Contraception
Volume 79, Issue 4 , Pages 247-258, April 2009

Bleeding patterns associated with non-oral hormonal contraceptives: a review of the literature☆

  • Gloria Bachmann

      Affiliations

    • Department of Ob/Gyn/Reproductive Science, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 0891-7035, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 732 235 7633; fax: +1 732 235 8302.
    • ,
  • Paul Korner

      Affiliations

    • Bayer HealthCare Pharmaceuticals, Wayne, NJ 07470-6806, USA

Received 11 July 2008; received in revised form 22 October 2008; accepted 22 October 2008. published online 12 December 2008.

Abstract 

It is generally accepted that poor tolerance to changes in vaginal bleeding associated with hormonal contraceptive use may influence compliance and continuation with the chosen method. However, disparities in the collation and reporting of bleeding data hamper comparison among studies and products. In this review, we systematically assessed MEDLINE and EMBASE for articles assessing parenteral hormonal contraceptives that reported bleeding data based on reference periods as recommended by the World Health Organization (WHO). Overall, 31 studies published between 1986 and October 2007 were included in this review. The use of parenteral hormonal contraception was in general associated with a decrease in bleeding with continued use from Reference Period 1 to 4. However, this decrease was less marked with the combined hormonal depots and both progestin-only and combined hormonal vaginal rings than with progestin-only implants, depots and the levonorgestrel intrauterine system. Overall, reporting vaginal bleeding by 90-day reference periods as recommended by the WHO allows straightforward comparison of bleeding patterns between studies.

Keywords: Parenteral, Hormonal contraception, Bleeding, Reference period

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☆ Dr. Bachmann has been on the scientific advisory board and has received research support from Bayer HealthCare Pharmaceuticals (a subsidiary of Bayer Schering Pharma AG), and Dr. Korner was an employee of Bayer HealthCare at the time this article was being developed. Editorial assistance for the development of this article was provided by Richard Glover, with the financial support of Bayer HealthCare Pharmaceuticals.

PII: S0010-7824(08)00493-9

doi:10.1016/j.contraception.2008.10.012

Contraception
Volume 79, Issue 4 , Pages 247-258, April 2009

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