Oral contraceptives, the transdermal norelgestromin/ethinyl estradiol patch (Ortho Evra), and the vaginal ring (etonogestrel/ethinyl estradiol, the NuvaRing) can all safely be used without a break to allow for withdrawal bleeding
, according to Dr.
In fact, monthly bleeding that occurs during the traditional seven-day break from combined hormonal contraception is not menstrual bleeding at all, but a symptom of the short-term hormone deprivation known as withdrawal bleeding
Sulak's study, presented in poster form, patients using OCs in the standard fashion of 21 days of active pills with a 7-day HFI were routinely asked whether they had headaches, pain, excessive withdrawal bleeding, or premenstrual symptoms associated with the HFI.
Their reasons for switching to the extended regimen included premenstrual symptoms (45%), dysmenorrhea and pelvic pain (40%), heavy withdrawal bleeding (36%), menstrual associated headaches (35%), desire to eliminate menstruation (13%), acne (10%), and perimenopausal symptoms (5%).
A longer (seven day) placebo interval was used at the time to help counteract higher estrogen-dose oral contraceptives and enable monthly withdrawal bleeding
The treatment group was composed of 24 women who were given a continuous oral monophasic contraceptive for 42-50 days and, following withdrawal bleeding
, were given 100 mg of clomiphene citrate on days 5-9 of their cycles.
Patients who use Estring and also take a progestin are not expected to experience withdrawal bleeding
Although there are no Food and Drug Administration--approved or packaged products for this indication, women using the pill who wish to reduce their withdrawal bleeding
could try skipping their spacer pills some of the time or entirely.