Contraception without bleeding: Women's attitudes

A. Szarewski

Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, London, United Kingdom

It has been believed for several decades, that women are worried if they do not see a monthly bleed: indeed, the combined oral contraceptive regimen, which provides a monthly withdrawal bleed, was specifically designed with that consideration in mind. Surveys in the 1970s and 80s tended to uphold this view. However, even in the late 1970s, Loudon et al demonstrated that a tri-cycle pill regimen was acceptable to the majority of women. Interestingly, the women were more positive about it than their providers, a difference which often persists to this day. Studies of extended cycle regimens in the 1980s and 1990s mostly support the acceptability of reduced bleed regimens. It is interesting that the more recent the survey or study, the greater the proportion of women who find no bleed or reduced bleed regimens acceptable, or even preferable to monthly cycles. This may reflect greater understanding of female reproductive physiology in the populations, coupled with the increasing role of women in the workplace, where monthly cycle may be a nuisance. There continue to be cultural differences, but it would appear these are decreasing. Further research is required in this area, particularly outside family planning clinic settings. It is also likely that a more positive attitude on the part of providers would help to dispel women's anxieties: there is now some evidence this is occurring.

References

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Loudon NB, Foxwell M, Potts DM, Guild AL, Short RV. Acceptability of an oral contraceptive that reduces the frequency of menstruation: the tri-cycle pill regimen. Br Med J 1977;2:487-90.

Sulak PJ, Buckley T, Kuehl TJ.. Attitudes and prescribing preferences of health care professionals in the United States regarding use of extended-cycle oral contraceptives. Contraception 2006;73(1):41-5.

World Health Organization Task Force on Psychosocial Research in Family Planning, Special Programme of Research, Development and Research, Training in Human Reproduction. A cross-cultural study of menstruation: implications for contraceptive development and use. Stud Fam Plann 1981;12(1):3-16.