Contraception 74 (2006) 359 – 366

Review article
Menstrual-cycle-related symptoms: a review of the rationale for
continuous use of oral contraceptives
David F. Archer4
Contraceptive Research and Development Program, Clinical Research Center, Eastern Virginia Medical School, Norfolk, VA, 23507, USA
Received 10 February 2006; revised 26 May 2006; accepted 6 June 2006

Abstract

As many as 80% of reproductive-aged women experience physical changes associated with menstruation, and 20% to 40% experience
menstrual-cycle-related symptoms. Decades of research in women with menstrual disorders, such as dysmenorrhea and menorrhagia, have
shown that continuous use of oral contraceptives (OCs), without the hormone-free interval, is a safe and effective method to relieve these
symptoms and ultimately induce amenorrhea in many women. If given the opportunity, a majority of women would opt for extended-cycle or
continuous regimens, and numerous clinical trials have shown that continuous OC regimens induce amenorrhea in 80% to 100% of women
by 10 to 12 months of use. For women who do not wish to become pregnant, a continuous OC regimen should be an available option.
D 2006 Elsevier Inc. All rights reserved.
Keywords: Oral contraceptives; Continuous use; Menstrual cycle symptoms; Pill-free period

1. Introduction prevalence of menstruation-associated symptoms. Only

22% of 19-year-old women in one study (N =596) had
Menstruation has an important impact on quality of life
sought medical attention for dysmenorrhea, although 72%
for many women, ranging from a simple inconvenience to a
suffered from various degrees of menstrual-cycle-related
major health concern for those suffering from menstrual
pain and nearly 40% required regular analgesics or
disorders and conditions that are aggravated during men-
antispasmodics [5].
struation [1]. Up to 80% of reproductive-aged women
Menstruation and menstrual disorders have a broader
experience physical changes associated with menstruation,
economic impact on women and society, which is a direct
and 20% to 40% experience menstrual-cycle-related symp-
result of time lost from work and decreased productivity [1].
toms [2]. Recognized menstrual-cycle-related disorders
Texas Instruments noted a 25% reduction in the productivity
affect approximately 2.5 million women between the ages
of female workers during menses as one example [6]. The
of 18 and 50 years in the United States alone [3].
total economic cost of menstrual disorders in the United
Menstrual-cycle-related symptoms contribute significant-
States is estimated to be 8% of total wages, with
ly to health care costs due to the number of patients
dysmenorrhea alone estimated at US$2 billion annually
accessing the health care system for diagnosis and therapy.
[7] and menorrhagia estimated at US$1692.00 annually per
Sixty-five percent of women with menstrual disorders in
woman [8].
one retrospective study (N = 1666) reported having con-
Many women, when given the choice, would eliminate or
tacted their physician [3]. Furthermore, 12% of emergency
reduce the frequency of their menses [9–11]. Medically
room visits have been attributed to gynecologic disorders in
induced amenorrhea relieves many menstrual-cycle-related
women 15 to 44 years of age, based on results from the
symptoms and menstrual disorders. Amenorrhea strictly
National Hospital Ambulatory Medical Care survey [4]. It is
defined is the absence of menses in menarcheal women. The
encouraging to note that women are seeking treatment for
lack of withdrawal bleeding associated with cessation or
these problems, but these statistics underestimate the
interruption of the exogenous steroids contained in oral
contraceptives (OCs) will be considered as amenorrhea for
4 Tel.: +1 757 446 7444; fax: +1 757 446 8998. this review. Continuous use of OCs, without the usual
E-mail address: archerdf@evms.edu. hormone-free week each cycle, has been used for decades to
0010-7824/$ – see front matter D 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.contraception.2006.06.003
360 D.F. Archer / Contraception 74 (2006) 359 – 366
safely and effectively suppress menses or bleeding for the
management of dysmenorrhea and menorrhagia [12]. This
review will discuss the impact of menstrual disorders,
symptoms and associated conditions on women and the
evidence in support of the safe induction of amenorrhea
with continuous OC use.
2. The prevalence and impact of menstrual-cycle-related
conditions and symptoms
A plethora of symptoms and pathologies are associated
with or exacerbated by menstruation. Measurement or
quantification of many of these symptoms and conditions
is difficult or impossible, and subjective indices are used in
assessing the resultant disability.
2.1. Dysmenorrhea
Many women experience the cramps and pelvic pain of
dysmenorrhea beginning shortly before or during the onset
of menses. These symptoms last for 1 to 3 days and may
have been present from adolescence (primary dysmenorrhea)
or may be secondary to pelvic organ pathology. Although the
pathogenesis of dysmenorrhea is not fully understood, it is
thought that elevated prostaglandin synthesis and inflamma-
tory processes associated with menstruation may produce
intense uterine contractions with associated vasoconstriction
of the small vessels in the uterine wall [13]. The painful
contractions are also commonly associated with other
symptoms, including headache, suprapubic cramping,
backache, pain radiating down the anterior thigh, nausea
and vomiting, diarrhea and syncope.
Reports on the prevalence of dysmenorrhea vary widely,
depending on the measurement approach, but this symptom
is more common in adolescent women [13]. One study
found that nearly 40% of adult women have menstrual pain
and that 10% are incapacitated for 1 to 3 days each month
[7]. A study of Swedish women (N = 489) found that 72% of
19-year-old women and 67% of 24-year-old women
experienced dysmenorrhea and that 10% of 24-year-olds
reported that dysmenorrhea interfered with their daily
routine [14]. The severity of dysmenorrhea appears to
decrease with age. While not life-threatening, primary
dysmenorrhea is the most common reason for absenteeism
from work and/or school among women younger than
30 years [13].
2.2. Menorrhagia
As many as 30% of premenopausal women believe that
their menses are excessive, and 10% to 20% of menstruating
women meet the requirements for menorrhagia, which is
defined clinically as a total blood loss exceeding 80 mL per
cycle or menses lasting longer than 7 days [15]. Normal
menstrual blood loss is approximately 30 mL, and blood loss
of more than 60 to 80 mL increases the risk of iron deficiency
anemia [16,17]. The diagnosis of menorrhagia is complicated
by the inability to accurately quantify menstrual effluent and
is usually based on a detailed menstrual history, including the
use of sanitary protection, number of pads used, double pad
use, instances of flooding and the necessity of frequent pad
changes [18,19]. There is a lack of correlation between
women’s subjective assessment of menstrual flow and actual
blood loss, further complicating the clinical evaluation of
blood loss [15]. The diagnosis of menorrhagia is clinically
confirmed by measured blood loss in less than 50% of
women complaining of excessive menses [20,21].
Menorrhagia is frequently associated with uterine myo-
mas or adenomyosis and more rarely with endometriosis
[18]. Among adolescents with menorrhagia, approximately
20% have an underlying systemic disorder, including
coagulation disorders such as thrombocytopenia or von
Willebrand’s disease, which are diagnosed in more than half
of these women [22]. Excessive blood loss associated with
endometrial bleeding is the most common cause of anemia
in premenopausal women.
While the term dysfunctional uterine bleeding (DUB) is
sometimes used interchangeably with menorrhagia, DUB
only refers to excessive menstrual bleeding in the absence of
an underlying disorder or pelvic pathology. A recent
consensus panel has recommended the use of the term
abnormal uterine bleeding to describe alterations in men-
struation, of which DUB is a subcategory [23]. The
terminology also varies by region: in the United States,
DUB only describes bleeding that occurs during anovula-
tory cycles [19], while outside of the United States, DUB is
also associated with ovulatory cycles. Therefore, this
appellation should only be used without clear evidence of
a cause of the menorrhagia. However, despite extensive
study, the causes of the excessive bleeding in women with
DUB are unknown [18].
Medical therapy is largely unsuccessful in the long-term
alleviation of symptoms, and many women eventually
undergo a hysterectomy, despite the fact that pathologic
evaluation of most uteri from menorrhagic women are free
of disease [24]. Each year in England and Wales, 90,000
hysterectomies are performed, with fully two thirds per-
formed on women with menorrhagia [15].
As women near menopause, cycle length irregularity is
common and is accompanied by an increased variability in
the length and heaviness of bleeding episodes [25]. The
onset of menstrual cycle irregularity is accompanied by
large variability in serum hormone concentrations [26].
Compared with younger women, follicle-stimulating hor-
mone (FSH) is elevated during perimenopause and luteal
insufficiency frequently occurs during presumptive ovula-
tory cycles. The estrogen-dependent positive feedback on
luteinizing hormone (LH) release through the hypothalam-
ic–pituitary–ovarian axis is depressed in perimenopausal
women [27].
2.3. Epilepsy
There appears to be a relationship between epilepsy and
the menstrual cycle. It has been apparent for over 100 years
 D.F. Archer / Contraception 74 (2006) 359 – 366
that menstruation can increase the occurrence of epileptic
seizures, referred to as catamenial epilepsy [28]. However, a
standard definition for these findings remains elusive.
Variously reported in 10% to 72% of epileptic women,
menstrual-cycle-related fluctuations in epileptic seizures are
thought to arise from changes in the excitability of neurons
in the cerebral cortex. A central nervous system mechanism
has been proposed, in which estrogens tend to lower the
seizure threshold while progestins have the opposite effect
and may protect against seizures [29].
A large retrospective study of 265 women with epilepsy
and 142 control subjects recently confirmed previous
smaller reports that women with epilepsy have an increased
frequency of menstrual disorders [30].
2.4. Chronic pelvic pain
Chronic pelvic pain is present throughout the menstrual
cycle in varying intensity. The most common cause of
chronic pelvic pain is endometriosis; this growth of
endometrial glands and stroma outside the uterus afflicts
7% to 10% of women in the general population [31], 20% to
50% of infertile women [32–34], and as many as 80% of
women who present with chronic pelvic pain [35]. The
cyclic pain of endometriosis can be associated with
hematuria if the bladder is involved, hematochezia (blood
in the stool) with bowel involvement and, in rare instances,
bleeding at the umbilicus, abdominal wall or perineum. The
degree of visible endometriosis does not correlate with the
degree of pain or other symptomatic impairment [36], but
pain does correlate with tissue infiltration [37].
2.5. Migraine headaches
Up to 75% of migraine sufferers are women, who
experience an average of two attacks per month [38]. During
the 2 days before menstruation, migraines not only are 1.7-
fold more likely to occur but also are more than 2-fold more
likely to be severe [39]. In the first 3 days of menstruation,
they are 2.5-fold more likely to occur and 3.4-fold more
likely to be severe [39]. The pathogenesis of menstrual
migraine has not been fully characterized but appears to be
related to estrogen withdrawal [40], which results in
vasoconstriction [41]. The incidence of menstrual-cycle-
related migraine is reportedly as high as 60% to 70% on the
basis of clinical experience in headache clinics, while the
prevalence is lower in non-headache clinic patients [38].
3. Is there a physiologic requirement for monthly
menstruation?
3.1. The physiology of menstruation and hormone
withdrawal
Menstruation has a single biological purpose: to allow
the endometrium to be reprogrammed for implantation of a
fertilized ovum. In a normal menstrual cycle (i.e., without
exogenous hormones), estrogen from the ovaries promotes
361
endometrial growth, a surge in LH from the pituitary results
in the release of a mature ovum from the ovary and
progesterone is secreted from the corpus luteum. The corpus
luteum maintains progesterone production in the luteal
phase of the cycle, and if pregnancy occurs, the corpus
luteum persists until the placenta assumes progesterone
production at about the 42nd day of gestation. Without
successful fertilization and implantation, estrogen and
progesterone levels decline as the corpus luteum regresses,
resulting in endometrial ischemia and bleeding, apparent as
the menstrual effluent.
Women using cyclic OCs experience a monthly bleed
that is a result of the withdrawal of the hormones — whether
the withdrawal occurs every 21 days or following extended-
cycle regimens. This monthly or periodic withdrawal
bleeding may not be similar to menstruation. OCs inhibit
the hypothalamic–pituitary–ovarian axis, suppressing the
preovulatory surge in LH and preventing follicular matura-
tion by suppression of FSH [42].
Most women taking OCs have evidence of follicular
development or hormonal cycling during active OC use.
Follicular activity characterized as a follicle N 10 mm in
diameter does occur in women using cyclic monophasic
OCs containing 15, 20 or 30 Ag of ethinyl estradiol (EE) and
norethindrone acetate, levonorgestrel or gestodene [43–51].
Triphasic contraceptive preparations have also been shown
to have follicular activity [52]. Ovulations have been
documented to occur with OC use based on follicle changes
(rupture) and serum progesterone levels. The incidence of
bovulationQ using these parameters is low and variable
between products and reports [46,49–51,53]. The reason
why some follicles ovulate and others do not is not known at
the present time [54]. The hormone-free interval allows
development of an ovarian follicle that could potentially
ovulate [53,54]. The current literature would indicate that
continuous use of OCs is more effective than cyclic use in
preventing the development of the dominant follicle and
allowing ovulation to occur [53].
Histological examination of the endometrium reveals an
atrophic endometrium, which reflects the progestogen
dominance of the OC [42]. The bleeding experienced by
women during the monthly pill-free interval does not reflect
physiological menstruation. Although the mechanisms
involved in normal menstruation may be similar in women
using OCs, no study to support this contention exists.
3.2. Why were current regimens developed?
Hormonal contraceptives were originally developed,
employing a regimen of 21 days of active drug followed
by 7 drug-free days, in an effort to mitigate the perception
that they would interfere with the normal menstrual cycle
and to make the concept of hormonal contraception more
acceptable to women, clinicians and the Roman Catholic
Church [55,56]. There were practical reasons for the 21-day/
7-day regimen as well. While women today have easy
access to accurate and affordable pregnancy tests, the
362 D.F. Archer / Contraception 74 (2006) 359 – 366
majority of women relied on the occurrence of regular
menstrual bleeding to determine if they were not pregnant
before the pill was originally designed and marketed. The
traditional OC regimen is an artifact of that bygone era,
rather than a scientifically established truth. Clinicians
realized from the beginning that OCs could prevent bleeding
as long as they are taken, producing a cycle or interval of
any desired length [57].
The frequency of menstruation has increased, at a time
when the role of women in society has dramatically
changed. Women have prolonged their menstrual lives as
they have gained the freedom to obtain an education, career
and sexual partner of their own choosing (Table 1) [58,59].
Women 100 years ago began menstruating at the age of 16
years, had their first child at 19.5 years of age and gave birth
six times between the ages of 20 and 34 years [58,59]. As a
consequence, they only experienced an average of 160
menstrual cycles during their lives. Modern women begin
menstruating much earlier, at an average age of 12.5 years,
and have fewer children (two children on average in the
United States), which translates into more than 450
menstrual cycles over their lifetime [58,59]. Overall,
modern women experience three times as many menstrual
cycles as their forebears.
4. Clinical experience in reducing menstrual frequency
Since the early days of OC use, studies about reducing
the number of pill-free periods have shown that it is a safe
and effective option for many women. Because each study
has used different OC formulations, with different intervals
between pill-free periods, retrospective comparison of these
regimens is difficult. The earliest such study, conducted by
Loudon et al. [56] in 1977, reduced the withdrawal bleed
frequency to once every 3 months (84 days of continuous
pills) in 196 women using a combination OC containing 50
Ag EE and 2.5 mg lynestrenol. Overall, 82% of women were
satisfied with the regimen, which was associated with
decreased menstrual and premenstrual symptoms. Many
women also missed fewer pills on the extended regimen.
A recent study reexamined the extended 3-month cycle
with a lower dose formulation (30 Ag EE/150 Ag levonor-
gestrel; SeasonaleR, Barr Laboratories, Pomona, NY) in
682 women and found similar efficacy and safety to a 28-day
Table 1
Changes in the frequency of menstruation and pregnancy among American
women [58,59]
Women in the Women in the
early 2000s early 1900s
Age at menarche (years) 12.5 16
Age at first birth (years) 24 19.5
Number of pregnancies 2 6
Period of breast-feeding (months) 0–3 24–48
Periods between pregnancies (years) Wide variation 1–3
Estimated number of menstrual cycles 450 160
Reprinted with permission [58].
Fig. 1. The percentage of women who achieved amenorrhea while taking
a cyclic (n = 40 randomized women, 28 of whom completed 12 cycles)
or a continuous (n = 39 randomized women, 32 of whom completed
12 cycles) OC regimen over the course of 1 year. Data derived from Ref
[65] with permission.
cycle [60]. Furthermore, endometrial biopsies, obtained prior
to starting the OC and at the completion of the study,
demonstrated both a rapid return to normal endometrial
cycling once OC use was terminated and an inactive or
atrophic endometrium while using the extended OC [61].
The approval of SeasonaleR introduced many women to
the concept of extending their cycle. A 3-month cycle is but
one of many different cycle lengths that have been studied.
A 49-day cycle successfully reduced the number of bleeding
days in each 3-month interval to 6.4 from 10.9 days with a
28-day cycle in the first trimester and to 5.8 from 11.4 days
in the fourth trimester [62]. Kwiecien et al. [63] found that
continuous use of 20 Ag EE/100 Ag levonorgestrel for 168
days (approximately 5.5 months) provided fewer bleeding
days that required sanitary protection and increased the
incidence of amenorrhea compared with a standard 21-day/
7-day cycle, with a decreased incidence of menstrual
symptoms. The use of an OC containing 30 Ag EE and
75 Ag gestodene for 24 weeks (approximately 6 months)
resulted in a gradual increase in amenorrhea from the fourth
month to a maximum of 81.2% of women achieving
amenorrhea by Week 24 [64].
True continuous use (for 336 days) safely and effectively
induced amenorrhea in a clinical trial that randomized
women to either a cyclic (n =16) or a continuous OC
regimen (n =16). Sixty-eight percent of women taking the
continuous OC regimen achieved amenorrhea in the first
3 months of use, which increased to 88% of women by
10 months (Fig. 1) [65,66]. Bleeding was significantly
decreased in continuous users compared with those on a
cyclic regimen, with an average of 3 days in Cycles 1 to 3
(vs. 10 days, pb .001) and 0 days for Cycles 10 to 12 (vs.
9 days, pb .001) [65]. Vaginal spotting was more common
in those women using the continuous OC regimen during
the first 3 months, but there was no difference by the end of
the trial.
A recent review evaluated the differences between cyclic
(21-day) and continuous use (N 28 days) of OCs [67]. Due
to the significant differences between published studies, the
authors were unable to perform a meta-analysis; however,
 D.F. Archer / Contraception 74 (2006) 359 – 366
the authors concluded that the available evidence suggests
that continuous use of OCs offers comparable contraceptive
efficacy and safety to cyclic OC regimens. Bleeding patterns
were either similar or improved with continuous OC use.
Where evaluated, the incidence of cycle-related symptoms
(such as headaches, tiredness and menstrual pain) was
reduced with continuous OC regimens.
4.1. What cycle length do women prefer?
When women are allowed to choose their cycle length
and duration of pill-free interval, they clearly prefer
extended cycles and shorter pill-free periods. Among
women who were permitted to set their own hormone-free
intervals (n =220), most (60%) continued using extended
cycles for more than 2 years, with 88% choosing a
hormone-free interval of V 4 days, with no serious sequelae
or pregnancy [9].
A clear majority of OC users (91%) would like to extend
their cycles, primarily to decrease the incidence of head-
aches (46%), dysmenorrhea (41%), hypermenorrhea (30%)
and premenstrual syndromes (22%) [10]. A Dutch telephone
survey found that women favor decreasing the frequency of
menses, with only 26.2% satisfied with monthly bleeding
and 21.8% favoring amenorrhea [11].
Furthermore, women using continuous OC regimens
miss fewer pills, particularly during the first day and first
week of the cycle [68]. Current low-dose OCs contain the
minimum hormone doses required to prevent ovulation; if
the pill-free period is extended by even 1 day, follicular
development may occur and the risk of ovulation increases
[42,69]. Similarly, missed or delayed pills affect cycle
control, and a single missed pill can result in breakthrough
bleeding [70]. A retrospective analysis of data from large
multicenter trials found that inconsistent OC use is
associated with a 60% to 70% increase in the risk of
intermenstrual bleeding [71]. Continuous use of OCs may
improve compliance and thereby increase both contracep-
tive effectiveness and patient satisfaction.
5. Health and quality-of-life benefits associated with
elimination of the menstrual cycle
Many women derive health and quality-of-life benefits
by eliminating their menstrual cycle, which may reduce the
occurrence of menstrual-cycle-related disorders such as
menorrhagia, dysmenorrhea and anemia [1].
Cyclic OC use is already known to improve quality of
life. A beneficial effect on psychological general well-being
(assessed using the Psychological General Well-Being
Index) was observed by Cycle 3 in women using an OC
that contained 3 mg drospirenone and 30 Ag EE in a 28-day
cyclic regimen (n = 336). This improved quality of life was
maintained through the end of the study [72]. The incidence
and severity of menstrual-cycle-related symptoms decreased
during the study. A total of 75% of subjects in this trial were
satisfied with the study treatment.
363
OC use is associated with a reduced incidence of ovarian
and endometrial cancers, benign breast disease, pelvic
inflammatory disease, ectopic pregnancy and anemia
(reviewed in Dayal and Barnhart [12]). Links to OC use
to increase bone mineral density and decreases in uterine
leiomyomas, toxic shock syndrome and colorectal cancer
are currently being investigated.
Continuous OC regimens are used to treat dysmenorrhea
and menorrhagia since this regimen has been shown to
reduce menstrual blood loss both in women with normal
menses and in those who experience heavy flow [12,73]. In
addition, reduced bleeding decreases the incidence of
anemia. Synthetic progestins can be particularly useful in
patients with hematologic disorders associated with menor-
rhagia such as von Willebrand’s disease [74]. Quality of life
is greatly impaired in patients with these disorders; 39%
report reducing work and other activities during menstrua-
tion and 47% feel less productive [74]. Dysmenorrhea is
also a significant problem for more than 50% of these
women with these disorders, and this condition is improved
with OC use [75]. Women who experience dysmenorrhea
and menorrhagia may benefit from a continuous OC
regimen that induces amenorrhea.
Clinical trials have recently confirmed smaller anecdotal
reports of the treatment of dysmenorrhea with continuous
OC use [76]. Among 50 women for whom cyclic OC use did
not relieve the pain of dysmenorrhea and/or symptomatic
Fig. 2. Current (n = 193; A) and new (n = 69; B) OC users rated the
incidence and severity of pelvic pain or cramps throughout their cycles
while taking a cyclic OC regimen with a 7-day pill-free period. Thinner
curves show the percentage of women who reported any pelvic pain or
cramps, and thicker curves show the percentage of women who reported
pelvic pain or cramps, which were rated as z 5 on a scale of 0 to 10. Data
obtained from Refs [77,78] with permission.
364 D.F. Archer / Contraception 74 (2006) 359 – 366
endometriosis, continuous use of an OC containing 20 Ag EE
and 150 Ag desogestrel for 2 years was evaluated [76]. Over
one third of women achieved amenorrhea (38%), and
measurements of the severity of dysmenorrhea (Visual
Analog Scale and Verbal Rating Scale) decreased signifi-
cantly. At the end of the study, 80% of women were satisfied
or very satisfied with the regimen [76].
Although they are different phenomena, the symptom-
atology of menstruation is similar to what many women
experience during the hormone withdrawal period (Fig. 2)
[77]. Nausea, breast tenderness, headaches, bloating and
cramping occurred significantly more often (p b .001) during
the pill-free week than while taking active drug when
evaluated over several 28-day cycles in 262 OC users [77].
These symptoms are frequent reasons for discontinuing OCs
and may be alleviated by eliminating the pill-free interval.
With continuous OC use, the total number of bleeding days
is dramatically decreased, as well as other symptoms
including headache, cramps and bloating [78].
There are many groups of women who may particularly
benefit from reduced or eliminated menstrual cycles. Many
women in the military (N 60%) report that menstrual or
premenstrual symptoms have affected their ability to
perform physical tasks and have created problems with
regard to changing, obtaining and disposing of hygiene
products [79]. Female athletes commonly take OCs to
protect bone health, to eliminate or postpone bleeding and
to control menstrual symptoms [80]. Virtually all perime-
nopausal women experience cycle irregularity, and OCs
regulate menses and suppress other perimenopausal symp-
toms such as hot flashes [81], which worsen during the pill-
free period [82]. In the United States, tubal sterilization is the
most common form of contraception [81]; this large group of
sterile women continue to menstruate with no possibility of
pregnancy. For all of these women, amenorrhea through
continuous OC use could improve their quality of life.
6. Summary
Menstruation can be a major cause of morbidity and
suffering in women and can exacerbate other disorders. For
many women, continuous regimens of combination OCs are
already used to alleviate their symptoms and induce
amenorrhea. In addition, some women choose to prolong
their 28-day cycles for major life events, such as honey-
moons and vacations. Studies have clearly shown that many
women would like to reduce the frequency of menstruation
or eliminate menstruation altogether. The popularity of the
recently approved OC with an extended 3-month cycle,
SeasonaleR, confirms these reports.
The physiological purpose of menstruation is to prepare
the uterus for pregnancy; however, monthly hormone
withdrawal bleeding in women taking OCs to prevent
pregnancy cannot be considered to have a physiological or
biological purpose, and it is not a physiological requirement.
Current cyclic OC regimens were not designed based on
empirical scientific evidence but out of a desire to suit the
needs and allay the fears of both women and society.
Effective contraception is no longer the radical concept that
it once was, and women clearly want more options for both
contraception and cycle control. The availability of a
continuous use of orally active estrogen and progestin
combination used to eliminate or reduce menstruation
would offer improved quality of life and provide greater
lifestyle convenience for many women. Use of this regimen
could be dissociated from the need for contraception and is
indicated for alleviating menstrual-cycle-related symptoms.
Acknowledgments
The manuscript was initially written under a contract with
a medical education company. Mr. Jason McDonough
provided the first draft of the manuscript and is acknowl-
edged in the manuscript. The principal author, David F.
Archer, M.D., has made extensive changes, corrections and
additions to the original manuscript without help from the
medical education company. Wyeth was the commercial
sponsor of the first draft. David F. Archer, M.D., has not
received any payment from Wyeth, nor are there any plans to
be reimbursed for the involvement and writing of this article.
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10th Congress of the European Society of Contraception

bNon-contraceptive impact of contraception
and family planningQ
30 April – 3 May 2008
Prague, Czech Republic

Information:
European Society of Contraception
Mr. Peter Erard
Opalfeneweg 3
1740 Ternat
tel. +32 2 582 08 52
fax. +32 2 582 55 15
congress@contraception-esc.com
esccentraloffice@contraception-esc.com
http://www.contraception-esc.com/