Real-world experience of women using extended-cycle vs monthly-cycle combined oral contraception in the United States: The National Health and Wellness Survey

Rossella E. Nappi, Iñaki Lete, Lulu K. Lee, Natalia M. Flores, Marie Christine Micheletti, Boxiong Tang

Research output: Contribution to journalArticlepeer-review


Background: The real-world experience of women receiving extended-cycle combined oral contraception (COC) versus monthly-cycle COC has not been reported. Methods: Data were from the United States 2013 National Health and Wellness Survey. Eligible women (18-50 years old, premenopausal, without hysterectomy) currently using extended-cycle COC (3 months between periods) were compared with women using monthly-cycle COC. Treatment satisfaction (1 "extremely dissatisfied" to 7 "extremely satisfied"), adherence (8-item Morisky Medication Adherence Scale©), menstrual cycle-related symptoms, health-related quality of life (HRQOL) and health state utilities (Medical Outcomes Short Form Survey-36v2®), depression (9-item Patient Health Questionnaire), sleep difficulties, Work Productivity and Activity Impairment-General Health, and healthcare resource use were assessed using one-way analyses of variance, chi-square tests, and generalized linear models (adjusted for covariates). Results: Participants included 260 (6.7%) women using extended-cycle and 3616 (93.3%) using monthly-cycle COC. Women using extended-cycle COC reported significantly higher treatment satisfaction (P = 0.001) and adherence (P = 0.04) and reduced heavy menstrual bleeding (P = 0.029). A non-significant tendency toward reduced menstrual pain (39.5% versus 47.3%) and menstrual cycle-related symptoms (40.0% versus 48.7%) was found in women using extended-cycle versus monthly-cycle COC. Significantly more women using extended-cycle COC reported health-related diagnoses, indicating preferential prescription for extended-cycle COC among women reporting more health problems. Consistent with this poorer health, more women using extended-cycle COC reported fatigue, headache, and activity impairment (P values < 0.05). There were no other significant differences between groups. Conclusions: This real-world observational study supports extended-cycle COC as a valuable treatment option with high satisfaction, high adherence, and reduced heavy menstrual bleeding.

Original languageEnglish
Article number22
JournalBMC Women's Health
Issue number1
Publication statusPublished - Jan 18 2018


  • Adherence
  • Extended-regimen
  • Heavy menstrual bleeding
  • Hormonal contraception
  • Menstrual cycle
  • Real-world
  • Satisfaction
  • Women's health

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology


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