Elsevier

Obstetrics & Gynecology

Volume 95, Issue 2, February 2000, Pages 261-266
Obstetrics & Gynecology

Original Articles
Hormone withdrawal symptoms in oral contraceptive users

https://doi.org/10.1016/S0029-7844(99)00524-4Get rights and content

Abstract

Objective: To measure the timing, frequency, and severity of hormone-related symptoms in oral contraceptive (OC) users, specifically to compare active-pill with hormone-free intervals.

Methods: Using daily diaries, women recorded pelvic pain, bleeding, headaches, analgesic use, nausea or vomiting, bloating or swelling, and breast tenderness during active-pill intervals and hormone-free intervals. Participants either had no prior OC use, had taken OCs and were restarting, or had been taking OCs continuously for 12 months or longer.

Results: Two hundred sixty-two women, 26 with no previous OC use, 43 prior users, and 193 current users, provided daily records of hormone-related symptoms. Subjects with no prior OC use and prior users restarting were similar in no recent OC use, and because of the small sample, they were pooled for analysis as new-start OC users. Current users had patterns of symptoms that were more frequent during hormone-free intervals than during the three active-pill weeks. These included pelvic pain (70% versus 21%, P < .001), headaches (70% versus 53%, P < .001), use of pain medication (69% versus 43%, P < .001), bloating or swelling (58% versus 19%, P < .001), and breast tenderness (38% versus 16%, P < .001). Similar patterns were seen in new-start OC users after the first cycle. Among new-start OC users, menstrual flow patterns, headache, bloating or swelling, and breast-tenderness symptoms decreased during the three cycles to approach those levels of current users.

Conclusion: Almost all symptoms assessed were significantly worse during the 7-day hormone-free interval than during the 21 days of hormone-containing pills.

Section snippets

Materials and methods

Women who requested OCs were recruited from the obstetrics and gynecology practice of Scott and White Clinic from November 1996 to August 1997 and were eligible for participation if they had no prior OC use, had used OCs previously but not in the prior 3 months, or were current users of OCs for 12 months or more. Women not currently using OCs were considered new starts because they were never users or were not taking OCs for a minimum of 3 months before enrollment. All patients used a

Results

Among 334 women who signed consent forms, 262 (78%) returned detailed calendars for analysis. As displayed in Table 1, the women were similar in age, height, weight, BMI, race, and education. Subjects were predominately white (84%), and most had high school educations or greater (97%). Subjects with no prior use and current users had higher percentages of nulligravidas because prior users included many women who had delivered and were restarting OCs postpartum. As indicated in Table 1, women

Discussion

We documented that hormone-related symptoms sometimes varied between new starts and long-term users of OCs, and between active-pill and hormone-free weeks. In current OC users of more than 12 months, headaches were more common during hormone-free intervals compared with the active-pill weeks, probably because of the estrogen withdrawal effect on the vasculature from declining estrogen levels during hormone-free intervals. Menstrual migraines have occurred in spontaneous cycles in women not

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Supported by a grant from Scott, Sherwood, and Brindley Foundation, Temple, Texas.

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