Extended-use OCs pose 'educational challenge': warn about breakthrough bleeding.(Gynecology)

LA JOLLA, CALIF. -- Suppressing menstrual periods with extended-use hormonal contraceptives such as the recently approved Seasonale sounds great, but isn't that unhealthy?

"The answer is a resounding 'no,'" Dr. Andrew Kaunitz said at the annual meeting of the Association of Reproductive Health Professionals.

"This is a big educational challenge, because most women aren't familiar with the practice of hormone suppression techniques," said Dr. Kaunitz, professor of obstetrics and gynecology at the University of Florida Health Science Center Jacksonville.

"There is no medical rationale for monthly withdrawal bleeding while on hormonal contraceptives," he added.

"The menstrual blood does not build up in women using hormone contraceptives and the lining of the uterus remains healthy."

At the same time, women need to be counseled to expect early onset, unscheduled spotting and bleeding when they begin the 91-day oral contraceptive Seasonale or another other form of extended contraception. In the Phase III study of Seasonale, for example, the median number of bleeding and spotting days per month was comparable to Nordette by cycle 4.

"Over time, this will reduce and be identical to the amount of unscheduled bleeding or spotting experienced by women using conventional oral contraceptives," Dr. Kaunitz said. "This is a critical counseling point."