MAQ Bulletin, East and Southern Africa

Extension of the Pill-Free Period by Three Days in Oral Contraceptive Users.³

Abstract: The authors studied the effect of extending the 7-day pill-free interval between cycles to 10 days. One hundred seven healthy volunteers with confirmed ovulatory cycles were randomly assigned to treatment groups with one of three new, low-dose COCs: monophasic gestadene (MG) with ethinyl estradiol (EE), triphasic gestadene with EE or monophasic desogestrel with EE.

Although evidence of pituitary-ovarian recovery (increasing FSH and E₂and follicular growth) during the extended pill-free interval was found, ovulation was not observed. (One patient on MG had ovulatory levels of progesterone in one cycle, but this was shown by ultra-sound to be due to an unruptured luteinized follicle, not ovulation.) Thus, although recovery of significant ovarian function appears to be common in COC users if the pill-free period is extended to 10 days, normal ovulation appears to be rare in this interval. Therefore, the risk of pregnancy for clients missing a pill early in the cycle or starting the pill a day or so late (beyond day 7) may not be as great as was formerly assumed.

³ Lähteenmäki P et al. The Family Federation of Finland: Helsinki, Finland. (Abstract presented at the meeting of the Society for the Advancement of Contraception, Guatemala City, Guatemala, March 1995.)

Cross-Sectional Study of Bone Density in Long-Term Users of DMPA⁴

Abstract: In 1991 Cundy et al (New Zealand) reported that long-term DMPA users (more than 1 to 2 years) experienced a significant loss in bone density. The design of that study was flawed, however, and variance in the measurements was very high (in many cases greater than the differences in the measured loss). Until this new (1995) paper was published there was no evidence to refute these findings. In the present cross-sectional study of long-term users of DMPA who were amenorrheic or only spotting for more than 1 year, spine and femoral neck bone density was measured and compared to that of an age-matched population of nonDMPA users.

Based on the preliminary results, the authors found no significant changes in spinal or femoral neck bone density (measured as 98–99.5% of that of the age-matched population). Because the youngest subject was 21, however, this study does not shed any light on the question of possible bone loss in DMPA users who are very young — ages 13 to 16. (This is the time period when the rate of bone deposition is greatest, and the potential effect of changes in bone metabolism also could be the greatest.)

Updating Contraceptive Technology and Standardizing Skills: Ugandan preservice faculty Elizabeth Katende and Samuel Emajuma use anatomic model to update and standardize IUD insertion skills, in Kampala, Uganda, August 1995.

⁴ Gbolade BA and RJE Kirkman. University of Manchester: Manchester, England. (Abstract presented at the meeting of the Society for the Advancement of Contraception, Guatemala City, Guatemala, March 1995.)

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Extension of the Pill-Free Period by Three Days in Oral Contraceptive Users.3

Cross-Sectional Study of Bone Density in Long-Term Users of DMPA4

Extension of the Pill-Free Period by Three Days in Oral Contraceptive Users.³

Cross-Sectional Study of Bone Density in Long-Term Users of DMPA⁴