Extended regimens of combined hormonal contraception to reduce symptoms related to withdrawal bleeding and the hormone-free interval: A systematic review of randomised and observational studies

Abstract

Objective To assess whether continuous and extended regimens (CRs/ERs) of combined hormonal contraceptives (CHCs) improve symptoms related to withdrawal bleeding or the hormone-free interval and to compare the efficacy, safety, and cost of CRs/ERs to those of conventional 28-day regimens.

Study design A literature search of the PubMed database was conducted for randomised clinical trials (RCTs) and observational studies published in any language between 2006 and 2013.

Results Sixteen RCTs and 14 observational studies evaluated issues related to our objectives. CRs/ERs, whose efficacy and safety were comparable to those described for conventional regimens, were preferred due to their improvement of symptoms related to withdrawal bleeding or the hormone-free interval and the lower costs resulting from the reduced incidence of these symptoms.

Conclusion The contraceptive efficacy and safety of CR/ER use of CHCs is at least equal to that of 28-days conventional regimens, and this use may have some cost savings. CRs/ERs are recommended for women willing to take a CHC for treatment of symptoms related to withdrawal bleeding or the hormone-free interval.

Chinese Abstract

摘要 目的 评估复方激素类避孕药（CHCs）连续与扩展周期给药方案能否改善撤 退性出血或停药期间的相关症状，并且与常规28天治疗方案相比较 其有效性、安全性及花费情况。

实验设计 对2006年-2013年间以任何语言发表在Pubmed数据库的随机临 床实验（RCTs）和观察性研究进行文献检索。

结果 针对研究目标，我们对16组随机临床实验和14组观察性研究进行 了评估。在有效性和安全性方面，连续/扩展周期给药方案优于常规方 案，主要是由于撤退性出血或是停药期间相关症状的改善以及由 此导致的成本降低。

结论 复方激素避孕药连续/扩展周期给药方案，其避孕的有效性和安全性至 少与28天常规给药方案等同，并可能节约一定的成本。

Keywords:

• Contraception
• Combined hormonal contraceptives
• Extended regimen
• Continuous regimen
• Withdrawal bleeding
• Hormone-free interval

ACKNOWLEDGEMENTS

This article has been translated and corrected by American Journal Experts.

Declaration of interest: Authors NM, PL, RL, MC, and RSB have participated in conferences, symposiums, and studies sponsored by various pharmaceutical companies.

The authors alone are responsible for the content and the writing of the paper.

This study benefited from an educational grant from the Fundación Española de Contracepción.