Irregular Bleeding Pattern as adverse effect of Hormonal contraception

A recent prospective randomized study evaluated the cycle control of three different hormonal contraceptives:  EE20μg/LNG100 μg;  EE15 μg/gestodene 60 μg versus vaginal ring containing EE15 μg/  etonogestrel 120 μg. The   length   of   the   menstrual   cycle   was   normal   in   all   cases   at screening; while, the length of menstrual flow showed a statistically significant reduction,among COC 20μg EE users in comparison with the other groups. Early and/or late withdrawal bleeding were reported at cycle 3, in 19.1% and 48.9% of the COC 20 μgEE and COC15μg users, respectively and in 15.9% of the vaginal ring users. In the same time, irregular bleeding was observed in 22.5%, 35.8% and 9.5%, respectively (4).

It is evident the highest prevalence of cycle control problems with the oral contraceptive very low-dose EE than with COC low-dose.

The good cycle control achieved with the vaginal ring(very low-dose EE) may be the result of the controlled release of estradiol and etonogestrel from the ring which avoids daily hormonal fluctuations(22). The weekly transdermal contraceptive   patch   (EE   20   μg/  norelgestromin   150μg)provides   effective contraception and cycle control comparable to oral contraceptives(23,24). Body weight above 90 kilograms is associated with lower efficacy. 

However,  the incidence of breakthrough bleeding and/or spotting seems higher with the patch, only in the first two cycles(25).  Much of the woman dissatisfaction because of menstrual changes can be averted by careful counseling prior to method prescription. Open dialogue explaining the potential for bleeding irregularities is crucial in this time, in order to avoid the discontinuation that place woman at risk of unwilling pregnancy.

Rosa Sabatini and Raffele Cagiano
Department of Obstetrics and Gynecology
Department of Pharmacology General Hospital Policlinico-University of Bari, Italy


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