Contraception without bleeding: Women’s attitudes

Contraception without bleeding: Women’s attitudes

A. Szarewski

Cancer Research UK Centre for Epidemiology, Mathematics and

Statistics, Wolfson Institute of Preventive Medicine, London, United Kingdom

It has been believed for several decades, that women are worried

if they do not see a monthly bleed: indeed, the combined oral contraceptive

regimen, which provides a monthly withdrawal bleed, was specifically designed

with that consideration in mind. Surveys in the 1970s and 80s tended to uphold

this view. However, even in the late 1970s, Loudon et al demonstrated that a

tri-cycle pill regimen was acceptable to the majority of women. Interestingly,

the women were more positive about it than their providers, a difference which

often persists to this day. Studies of extended cycle regimens in the 1980s and

1990s mostly support the acceptability of reduced bleed regimens. It is

interesting that the more recent the survey or study, the greater the proportion

of women who find no bleed or reduced bleed regimens acceptable, or even

preferable to monthly cycles. This may reflect greater understanding of female

reproductive physiology in the populations, coupled with the increasing role of

women in the workplace, where monthly cycle may be a nuisance. There continue to

be cultural differences, but it would appear these are decreasing. Further

research is required in this area, particularly outside family planning clinic

settings. It is also likely that a more positive attitude on the part of

providers would help to dispel women’s anxieties: there is now some evidence

this is occurring.


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preferences of health care professionals in the United States regarding use of

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Family Planning, Special Programme of Research, Development and Research,

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implications for contraceptive development and use. Stud Fam Plann


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