Original research article| Volume 88, ISSUE 3, P426-430, September 2013

Characteristics of scheduled bleeding manipulation with combined hormonal contraception in university students



      There is a lack of information concerning the decision factors and sources of information influencing women who purposefully deviate from the prescribed use of their combined hormone contraceptives to exert elective control of their scheduled bleeding.

      Study Design

      A self-administered email survey of scheduled bleeding practices and beliefs was distributed to 11,900 female students at the University of Oregon. Assessment of survey participant characteristics, scheduled bleeding manipulation features and attitudes and knowledge toward hormonal contraception was analyzed.


      Of 1719 respondents to the survey, 1374 (79.9%) reported using combined hormonal contraception currently or recently. Approximately 17% of these women altered their scheduled bleeding pattern by deviating from package instructions. Of these, 50% indicated they delayed or skipped their scheduled bleeding for convenience or personal choice. Within this group, 47% of women indicated they learned to modify their scheduled bleeding from health care professionals, while 30% indicated such knowledge was obtained from family or friends. Characteristics that decreased the likelihood of this practice included being of Asian race, use of hormonal contraceptive for bleeding cycle regulation, following a regular exercise program, and personal preference for a monthly cycle.


      The majority of university females who choose to modify their scheduled bleeding cycle with combined hormonal contraceptives do so for convenience rather than to avoid menstrual symptoms, and many learn from nonmedical sources. There is some disparity between the preferences of menstruation frequency and actual scheduled bleeding pattern behaviors, suggesting potential for improvement in patient education.


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        • Glasiera A.F.
        • Smith K.B.
        • van der Spuyb Z.M.
        • et al.
        Amenorrhea associated with contraception — an international study on acceptability.
        Contraception. 2003; 67: 1-8
        • Thomas S.L.
        • Ellertson C.
        Nuisance or natural and healthy: should menstruation be optional for women?.
        Lancet. 2000; 355: 922-924
        • Den Tonkelaar I.
        • Oddens B.I.
        Preferred frequency and characteristics of menstrual bleeding in relation to reproductive status, oral contraceptive use, and hormonal replacement therapy use.
        Contraception. 1999; 59: 357-362
        • Edelman A.
        • Lew R.
        • Cwiak C.
        • Nichols M.
        • Jensen J.
        Acceptability of contraceptive-induced amenorrhea in a racially diverse group of U.S. women.
        Contraception. 2007; 75: 450-453
        • Hicks C.W.
        • Rome E.S.
        Menstrual manipulation: options for suppressing the cycle.
        Cleve Clin J Med. 2010; 77: 445-453
        • Miller L.
        • Notter K.M.
        Menstrual reduction with extended use of combination oral contraceptive pills: randomized controlled trial.
        Obstet Gynecol. 2001; 98: 771-778
        • Greig A.J.
        • Palmer M.A.
        • Chepulis L.M.
        Hormonal contraceptive practices in young Australian women (25 years) and their possible impact on menstrual frequency and iron requirements.
        Womens Health Issues. 2010; 1: 99-103
        • Powell-Dunford N.
        • Cuda A.S.
        • Moore J.L.
        • Crago M.S.
        • Deuster P.A.
        Menstrual suppression using oral contraceptives: survey of deployed female aviation personnel.
        Aviat Space Environ Med. 2009; 80: 971-975
        • Powell-Dunford N.
        • Cuda A.S.
        • Moore J.L.
        • Crago M.S.
        • Kelly A.M.
        • Deuster P.A.
        Menstrual suppression for combat operations: advantages of oral contraceptive pills.
        Womens Health Issues. 2011; 21: 86-91
        • Loudon N.B.
        • Foxwell M.
        • Potts D.M.
        • Guild A.L.
        • Short R.V.
        Acceptability of an oral contraceptive that reduces the frequency of menstruation: the tri-cycle pill regimen.
        Br Med J. 1977; 2: 487-490
        • Anderson F.D.
        • Gibbons W.
        • Portman D.
        Long-term safety of an extended-cycle oral contraceptive (Seasonale): a 2-year multicenter open-label extension trial.
        Am J Obstet Gynecol. 2006; 195: 92-96
        • Dayal M.
        • Barnhart K.T.
        Noncontraceptive benefits and therapeutic uses of the oral contraceptive pill.
        Semin Reprod Med. 2001; 19: 295-303
        • Sulak P.J.
        • Willis S.A.
        • Kuehl T.J.
        • Coffee A.
        • Clark J.
        Headache and oral contraceptives: impact of eliminating the standard 7-day placebo interval.
        Headache. 2007; 47: 27-37
        • Coffee A.
        • Kuehl T.K.
        • Willis S.A.
        • Sulak P.J.
        Oral contraceptives and premenstrual symptoms: comparison of a 21/7 and extended regimen.
        Am J Obstet Gynecol. 2006; 195: 1311-1319
        • Gerschultz K.L.
        • Sucato G.S.
        • Hennon T.R.
        • Murray P.J.
        • Gold M.A.
        Extended cycling of combined hormonal contraceptives in adolescents: physician views and prescribing practices.
        J Adolesc Health. 2007; 40: 151-157
        • Sánchez-Borrego R.
        • García-Calvo C.
        Spanish women's attitudes towards menstruation and use of a continuous, daily use hormonal combined contraceptive regimen.
        Contraception. 2008; 77: 114-117
        • Andrist L.C.
        • Arias R.D.
        • Nucatola D.
        • Kaunitz A.M.
        • Musselman B.L.
        • Reiter S.
        • et al.
        Women's and providers' attitudes toward menstrual suppression with extended use of oral contraceptives.
        Contraception. 2004; 70: 359-363
        • Seval D.L.
        • Buckley T.
        • Kuehl T.J.
        • Sulak P.J.
        Attitudes and prescribing patterns of extended-cycle oral contraceptives.
        Contraception. 2011; 84: 7
        • Carini R.M.
        • Hayek J.C.
        • Kuh G.D.
        • Kennedy J.M.
        • Ouimet J.A.
        College student responses to web and paper surveys: does mode matter?.
        Res High Educ. 2003; 44: 1-19
        • Deutskens E.
        • De Ruyter K.
        • Wetzels M.
        • Oosterveld P.
        Response rate and response quality of internet-based surveys: an experimental study.
        Mark Lett. 2004; 15: 21-36
        • Sax L.J.
        • Gilmartin S.K.
        • Bryant A.N.
        Assessing response rates and nonresponse bias in web and paper surveys.
        Res High Educ. 2003; 44: 409-432