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Extended cycle hormonal contraception in adolescents

Sucato, Gina Sa,b; Gerschultz, Kelly Lb

Current Opinion in Obstetrics & Gynecology: October 2005 - Volume 17 - Issue 5 - p 461–465
Adolescent and pediatric gynecology

Purpose of review: There is increasing interest in the use of extended cycles of hormonal contraception to manage menstrual cycle-related complaints in adolescents and to accommodate the menstrual preferences of patients using hormonal contraception. This review summarizes recent findings related to the use of extended cycles and highlights their relevance to adolescents.

Recent findings: Many adolescents would prefer to menstruate less frequently. Among health care providers who prescribe hormonal contraceptives, the majority believe suppressing withdrawal bleeding is well tolerated and prescribe extended cycling regimens to their patients. Shortening or eliminating the hormone-free interval results in greater ovarian suppression and thus may increase contraceptive efficacy. Studies in adult women have not identified changes in metabolic parameters beyond what would be expected from traditional cyclic use. New endometrial biopsy data have found no pathologic changes; most women using an extended cycle had atrophic endometriums. Extended cycling is frequently associated with breakthrough bleeding. In some women, this can be managed with a brief hormone-free interval.

Summary: Recent findings demonstrate high levels of interest in extended cycling among adolescents and providers, and continue to add to the growing body of literature supporting the safety and improved contraceptive efficacy of extended regimens. Further research is warranted to focus on issues including cancer, thrombotic disease and fertility, and should enroll a sufficient adolescent sample.

aDivision of Adolescent Medicine, Department of Pediatrics

bSchool of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Correspondence to Gina S. Sucato MD, MPH, Division of Adolescent Medicine, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA Tel: +1 412 692-7227; fax: +1 412 692-8584; e-mail: Gina.Sucato@chp.edu

© 2005 Lippincott Williams & Wilkins, Inc.