Outcomes of extended oral contraceptive regimens with a shortened hormone-free interval to manage breakthrough bleeding

Contraception. 2004 Oct;70(4):281-7. doi: 10.1016/j.contraception.2004.04.007.


Objective: To evaluate in a clinical practice setting the acceptance, continuation and variability of extending the active interval of oral contraceptives (OCs) with introduction of a shortened hormone-free interval (HFI) to manage breakthrough bleeding.

Methods: A retrospective review was undertaken of patients seen by one obstetrician/gynecologist and counseled on extending the active interval of OCs with a shortened HFI of 3-4 days to manage bleeding. Electronic medical records were searched for the phrase "extending the number of active pills" for patients counseled between January 1, 2000, and January 31, 2003, with follow-up through January 31, 2004. A structured query of each patient's initial and follow-up records was performed.

Results: The 220 patients counseled on the extended regimen were 14-52 years of age (mean 36.4, SD 9.3 years). At initial counseling before extending, the majority of patients cited more than one reason for using OCs in the standard fashion with 59% using OCs for noncontraceptive reasons. Reasons for extending the active interval of OCs included premenstrual symptoms (45%), dysmenorrhea/pelvic pain (40%), heavy withdrawal bleeding (36%), menstrual associated headaches (35%), convenience (13%), acne associated with menses (10%) and other (15%). Of the 181 patients with follow-up data, 174 (96%) attempted an extended regimen with 121 (67%) continuing to do so at last follow-up. Follow-up intervals ranged from 0.3 to 3.8 years (mean 1.6 years). Using Kaplan-Meier product limit survival analysis, 60% of patients continued using extended patterns of OCs for more than 2 years. For 121 currently extending, the HFI varied from 0 to 7 days with 88% utilizing a 0 to 4 day HFI.

Conclusions: Sixty percent of patients offered extending the active interval and shortening the HFI of OCs initiate and continue this pattern for more than 2 years without serious sequelae or pregnancy while individually directing both the number of days of continuous pills and the length of the HFI.

MeSH terms

  • Adolescent
  • Adult
  • Contraceptives, Oral / administration & dosage*
  • Contraceptives, Oral / adverse effects*
  • Dysmenorrhea / drug therapy
  • Dysmenorrhea / epidemiology
  • Female
  • Humans
  • Hypertension / epidemiology
  • Middle Aged
  • Pelvic Pain / drug therapy
  • Pelvic Pain / epidemiology
  • Premenstrual Syndrome / drug therapy
  • Premenstrual Syndrome / epidemiology
  • Quality of Life
  • Retrospective Studies
  • Thrombophlebitis / epidemiology
  • Uterine Hemorrhage / prevention & control*


  • Contraceptives, Oral