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Extended cycling or continuous use of hormonal contraceptives for female adolescents

Gold, Melanie Aa; Duffy, Kaiytib

Current Opinion in Obstetrics and Gynecology: October 2009 - Volume 21 - Issue 5 - p 407–411
doi: 10.1097/GCO.0b013e32832e493e
Adolescent and pediatric gynecology: Edited by Paula J. Adams Hillard

Purpose of review The purpose of this review is to present the most recent data on extended cycling and continuous use of hormonal contraception for female adolescents.

Recent findings Since 2003, several new products have been US Food and Drug Administration approved to provide extended cycling or continuous use of hormonal contraception. Clinical trials have been conducted with adult women of 18 years and older and not with adolescents under age of 18 years. Studies find successful menstrual suppression using extended cycling and continuous-use regimens that are safe and effective without negative effects on the endometrium or hemostasis. Extended cycling and continuous use improves menstrual symptoms attributed to the hormone-free interval in traditional cyclic regimens. Adolescent health providers report prescribing extended cycles of contraception with increasing frequency to adolescents. It is unknown how well female adolescents tolerate breakthrough bleeding, but data suggest that bleeding is the main reason for discontinuing. Supplementation with intermittent estrogen or instituting a 4-day hormone-free interval in response to persistent bleeding may decrease this side effect; adolescents should be counseled about these options.

Summary Extended cycling or continuous use of hormonal contraception offers adolescents an opportunity to decrease, delay or suppress monthly menstruation for health or personal reasons.

aDivision of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

bPhysicians for Reproductive Choice and Health, New York, New York, USA

Correspondence to Melanie A. Gold, DO, Staff Physician, Research Coordinator for Student Health Services, Division of Student Affairs, University of Pittsburgh Student Health Service, Medical Arts Building, Suite 500, 3708 Fifth Avenue, Pittsburgh, PA 15213, USA Tel: +1 412 383 1800; fax: +1 412 383 1807; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.