J Midwifery Womens Health. 2012 Nov-Dec;57(6):585-592. doi: 10.1111/j.1542-2011.2012.00250.x.
Many women have medical indications for menstrual suppression or a personal preference to reduce or eliminate monthly bleeding, which can be achieved with extended and continuous regimens of combined estrogen and progestin contraceptives. Combined contraceptives are traditionally administered in a 28-day cycle, with 21 days of a contraceptive pill, vaginal ring, or transdermal patch followed by a hormone-free interval that is usually 7 days. During the hormone-free interval, women either take a placebo pill or do not use their combined contraceptive method. Hormone-related symptoms are significantly worse during the hormone-free interval than the days when the contraceptive is used. Alterations of the standard 28-day cyclic regimen for menstrual suppression include decreasing the frequency of the hormone-free interval, thus extending the time between withdrawal bleeding episodes (extended use), and eliminating the hormone-free interval altogether (continuous use). This article reviews menstrual suppression indications and physiology. Research demonstrating that the effectiveness, safety, and side effects of oral, vaginal, and transdermal extended and continuous regimens are comparable to cyclic regimens is summarized. Findings from studies of women's and health care providers' attitudes toward menstrual suppression also are reviewed. Important topics to include in evidence-based counseling for extended and continuous combined contraceptive use are presented.
许多女性存在医学指征需要抑制月经或个人偏好减少或消除每月出血，这可以通过延长和连续使用雌孕激素联合避孕药来实现。联合避孕药传统上以 28 天为一个周期给药，其中避孕药丸、阴道环或经皮贴剂使用 21 天，然后是无激素间隔期，通常为 7 天。在无激素间隔期，女性要么服用安慰剂药丸，要么不使用联合避孕药方法。无激素间隔期的激素相关症状比使用避孕药丸的日子明显更严重。为了抑制月经而改变标准的 28 天周期性方案包括减少无激素间隔期的频率，从而延长停药出血事件之间的时间（延长使用），并完全消除无激素间隔期（连续使用）。本文综述了抑制月经的适应证和生理学。总结了证明口服、阴道和经皮延长和连续使用与周期性方案相比具有等效有效性、安全性和副作用的研究结果。还综述了关于女性和医疗保健提供者对抑制月经的态度的研究结果。提出了在延长和连续使用联合避孕药的循证咨询中应包括的重要话题。
