[epl0517]

It's hard to find clear, consistent information about oral hormonal contraception. Even reliable sources such as the Mayo Clinic fail to make certain points clear. Currently, I am confused about the following:

1) Sources variously claim that a) oral contraception prevents menstruation, and that the bleeding associated with 21/28 use of combined oral contraception is a symptom of withdrawal that only resembles menstruation, and b) oral contraception, depending on use, may cause shorter, lighter, or even less frequent periods. Obviously, (a) and (b) can't both be true, because periods either occur or they do not. If they don't occur, they can't be shorter, lighter, or less frequent. Can someone help me understand this confusion?

2) Sources such as Planned Parenthood state that when using combined oral contraception, active pills may be taken continuously, instead of for the usual 21 days followed by 7 days of placebo. In this case, withdrawal bleeding will not occur (although breakthrough bleeding may occur). If this is true, what is the advantage of new products called extended cycle combined oral contraceptive, and why did it take so long for them to appear?

[kira]

The first is just a matter of semantics. For help getting young people and the uninformed to understand they just call it a period. Technically it's not but explaining that is long and not really necessary for most people to know. Generally it causes lighter bleeding than if you had your actual period.

The 2nd is due to the changing views of society. For the longest time women felt they had to have their period every month to be normal and prove they weren't pregnant. Doctors also did not know the effects of skipping that week of bleeding. Over time it has become more and more acceptable to skip "periods" with bcp. That led to the creation of specialized pills for having a 3month cycle. They are extra difficult to get your body to listen to though. It took me a good 6 months or more to stop having breakthrough bleeding on seasonique. It's the highest dose extended cycle pill with no inactive pills. Even the week that is supposed to have bleeding is just a low dose version instead of sugar pills like most bcp. I tend to only have a 2-3 day very light "period" that only requires one light tampon during the hours of the day I'm active.

[epl0517]

I understand everything you said, and it was very helpful. But there
are a few points I still don't get.

First, the reason why the substitution of terms strikes me as particularly confusing is because most sources do not explain the particular ways t withdrawal bleeding is different from normal menstruation:
- Normal menstrual "bleeding" actually contains a mixture of blood, mucus, vaginal secretions, and tissue. Does withdrawal bleeding comprise any material besides blood?
- Menstruation in most women lasts 3-5 days, whereas the placebo period for combined pills is 7 days. Does the 21/28 use of the combined pill generally mean a longer interval of flow as compared to normal menstruation?
- Periods may come with other symptoms besides flow, often uncomfortable, depending on the individual (e.g. cramping). Do these symptoms continue after use of the pill begins? Is there any difference for continuous use versus use with a placebo interval?

Second, what is the value of new continuous use products as opposed to continuous use of traditional combined products? It's widely claimed that combined pills, taken continuously without placebo, are safe and that this usage does not entail withdrawal bleeding.

[kira]

In many people some uterine wall does build up while on the pill and a few still produce an egg but because of how the pill acts it is rarely fertilized and if it is then it can't implant in the uterine wall. This all must come out with the bleeding. It was thought this needed to happen monthly but time has proven with the right combo of hormones the build up is minimal and a longer cycle is safe. You can still get cramps, excessive bleeding, emotional changes, etc... but they are usually lessened greatly when on the pill and sometimes switching pills until you find one that works well for your body can eliminate those symptoms. Most people don't start bleeding on the first inactive pill. It always took me 4 days in to the inactive pills and then a day or 2 of light bleeding during the new pack of active pills before the pill would stop it. That's about 4-5days of bleeding with 2-3 of it light when I used to lose blood like crazy on my period. Now that I'm on seasonique that is extended cycle with no inactive pills just lower dose pills I only bleed lightly for 2 days with no cramps or other symptoms. I used to take yasmin with the inactive pills skipped for one month and taken the next month so I had an every other month period.

I'm not sure exactly what it is that makes the extended cycle pills better than just taking several packs of other pills in a row. Doctors did use to prescribe pills that way for people who had problems during their period before approved extended cycle pills were released by the FDA.