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Contraceptive Update: Contraceptive Pearls
(September 2003)
The "Contraceptive Pearls" offer answers to commonly asked questions about family planning. These "Pearls" were prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population and Reproductive Health, United States Agency for International Development (USAID). They are reprinted with permission. To view archives of Jim Shelton's Pearls online, visit Jim Shelton's Pearls onlin
Speculation on Seasonale
Question: In addition to the reduced number of menstrual cycles with Seasonale, do you see other advantages and disadvantages?
Answer: Here are a few that occur to me, though they are somewhat speculative.
One disadvantage is that the overall level of hormone exposure is slightly higher because there are fewer 7-day breaks in pill taking.
Potential advantages may include:
- Efficacy: There is good reason to believe that the pill-free interval (especially if it is extended by missed active pills) contributes to contraceptive failure because new egg-producing follicles grow during that time. Since Seasonale has only 1/4 of the pill-free intervals, use-effectiveness might be better.
- Supply: A 4-month supply is built-in, so the all-too-common practice of providing only 1 cycle at a time is avoided.
- Ovarian and uterine cancer: Since both the ovary and the endometrium are quiescent for a longer period of time, it is conceivable (though highly speculative) that ovarian and endometrial cancer may be reduced even further than with 21-day OCs.
- Reduced anemia: 21-day OCs provide protection against anemia because of overall reduced blood loss - an effect that should increase with the reduced blood loss with the 84/7 regimen.
Hopefully over time good evidence will emerge on these and other issues.