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3 Deec 52258 C 963974 C
3 Deec 52258 C 963974 C
ORAL CONTRACEPTIVES
Abstract
Objective To investigate whether the rst cycle after stopping oral contraceptive (OC) intake had a normal duration.
Methods A retrospective study was performed in 680 women, 300 non-OC users and 380 women discontinuing OC intake.
The length of one or two menstrual cycles was recorded.
Results In the non-user group, the median duration of both the rst and second cycle was 29 days (range 1897 and 2056
days, respectively). In the OC user group the median duration from withdrawal bleeding until next menstruation was 30 (15
82) days. The second cycle lasted 29 (17122) days. The duration of the rst post-treatment cycle was not signicantly
different from the next cycle or the cycle length in non-users. When the subjects were divided into different age categories, a
signicantly longer rst posttreatment cycle was observed in the group aged 1824 years, but a shorter rst post-treatment
cycle in the group aged 2529 years. No differences were seen in the higher age groups. The ethinyl estradiol dose of the OC
preparation did not inuence the results.
Conclusions The rst cycle after OC discontinuation had a normal duration.
Introduction
Many clinicians assume that the rst cycle after
stopping combined oral contraceptive (OC) intake
is not completely normal and has a longer duration
than the next menstrual cycles [1,2]. Surprisingly,
hardly any literature appears to exist on this
subject. In the past a few studies were done to
investigate the cycle length after discontinuation of
high-dose combination OCs [36], most of them
reporting an increased duration of the rst post-pill
cycle. In more recent studies with lower-dose OCs
a rapid return of ovulation after cessation of OC
intake was reported, but data on the day of
ovulation or the next menstruation were not given
[79] or only the duration until the rst ovulation
was investigated [10,11]. Recently, a large prospective study reported the characteristics of
multiple cycles after discontinuation of OCs in
175 women, in comparison with a control group of
284 non-OC users [12]. In the post-pill group the
cycle length was signicantly prolonged up to the
ninth cycle.
We performed a study to increase our knowledge
on the subject. We investigated the length of the rst
menstrual cycles after stopping the intake of a
combination OC in healthy female volunteers, in
comparison with the cycle length of women who did
Correspondence: I. J. M. Duijkers, Dinox Medical Investigations, Groenewoudseweg 317, 6524 TX Nijmegen, The Netherlands. Tel: +31-24-3224445.
Fax: +31-24-3888953. E-mail: iduijkers@dinoxgroup.com
ISSN 0951-3590 print/ISSN 1473-0766 online # 2005 Taylor & Francis Group Ltd
DOI: 10.1080/09513590400021011
75
Non-users
OC users
1824
2529
3034
3540
Total
158
70
58
14
300
252
84
33
11
380
(23.2)
(10.3)
(8.5)
(2.1)
(44.1)
(37.1)
(12.4)
(4.9)
(1.6)
(55.9)
Total
410
154
91
25
680
(60.3)
(22.6)
(13.4)
(3.7)
(100)
76
I. J. M. Duijkers et al.
Table II. Median duration (with range) and mean duration (+ standard deviation (SD)) of the rst and second menstrual cycle in non-users
of oral contraceptives (OCs) and women who discontinued OC use. After OC discontinuation, both the duration from the last OC intake and
from the start of withdrawal bleeding until the next menstruation are listed.
[Duration (days)]
[First cycle]
[Second cycle]
n
Non-users
29 (1897)
29 (2056)
33 (1889)
30 (1582)
29 (17122)
Figure 3. Median cycle length of the rst and second cycles after
discontinuation of oral contraceptives (OCs) comparing OCs with
different doses of ethinyl estrradiol (EE).
dose, the length of the rst and second cycle did not
differ signicantly between the groups.
Table III. Number of cycles (and percentage) with a duration
shorter than 35 days, between 36 and 70 days and longer than 70
days in the non-user group and the group who discontinued oral
contraceptive (OC) use.
Cycle length
(days)
1st cycle
non-users
2nd cycle
non-users
1st cycle
after OC
2nd cycle
after OC
4 35
3670
4 70
261 (87.0)
36 (12.0)
3 (1.0)
185 (95.3)
9 (4.6)
0 (0)
235 (85.5)
38 (13.8)
2 (0.7)
242 (84.3)
43 (15.0)
2 (0.7)
Discussion
It is generally assumed that the length of the rst
menstrual cycle after discontinuation of the use of an
OC is increased compared with the regular cycle
length. The present study was performed to investigate the cycle lengths of the rst and second
menstrual cycles after discontinuation of OC use,
and to compare them with normal cycle length.
The results of the present study showed that the
median duration from last OC intake until withdrawal bleeding was 3.5 days. The duration from
withdrawal bleeding until next menstruation was
similar to the second cycle duration and the cycle
length in non-users. Apparently, a few days after
stopping OC intake ovarian function was already
restored. The terminal half-life of ethinyl estradiol is
approximately 10 h, and of progestogens, 824 h
[16,17]. As soon as these steroids were largely
cleared from the body, as indicated by the start of
withdrawal bleeding, follicular growth must have
started again. This nding is supported by several
other studies. Changes in gonadotropin and 17bestradiol (E2) levels in the pill-free period in OC
users were determined [18], in some studies in
combination with ultrasound measurements of follicular growth [11,13,19,20]. When these parameters
in the pill-free period are compared with the early
77
78
I. J. M. Duijkers et al.
79
21. Van Santbrink EJP, Hop WC, van Dessel TJHM, de Jong FH,
Fauser BCJM. Decremental follicle-stimulating hormone and
dominant follicle development during the normal menstrual
cycle. Fertil Steril 1995;64:3743.
22. Yu A-F, Wu S-X, Liu J-L, Liu A-R, Li J-Z, Wu J-H, Hu Z-Z,
Yin B-Y, Xu G-X, Fotherby E. Metabolic changes in women
using a long-acting monthly oral contraceptive and return of
ovulation on discontinuation. Contraception 1988;37:517
528.