sur ces régimes, leur profil de saignement, leur tolérance, et leur efficacité dans la réduction de certains symptômes menstruels ou prémenstruels. [ABSTRACT FROM AUTHOR]

Objective Monthly bleeding can be uncomfortable and inconvenient. Fifty years after the introduction of the pill, one wonders whether women still want to bleed every month. Methods Cross-national online survey of women aged 15-49 years ( N = 4039) who were currently using, had used or would consider using a hormonal contraceptive. The survey was conducted in eight countries across Europe, North America and Latin America to assess attitudes towards monthly bleeding. Results Almost one-third of women reported that bleeding had a severe negative impact on their daily life, particularly with respect to sexual life and sports activities. Approximately 60% of women would, at least sometimes, like to postpone their bleeding and 50% wished they had the flexibility to determine when their menstrual bleeding starts. Overall, 34% of women would change the frequency of their bleeding to once every two or three months. Conclusions Past, current or future users of hormonal contraception reported that bleeding has a severe negative impact on daily life. Given the choice, most women surveyed would reduce the frequency of their bleeding. [ABSTRACT FROM AUTHOR]

Secondary amenorrhea in women with normal estrogen levels increases the risk of endometrial carcinoma. Cyclical dydrogesterone induces regular withdrawal bleeding and effectively protects the endometrium of postmenopausal women receiving estrogens. In order to assess the efficacy of dydrogesterone in inducing regular withdrawal bleeds in premenopausal women with secondary amenorrhea or oligomenorrhea and normal estrogen levels, a double-blind, randomized, placebo-controlled, multicenter study was conducted in 104 women using cyclical dydrogesterone as is used for estrogen replacement therapy. Treatment consisted of dydrogesterone (10 mg/day on days 1-14 followed by placebo on days 15-28 of each cycle) given for six cycles of 28 days. The control group received placebo throughout the six cycles. Bleeding was documented by the patient on diary cards. The number of women with withdrawal bleeding during the first cycle was twice as high in the dydrogesterone group as in the placebo group (65.4% vs. 30.8%; p = 0.0004). Superiority of dydrogesterone was also observed for regularity of bleeding over the six cycles (p < 0.0001), although endometrial thickness after six cycles did not differ between the groups. In conclusion, dydrogesterone is significantly superior to placebo in inducing withdrawal bleeding, and maintaining regular bleeding, in women with secondary amenorrhea and normal estrogen levels. [ABSTRACT FROM AUTHOR]

Abstract: Background: New low-dose formulations of combination oral contraceptives (COCs) are safe and effective, but they may be associated with an increased risk of breakthrough bleeding. Extending the duration of active hormonal treatment may reduce the frequency of intracyclic bleeding/spotting while maintaining efficacy and tolerability. Methods: This 6-month, open-label, randomized, active-controlled study involved healthy women aged 18–45 years who were at risk for pregnancy. Women were randomized 4:1 to a 24-day regimen of norethindrone acetate 1 mg/ethinyl estradiol 20 μg (NETA/EE-24) or to a 21-day regimen of the same combination (NETA/EE-21). The outcomes assessed included pregnancy and incidence, duration of bleeding and intensity of bleeding. Results: The cumulative risk of pregnancy in the NETA/EE-24 group (n=705) was 0.9% during six cycles of treatment. Compared with NETA/EE-21 (n=181), NETA/EE-24 was associated with significantly fewer intracyclic bleeding days (0.95 vs. 1.63; p=.005), fewer days of withdrawal bleeding (2.66 vs. 3.88; p<.001) and fewer total bleeding/spotting days for Cycles 2–6 (18.6 vs. 23.2; p<.001). NETA/EE-24 was well tolerated, and side effects were generally mild to moderate in severity. Conclusions: NETA/EE-24 is an effective well-tolerated COC that is associated with a bleeding profile more favorable than that of NETA/EE-21. [Copyright &y& Elsevier]

Objectives The aim of this study is to review the development of NuvaRing® over the past decade to illustrate its use-effectiveness and acceptance as an alternative contraceptive option for women. Methods The data were extracted from the literature using computerised MEDLINE system. NuvaRing® is a new combined hormonal contraceptive vaginal ring made of ethylene-vinyl-acetate copolymer, releasing 120&ThickSpace;μg etonorgestrel and 15&ThickSpace;μg ethinyloestradiol per day. This ring is inserted on any day from day 1 to day 5 of a menstrual cycle for 21 days, thereafter removed for 7 days ring-free period and discarded. Results Complete inhibition of ovulation is observed during treatment with this device. Clinical exposure to NuvaRing® for 1786 women-years has resulted in 21 pregnancies, giving a Pearl Index of 1.18. Withdrawal bleeding (4.7–5.3 days) is regular (97–99% of cycles) with rare incidence of irregular bleeding (2.6–6.4%). The cycle control is good with the use of this combined contraceptive vaginal ring. NuvaRing® is well tolerated and accepted by women as compared to oral pill. Conclusions NuvaRing® is an effective vaginal contraceptive option for women. However, further study is needed for monitoring its long-term effectiveness and impact on patient's quality of life since the NuvaRing R is marketed in many countries. [ABSTRACT FROM AUTHOR]