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1.         Overall, users of pills have the most bleeding/spotting days during the first 90 days, and this decreases by the 4th 90 or 91-day reference period.

2.         Triphasic pills appear to have similar bleeding indices and patterns as monophasic pills with continued use beyond the first 90 day reference period.

3.         The most marked fall in the number of bleeding days occurred from the first to the second 90 day reference period.

4.        The number of bleeding/spotting days for combined pills ranged between 10 and 24 days for the first 90 day period, decreasing to 7.5 to 15 days for Reference period 4. 

5.         Interestingly, the 42/7, 84/7 and 126-day continuous treatment regimen was generally associated with the fewest number of bleeding/spotting days during Reference Periods 1 and 4 compared with the 21/7 and 14/4 regimens.

6.         Over time days of spotting/bleeding fell and amenorrhea increased in women using progestin-only pills. 

7.         Poor compliance can lead to unexpected intermenstrual spotting or bleeding - even one pill may cause intermenstrual bleeding.

8.         Intermenstrual bleeding in women previously well regulated on OCs appears to be a good indication for Chlamydial infection. (Krettek 1993)

9.         One study showed that smokers were more likely to experience bleeding distrubances with higher incidences of both spotting and bleeding than non-smokers.     

What a great paper.  Special thanks to the author of this recent article in CONTRACEPTION. 

Key Words:  oral contraceptives, spotting, bleeding, first year, pill use, long-term patterns, period, decreases, triphasic pills, monophasic pills, combined pills, continuous use, amenorrhea, increased, progestin-only pills, poor compliance, intermenstrual bleeding, Chlamydia infection, smokers, Contraception