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Teaching an Old Pill New Tricks

Extended-use birth control pills reduce some side effects

MONDAY, Nov. 19, 2001 (HealthDayNews) -- Fewer periods a year, less breakthrough bleeding and no-hassle birth control, to boot. For a woman, it almost sounds too good to be true.

But it is, indeed, the promise of a new study that found extended-use birth control pills -- those that lengthen a woman's monthly cycle from the normal 28 days to 49 days -- seem to offer a number of benefits.

"Reduced bleeding and use of hygiene products was the main benefit," says study author Dr. Leslie Miller, assistant professor of obstetrics and gynecology at the University of Washington. Another possible benefit: Women who have headaches and PMS during the hormone-free week of the usual birth control pill will probably have fewer of these symptoms with the extended use pill, says Miller.

Recently, scientists had found that continuous (non-cyclic) hormone replacement therapy (HRT) protected and prevented more pre-cancer of the uterus than cyclic HRT. This finding, Miller says, supports the belief that extended birth control pill use may have similar benefits.

Other pluses linked to normal birth control use -- reducing ovarian cysts, acne and anemia, as well as cutting the risk of death from breast, uterine and ovarian cancers -- are also expected to remain with extended use.

"There is no reason to think these benefits would not continue," says Miller.

But birth control pills have their down side for many women. Studies have shown that strokes, clots, even heart attacks and high blood pressure are side effects for some. That's why any woman contemplating going on the pill in any form should see her doctor and review her risks for these side effects, say experts.

But the researchers say that perhaps the ultimate benefit with extended use is better use of the pill for birth control.

"Breakthrough bleeding is a nuisance, but it's not dangerous. Still, it is one of the main reasons women stop using the pill," says Dr. Ann Davis, associate clinical professor of obstetrics and gynecology at Columbia Presbyterian Medical Center. Breakthrough bleeding is when a woman sheds blood from her uterus between periods.

If bleeding is under better control, says Rice, women are more likely to use the pill more consistently, and that could translate into better birth control.

Although most women grow up believing that a "normal" menstrual cycle should be just 28 days, doctors say there is no downside to a cycle that is almost twice that length -- unless a woman is trying to get pregnant.

"Extending the cycle with pill use would not, for example, re-set the body clock. Once you stop using the pill, you would resume your normal ovulatory pattern, and if you had a 28-day cycle before, it's likely this would return," says Davis.

The study took place over four 84-day time periods split into "trimesters" and involved 90 women between the ages of 18 and 45. At the start of the study, all were measured for height, weight and blood pressure, and they detailed their age, education and tobacco use, as well as contraceptive use, menstrual and reproductive history, incidence of uterine tumors and history of intimate infection.

The women were then randomly assigned to take either a 28-day contraceptive cycle (21 active pills and 7 placebos) or a 49-day cycle (42 active pills and 7 placebos).The pills used in the study were a combination of ethinyl estradiol (a type of estrogen) and norgestrel (a form of progesterone) and were supplied by Wyeth-Ayerst, which also partially funded the study.

The women kept diaries of their physical symptoms, particularly bleeding episodes, as well as possible menstrual or cyclic symptoms such as cramping, headache, fatigue, breast tenderness and genital irritation.

At three-month intervals, their weight and blood pressure were re-checked, and they answered more questions about missed pills, money spent on sanitary protection and satisfaction with pill use.

At the end of the study, 24 women had completed the 28-day cycles and 29 had completed the 49-day cycles.

The result: Throughout the study, women in the 49-day cycle group had fewer bleeding days (seven versus 11 for the 28-day cycle group), as well as fewer bleeding episodes

The cost of sanitary products for the 49-day cycle group was also significantly lower than for the 28-cycle group.

"This was an incredibly detailed and well-designed study; the patients offered a lot of important details about their pill use and symptoms, and the doctors covered all the bases and controlled for many important variables. Their results represent an important contribution towards more effective and better use of oral contraceptives," says Davis.

The research is in the November issue of the journal Obstetrics and Gynecology.

What To Do

Although Miller says "off label" use of birth control pills has been common for many years, she reminds you that no oral contraceptive is approved by the FDA for extended use.

"Hence, all the decisions to try a different schedule need to be done with your healthcare provider balancing both the known and the unknown risks in the context of your own medical history and prior [oral contraceptive pill] experience," says Miller.

To learn more about birth control pills, including other ways to reduce incidence of side effects, visit the American Medical Associations Contraception Information Center.

To learn about other methods of birth control, click here.

SOURCES: Interviews with Leslie Miller, M.D., study author, assistant professor obstetrics and gynecology, University of Washington, and Director of Family Planning, Harborview Medical Center, Seattle; Ann Davis, M.D., assistant clinical professor of obstetrics and gynecology, Columbia Presbyterian Medical Center, New York City; November 2001 Obstetrics and Gynecology
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