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Manipulation of the pill-free interval in oral contraceptive pill users: the effect on follicular suppression.

Author(s): Schlaff WD, Lynch AM, Hughes HD, Cedars MI, Smith DL

Affiliation(s): Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology, University of Colorado Health Sciences Center, Denver, 80010, USA. Willaim.Schlaff@uchsc.edu

Publication date & source: 2004-04, Am J Obstet Gynecol., 190(4):943-51.

Publication type: Clinical Trial; Randomized Controlled Trial

OBJECTIVE: The purpose of this study was to compare follicular suppression that was produced by 3 different oral contraceptive regimens that differ by treatment in the pill-free interval. STUDY DESIGN: In a university setting, 54 women were assigned randomly to receive either 20 microg ethinyl estradiol+100 microg levonorgestrel followed by 7 pill-free days, 20 microg ethinyl estradiol+150 microg desogestrel followed by 2 days of placebo then 10 microg ethinyl estradiol for 5 days, or 28 days of 20 microg ethinyl estradiol plus 150 microg desogestrel. Follicular suppression was evaluated by serial ultrasound scans and by serum and urinary hormone levels during a 2-month study period. Data were analyzed by nonparametric statistical tests. RESULTS: There was a significant difference in follicle count among the 3 groups (P=.005). Women who were treated with a 7-day pill-free interval experienced the least suppression. Estrogen levels were more variable and led to an observation that overweight (body mass index, >25 kg/m(2)) was associated with reduced follicle suppression (relative risk, 1.6; 95% CI, 1.0, 2.7) and higher estrogen levels (relative risk, 5.3; 95% CI, 1.3, 21). CONCLUSION: Contraceptive pill users who were treated with a 7-day pill-free interval demonstrated less follicular suppression than women who were supplemented with either estrogen alone or estrogen plus progestin. Overweight women were less suppressed than women of normal weight.

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