Bleeding patterns after immediate vs. conventional oral contraceptive initiation: a randomized, controlled trial

Fertil Steril. 2003 Feb;79(2):322-9. doi: 10.1016/s0015-0282(02)04680-0.


Objective: To compare bleeding patterns after immediate vs. conventional oral contraceptive (OC) initiation.

Design: Randomized controlled trial.

Setting: University-based clinic.

Patient(s): One hundred thirteen women initiating combination OCs.

Intervention(s): Participants received a 4-month supply of a monophasic 35-microg ethinyl E(2) (EE) OC and a bleeding diary, were randomized to immediate or conventional OC start, underwent monthly telephone follow-up, and after 90 days returned the diary and completed an exit interview.

Main outcome measure(s): Total number of bleeding-spotting days, using the World Health Organization 90-day reference period method. Comparisons were made by trial assignment (immediate vs. conventional) and cycle day of OC initiation (day 8+ vs. days 1-7).

Result(s): There was no significant difference in the number of bleeding-spotting days (mean difference: -0.5 days; 95% CI: -3.4 to 2.3) or any other bleeding parameter between the immediate and conventional starters, or days 1-7 and day 8+ starters.

Conclusion(s): Immediate start of OCs does not induce bleeding patterns different from conventional starting regimens. Concern about adverse bleeding patterns should not be considered a justification for instructing women to wait until menses before starting OCs.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Body Constitution
  • Contraceptives, Oral / pharmacology*
  • Ethnicity
  • Female
  • Follow-Up Studies
  • Humans
  • Menstrual Cycle / drug effects
  • Menstrual Cycle / physiology*
  • Patient Selection
  • Smoking
  • Time Factors


  • Contraceptives, Oral