Skip to main content

Oral contraceptives and cycle control: A critical review of the literature

Abstract

Control of spotting and breakthrough bleeding and absence of withdrawal bleeding, collectively termed cycle control, is the single most important determinant of whether a new user of oral contraceptives (OCs) will continue this method. However, information about different OC preparations and how they affect such problems, including the effects of progestogen and estrogen phasing and the components of these hormones, is scant and confusing. Studies cited in this report reveal highly variable rates of bleeding problems in women taking OCs: after 6 months of OC use, the prevalence of spotting varied between 0% and 8.5%; of breakthrough bleeding, 0% and 12.2%; and of amenorrhea, 0% and 5.8%. At least some of this variation is attributable to differing study populations and cultures, study designs, and the manner in which data were collected and reported. However, methodologic weaknesses were common, often involving lack of randomization and blinding, and attrition rates were high.

Despite these limitations, it is clear that the frequency of bleeding problems decreases with continuing use of OCs, emphasizing the need for patient reassurance about the transient nature of these problems. In addition, gestodene-containing preparations appear to offer better cycle control than do desogestrel-containing preparations and levonorgestrel-containing preparations better control than norethindrone-containing preparations. However, the strongest lesson to emerge is the need for more rigorous studies to adequately address questions of comparative bleeding problems, particularly with newer triphasic formulations. These conclusions underscore the importance of counseling new OC users about the possibility of bleeding problems, reassuring them that most such problems are temporary, and, that if compliance is maintained, these will not impair contraceptive efficacy.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    HatcherRA, StewartF, TrussellJ, et al., editors. Contraceptive Technology, 1990–1992. 15th ed. New York: Irvington Publishers, 1990.

    Google Scholar 

  2. 2.

    DeLiaJE, EmeryMG. Clinical pharmacology and common minor side effects of oral contraceptives. Clin Obstet Gynecol. 1981;24:879–92.

    PubMed  Google Scholar 

  3. 3.

    UptonGV. The phasic approach to oral contraception: the triphasic concept and its clinical application. Int J Fertil. 1983;28:121–40.

    PubMed  Google Scholar 

  4. 4.

    ZadorG. Fertility regulation using “triphasic” administration of ethinyl estradiol and levonorgestrel in comparison with the 30 plus 150 μg fixed dose regime. Acta Obstet Gynecol Scand. 1979;88(suppl):43–8.

    Google Scholar 

  5. 5.

    CullbergG, SamsioeG, AndersenRF, et al. Two oral contraceptives, efficacy, serum proteins, and lipid metabolism. Contraception. 1982;26:229–43.

    PubMed  Google Scholar 

  6. 6.

    WisemanA, BowieJ, CogswellD, et al. Marvelon: clinical experience in the UK. Br J Fam Plann. 1984;10:38–42.

    Google Scholar 

  7. 7.

    FiorettiP, FruzzettiF, NavalesiR, et al Clinical and metabolic study of a new pill containing 20 mcg ethinylestradiol plus 0.150 mg desogestrel. Contraception. 1987;35:229–43.

    PubMed  Google Scholar 

  8. 8.

    HansonMS, StewartGK, BechtelRC, TuranES. Planned Parenthood experience with Triphasil. J Reprod Med. 1987;32:592–6.

    PubMed  Google Scholar 

  9. 9.

    Nevinny-StickelJ. German trial of an oral contraceptive containing 0.150 mg desogestrel plus 0.020 mg ethinylestradiol. Acta Obstet Gynecol Scand. 1987;144(suppl):19–21.

    Google Scholar 

  10. 10.

    RabeT, RunnebaumB, KohlmeierM, HarenbergJ, WeickerH, UngerR. Clinical and metabolic effects of gestodene on levonorgestrel. Int J Fertil. 1987;32(suppl):29–44.

    PubMed  Google Scholar 

  11. 11.

    vanKetsHE. Belgian trial of an oral contraceptive containing 0.150 mg desogestrel and 0.020 mg ethinylestradiol. Acta Obstet Gynecol Scand. 1987;144(suppl):13–7.

    Google Scholar 

  12. 12.

    WouterszTB, ButlerAJ, CohenM, KorbaVD, CanavanRC. A low-dose triphasic oral contraceptive. Fertil Steril. 1987;47:425–30.

    PubMed  Google Scholar 

  13. 13.

    BilottaP, FavilliS. Clinical evaluation of a monophasic ethinylestradiol/desogestrel-containing oral contraceptive. Drug Res. 1988;38:932–4.

    Google Scholar 

  14. 14.

    HoppeG. Gestoden, an innovative progestogen. Contraception. 1988;37:493–501.

    PubMed  Google Scholar 

  15. 15.

    PrivrelT, DaubenfeldO. Clinical experience in Switzerland with the new monophasic oral contraceptive Minulet (75 mcg gestodene, 30 mcg ethinyl oestradiol). Br J Clin Pract. 1988;42:292–8.

    PubMed  Google Scholar 

  16. 16.

    RekersH. Multicenter trial of a monophasic oral contraceptive containing ethinyl estradiol and desogestrel. Acta Obstet Gynecol Scand. 1988;67:171–4.

    PubMed  Google Scholar 

  17. 17.

    BenagianoG. Comparison of two monophasic oral contraceptives: gestodene/ethinyl estradiol versus desogestrel/ethinyl estradiol. Int J Fertil. 1989;34(suppl)31–9.

    PubMed  Google Scholar 

  18. 18.

    ChristieT. A clinical overview of a new triphasic contraceptive containing gestodene. Int J Fertil. 1989;34(suppl):40–9.

    Google Scholar 

  19. 19.

    deAndradeRP. A multicenter clinical evaluation of a new monophasic combination: Minulet (gestodene and ethinyl estradiol). Int J Fertil. 1989;34(suppl):22–30.

    PubMed  Google Scholar 

  20. 20.

    DroegemuellerW, KattaLR, BrightTG, BowesWAJr. Triphasic randomized clinical trial: comparative frequency of intermenstrual bleeding. Am J Obstet Gynecol. 1989;161:1407–11.

    PubMed  Google Scholar 

  21. 21.

    EdgrenRA, NelsonJH, GordonRT, KieferWSJr. Bleeding patterns with low-dose, monophasic oral contraceptives. Contraception. 1989;40:285–97.

    PubMed  Google Scholar 

  22. 22.

    RamosR, ApeloR, OsteriaT, VilarE. A comparative analysis of three different dose combinations of oral contraceptives. Contraception. 1989;39:165–77.

    PubMed  Google Scholar 

  23. 23.

    SchillingLH, BoldingOT, ChenaultCB, et al Evaluation of the clinical performance of three triphasic oral contraceptives: a multicenter, randomized comparative trial. Am J Obstet Gynecol. 1989;160:1264–8.

    PubMed  Google Scholar 

  24. 24.

    BrillK, NorpothT, SchnitkerJ, AlbringM. Clinical experience with a modern low-dose oral contraceptive in almost 100,000 users. Contraception. 1991;43:101–10.

    PubMed  Google Scholar 

  25. 25.

    BrillK, SchnitkerJ, AlbringM. Long-term experience with a low-dose oral contraceptive. Gynecol Endocrinol. 1990;4:277–86.

    PubMed  Google Scholar 

  26. 26.

    CorsonSL. Efficacy and clinical profile of a new oral contraceptive containing norgestimate: U.S. clinical trials. Acta Obstet Gynecol Scand. 1990;152(suppl):25–31.

    Google Scholar 

  27. 27.

    LoudonNB, KirkmanRJE, DewsburyJA. A double-blind comparison of the efficacy and acceptability of Femodene and Microgynon-30. Eur J Obstet Gynecol Reprod Biol. 1990;34:257–66.

    PubMed  Google Scholar 

  28. 28.

    SkoubySo. Oral contraception with a triphasic combination of gestodene and ethinyl estradiol: results of a multicenter clinical study. Int J Fertil. 1987;32(suppl):45–8.

    PubMed  Google Scholar 

  29. 29.

    Lachnit-FixonU, AydinlikS, LehnertJ. Clinical comparison between a monophasic preparation and a triphasic preparation. Advances in Fertility Control and Treatment of Sterility. Lancaster, UK: MTP Press, 1984:71–79.

    Google Scholar 

  30. 30.

    ChezRA. Clinical aspects of three new progestogens: desogestrel, gestodene, and norgestimate. Am J Obstet Gynecol. 1989;160:1296–300.

    PubMed  Google Scholar 

  31. 31.

    RothmanKJ. Modern epidemiology. Boston: Little, Brown and Company; 1986:81.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rosenberg, M.J., Long, S.C. Oral contraceptives and cycle control: A critical review of the literature. Adv Contracept 8, 35–45 (1992). https://doi.org/10.1007/BF01849449

Download citation

Keywords

  • Estrogen
  • Oral Contraceptive
  • Attrition Rate
  • Amenorrhea
  • Rigorous Study