Attitude of German women and gynecologists towards long-cycle treatment with oral contraceptives

Abstract

Long-cycle regimens with continuous use of oral contraceptives (OCs) for 3 or 6 months followed by a hormone-free interval of 7 days may reduce or prevent cycle-dependent and menses-related complaints. A representative survey carried out with 1195 German women in different age groups revealed that only 26–35% of the women aged between 15 and 49 years preferred monthly bleeding, while 37–46% wished to never bleed. The reasons for the refusal of regular menstruations were fewer severe menstrual complaints, better hygiene, higher quality of life, and less blood loss. Among the women who preferred regular withdrawal bleeding during the use of OCs, the main reasons were fear of pregnancy, infertility and adverse effects, and that menstruations were natural. Between 32% and 54% of the women would suppress menstruation sporadically and 11–14% for a longer period of time. After continuous treatment with a combination of 30 μg ethinyl estradiol and 2 mg dienogest for 6 months, the majority of women preferred the long-cycle regimen as compared to the conventional OC regimen despite a higher rate of irregular bleeding. Bleeding occurred primarily in first-time users of OC, particularly during the administration of the second OC pack. A survey carried out with German gynecologists revealed that most physicians prescribed extended OC cycles primarily for medical reasons, e.g., dysmenorrhea, hypermenorrhea, endometriosis and premenstrual dysphoric disorder. The gynecologists preferred a regimen with three packs of extended use of OCs.

Introduction

It is well known that the return of regular bleeding in postmenopausal women under sequential hormone replacement therapy is a common reason for stopping treatment. Therefore, estrogen-progestin combinations for continuous use have been developed that cause endometrial atrophy and amenorrhea and, therefore, are preferred by most of the older women.

Although the delay of menstruation for a limited period of time by extended use of oral contraceptives (OCs) is a frequently practiced option in special situations [1], [2], [3], the results of a recent survey on young women's attitude to withdrawal bleeding were quite surprising. As much as 80.5% of currently menstruating women preferred changes in bleeding pattern in order to reduce pain or inconvenience associated with menses [4]. As early as 1977, it was reported that 82% of the women welcomed the reduction in the number of periods during the continuous use of an OC for 12 weeks [1]. Some years later, a survey carried out with 158 women and 20 young female doctors revealed that the majority would prefer to bleed at intervals of 3 months or greater, if they could determine the time of withdrawal bleeding [5]. On the other hand, 85% of the same women believed that monthly withdrawal bleeding was necessary when taking OCs, and 69% believed that continuous use of OCs was undesirable [5]. The results reflect a split attitude that was determined on the one hand by the wish for reducing menses-related symptoms and, on the other hand, by a large deficit of knowledge of the mechanisms of action of OCs.

To investigate whether the results obtained with Dutch women also held true for Germany, a representative survey was carried out by a German survey organization that closely followed the methods used by den Tonkelaar and Oddens [4]. Moreover, the attitude of German gynecologists toward suppression of withdrawal bleeding was examined by means of a questionnaire. Experience was also gathered with 6 months of continuous use of an OC by 30 patients who were recruited from a private gynecological practice.