Weiterführende Informationen

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„A survey on Swiss women’s preferred menstrual/withdrawl bleeding pattern over different phases of reproductive life and with use of hormonal contraception“ , 2014


Background Today, options for bleeding-free lifestyle are actively promoted by the media, the pharmaceutical industry and health specialists. With regard to contraceptive counselling it is important to find out what women really want. Methods In the present study we collected information on women’s attitudes towards monthly bleeding and preferences, if they could have the option to modify their individual bleeding pattern. Furthermore we evaluated the preferences with use of combined hormonal contraceptives (CHCs). Switzerland has never been surveyed before with regard to these issues. Questionnaires were distributed in our family planning clinic and two outdoor offices to clients aged 15 to 19 years, 25 to 34 years, and 45 to 49 years. Results Of 530 questionnaires, 292 were eligible for analysis. Around 50 of the participants would appreciate having fewer menstrual period-related symptoms. Some 37% preferred experiencing a monthly bleeding; 32% opted for every 2 to 6 months; and 29%, for no bleeding at all. This heterogeneous distribution did not differ between clients with and without menstrual symptoms. With regard to CHC use, predictable bleeding was rated as very positive and breakthrough bleeding as negative. Conclusion Contraceptive counsellors should be aware that women’s wishes differ widely. Predictability of bleeding seems to be more important to them than postponing it.
A survey on Swiss women’s preferred menstrual/withdrawal bleeding pattern over different phases of reproductive life and with use of hormonal contraception.
By Gabriele S. Merki-Feld, Nicole Breinschmid, Burkhardt Seifert and Martina Kreft in: The European Journal of Contraception and Reproductive Health Care, 2014

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„Extended and continuous combined contraceptive regimens for menstrual suppression.“, 2012


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.
By Jacobson JC1, Likis FE, Murphy PA., in: American College of Nurse-Midwives, 2012
Source: www.ncbi.nlm.nih.gov

„Women’s attitudes towards monthly bleeding: Results of a global population-based survey.“ , 2012


Objective Monthly bleeding can be uncomfortable and inconvenient. Fifty years after the introduction of the pill, one wonders whether women still want to bleed every month.

Methods Cross-national online survey of women aged 15–49 years (N = 4039) who were currently using, had used or would consider using a hormonal contraceptive. The survey was conducted in eight countries across Europe, North America and Latin America to assess attitudes towards monthly bleeding.

Results Almost one-third of women reported that bleeding had a severe negative impact on their daily life, particularly with respect to sexual life and sports activities. Approximately 60% of women would, at least sometimes, like to postpone their bleeding and 50% wished they had the flexibility to determine when their menstrual bleeding starts. Overall, 34% of women would change the frequency of their bleeding to once every two or three months.

Conclusions Past, current or future users of hormonal contraception reported that bleeding has a severe negative impact on daily life. Given the choice, most women surveyed would reduce the frequency of their bleeding.
By Anne Szarewski, Ariane von Stenglin, and Sarah Rybowski, in: The European Journal of Contraception and Reproductive Health Care, 2012
Source: informahealthcare.com/

„Attitudes to bleeding and OC use“
by Anne Szarewski, Gynaecology Forum, 2011
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„Sisters doing it for themselves“, 2009


Although  tailored  extended  COC  use  certainly  requires some  explanation  and  education,  it  is  very  rewarding  to both the client (for whom this is frequently a revelation, and  who  leaves  empowered)  and  the  clinician,  who  can reflect  that  today  she/he  has  truly  made  a  difference  to someone’s life. I feel strongly that this simple modification of pill use liberates and empowers women. I predict that, increasingly, as the song suggests, “sisters” will be “doing it for themselves”.
By Anne Szarewski, FSRH in: Fam Plann Reprod Health Care, 2009

[downolad pdf]

„Are monthly menstrual periods optional? – A European Perspective“ , 2007


Throughout human history, women have experienced menstruation, whether as a positive or a negative experience. The timing of periods was impossible to predict or to change. For the first time in human history, hormonal contraception has changed women’s options, and the use of oestrogen-progestogen contraception can control whether and when a woman has a period. This article argues, on the basis of recent studies in the Netherlands, Germany, France and Italy, that a growing number of Western European women want no periods or would like to have a longer interval between periods. And why not!
By Elizabeth Aubeny, Reproductive Health Matters, 2007

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„The clinical rationale for menses-free contraception.“,  2007


The impact of monthly menstruation may range from a minor inconvenience for some women to a major health concern for those who suffer from menstrual disorders and health conditions that are aggravated during their menstrual cycle. Oral contraceptives (OCs) have been used safely in continuous regimens for the treatment of menstrual disorders in some women and for others who choose to extend their 28-day menstrual cycle to accommodate major life events. There is no physiological requirement for the monthly hormone withdrawal bleed that is experienced by women taking cyclic OCs or for a menstrual period in women who do not desire to (or cannot) become pregnant. Thus, the use of continuous or extended-cycle OC regimens that eliminate the menstrual cycle represents a viable and attractive option for many women. The availability of more choices for menstrual suppression, such as continuous use of OCs, will improve the quality of life for many women who suffer from menstrual-related disorders and provide greater convenience for women with busy and active lifestyles.
By Kat Lin, Kurt Barnhart, in: Journal of Women’s Health, 2007
Source: www.ncbi.nlm.nih.gov

„Women’s and providers‘ attitudes toward menstrual suppression with extended use of oral contraceptives.“, 2004


The United States Food and Drug Administration approved a dedicated extended regimen of oral contraceptive (OC) pill in the fall of 2003. Few studies have explored how women or providers feel about menstrual suppression. This study describes women’s and providers‘ attitudes toward menstrual suppression. A national sample of 1470 women and 512 providers responded to surveys asking about attitudes toward menstrual suppression. Seventy-eight percent of the women sample had never heard of menstrual suppression with OCs. Fifty-nine percent of women would be interested in not menstruating every month and one third would choose never to have a period. Only 7% of the providers thought it was physically necessary to have a period every month and 44% thought that menstrual suppression is a good idea. While 57% of providers said that their patients do not ask about extended use of OCs, 52% do prescribe them; patient request was the most common reason. Both samples thought that more research should be conducted and that the factors that would influence their decisions included long-term health effects, side effects, future fertility and cost. Results demonstrate that providers need to discuss this option with their patients.
By Andrist LC1, Arias RD, Nucatola D, Kaunitz AM, Musselman BL, Reiter S, Boulanger J, Dominguez L, Emmert S., in: Contraception, 2004
Source: www.ncbi.nlm.nih.gov

„Attitude of German women and gynecologists towards long-cycle treatment with oral contraceptives.“ , 2003


Long-cycle regimens with continuous use of oral contraceptives (OCs) for 3 or 6 months followed by a hormone-free interval of 7 days may reduce or prevent cycle-dependent and menses-related complaints. A representative survey carried out with 1195 German women in different age groups revealed that only 26-35% of the women aged between 15 and 49 years preferred monthly bleeding, while 37-46% wished to never bleed. The reasons for the refusal of regular menstruations were fewer severe menstrual complaints, better hygiene, higher quality of life, and less blood loss. Among the women who preferred regular withdrawal bleeding during the use of OCs, the main reasons were fear of pregnancy, infertility and adverse effects, and that menstruations were natural. Between 32% and 54% of the women would suppress menstruation sporadically and 11-14% for a longer period of time. After continuous treatment with a combination of 30 microg ethinyl estradiol and 2 mg dienogest for 6 months, the majority of women preferred the long-cycle regimen as compared to the conventional OC regimen despite a higher rate of irregular bleeding. Bleeding occurred primarily in first-time users of OC, particularly during the administration of the second OC pack. A survey carried out with German gynecologists revealed that most physicians prescribed extended OC cycles primarily for medical reasons, e.g., dysmenorrhea, hypermenorrhea, endometriosis and premenstrual dysphoric disorder. The gynecologists preferred a regimen with three packs of extended use of OCs.
By I. Wiegratz, H.H. Hommel, T. Zimmermann, H. Kuh, in: Contraception, 2003
Source: www.ncbi.nlm.nih.gov

„To Bleed or Not to Bleed: Young Women’s Attitudes Toward Menstrual Suppression., 2003


The purpose of this study was to investigate women’s knowledge about and attitudes toward the medical suppression of menstruation. One hundred and three female undergraduate students completed several questionnaires. Thirty-five percent of the participants were familiar with menstrual suppression, and 12% reported using birth control methods to suppress their menses; oral contraceptive users were more knowledgeable about menstrual suppression than other women. Women who regarded menstruation as bothersome and shameful were more supportive of suppression than women with more positive attitudes. Women who scored higher on measures of body consciousness were not more likely to support menstrual suppression or to report a desire for more information about menstrual suppression. Future investigations of women’s attitudes toward menstrual suppression could inform reproductive health care and health education.
By Ingrid Johnston-Robledo PhDa, Melissa Ball BAa, Kimberly Lauta BAa & Ann Zekoll BAa, in: Woman & Health, 2003
Source: www.tandfonline.com

„Nuisance or natural and healthy: should monthly menstruation be optional for women?“, 2000


It is simplicity itself to eliminate menstruation with safe, inexpensive, and widely available oral contraceptive tablets. Yet monthly menses continue to be the standard for women. Why? Any woman can tell you that menstruating is a pain, literally and metaphorically. At a minimum, it is a nuisance that requires planning and expensive sanitary supplies and paracetamol to avoid messy discomfort for about 1 week each month. In many cases, however, menstruation has a far greater impact on the female half of the population.
By Sarah L Thomas, BA , Charlotte Ellertson, in: The Lancet, 2000

„Preferred frequency and characteristics of menstrual bleeding in relation to reproductive status, oral contraceptive use, and hormone replacement therapy use.“, 1999


This study addresses attitudes towards changes in menstrual bleeding patterns caused by oral contraceptives (OC) or hormone replacement therapy (HRT) and preferred changes in bleeding pattern with and without use of OC or HRT in relation to reproductive age group. Data were collected by means of telephone interviews with 325 women in each of four age groups (15-19, 25-34, 45-49, and 52-57 years). In total, 80.5% of currently menstruating women preferred one or more changes in bleeding pattern such as less painful, shorter, or less heavy periods, or amenorrhea. The majority of the menstruating women in all age groups preferred to have a bleeding frequency of less than once a month or never, whether the bleeding was spontaneous or induced by OC. In the case of HRT, amenorrhea was most preferred. These findings with respect to preferred bleeding frequency and OC may have important implications for health care providers and for future contraception development.
By Isolde den Tonkelaar, Björn J. Oddens, in: Contraception, 1999
Source: www.ncbi.nlm.nih.gov

Buchempfehlung: „Is Menstruation Obsolete?“ by Elsimar M. Coutinho, Sheldon J. Segal, 1999
Inhalt: Is Menstruation Obsolete? argues that regular monthly bleeding is not the „natural“ state of women, and that it actually places them at risk of several medical conditions of varying severity. The authors maintain that while menstruation may be culturally significant, it is not medically meaningful. Moreover, they propose that suppressing menstruation has remarkable health advantages.

„Why menstruate?“, 1984
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„Acceptabilty of an oral contraceptive that reduces the frequency of menstruation: the tri-cycle pill regimen“ , 1977


Because of cultural changes, shorter durations of breast feeding, and birth control, the reproductive patterns of modern women no longer resemble that of their Stone age ancestors. Women have moved from the age of incessant reproduction to the age of incessant menstruation. Consequently, they often suffer from clinical disorders related to menstruation: anemia, endometriosis, and PMS, just to name a few. The authors encourage readers to recognize what has gone previously unnoticed that this monthly discomfort is simply not obligatory. They present compelling evidence that the suppression of menstruation is a viable option for women today, and that it can be easily attained through the use of birth control pills. In fact, they reveal that contraceptive manufacturers, knowing that many women equate menstruation with femininity and that without monthly bleeding would fear that they were pregnant, engineered pill dosage regimens to ensure the continuation of their cycles. Indeed, throughout history societies have assigned menstruation powerful meaning, and Is Menstruation Obsolete? presents a fascinating history of how menstruation inspired doctors to try therapeutic bleeding for a variety of ailments, and how this therapy remained dominant in Western medicine until the early 20th century.
Is Menstruation Obsolete? offers women a fresh view of menstruation, providing them with the information they need to make progressive choices about their health. This is a message whose time has come.
By N.B. Loudon, M. Foxwell, D.M. Potts, A.L. Guild, R.V. Short, in: British Medical Journal, 1977

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Women’s preferences for menstrual bleeding frequency in 12 European countries: the Inconvenience Due to Women’s Monthly Bleeding (ISY) survey., 2017
Fiala C, Chabbert-Buffet N, Häusler G, Jamin C, Lete I, Lobo P, Nappi RE, Pintiaux A, 26.06.2017

Missed pills: frequency, reasons, consequences and solutions., 2017
PubMed, Chabbert-Buffet N, Jamin C, Lete I, Lobo P, Nappi RE, Pintiaux A, Häusler G, Fiala C, 165-169, 22.06.2017

Women’s preferences for menstrual bleeding frequency: results of the Inconvenience Due to Women’s Monthly Bleeding (ISY) survey., 2016
Nappi R, Fiala C, Chabbert-Buffet N, Häusler G, Jamin C, Lete I, Lukasiewic M, Pintiaux A, Lobo P., 24.03.2016

Langzyklus: Wissen und Anwendung, 2019
Österreichischer Verhütungsreport 2019, gynmed.at

Menstruationsmanagement / Langzyklus, 2019
Österreichischer Verhütungsreport 2012, gynmed.at

Verhütungsverhalten Erwachsener, 2011
BZgA 2011, bzga.de

Lebensqualität und allgemeines Wohlbefinden nach Umstellung auf ein Drospirenon-haltiges orales Kontrazeptivum, 2007
Bitzer et al., Journal für Fertilität und Reproduktion 2007

Endometrial microstructure after long-term use of a 91-day extended-cycle oral contraceptive regimen, 2005
Anderson et al., Contraception 71 (2005) 55–59

The control of Fertility, 1965
Gregory Pincus, 1965, www.muvs.org

Will period-free hormonal contraception become the norm of the twenty-first century?, 2006
Eur Aubeny E., J Contracept Reprod Health Care. 2006 Mar;11(1):1-5