Background: Combination oral contraceptive (COC) is the most common method of contraception utilized in the United States. Currently, the traditional 28-day cyclic COC is the most popular. The newly developed continuous COC shows multiple advantages over the traditional cyclic COC, both in reducing the frequency of menses and the severity of associated symptoms, as well as providing the lifestyle benefits and convenience for women. This systematic review evaluates the effect of continuous COC use on subsequent fertility in healthy women of child-bearing age.
Method: An extensive search of MEDLINE, CINAHL, and Evidence Based Medicine Review Multifile was conducted using fertility and oral contraceptives as key words. Articles written in the English language between 1990 and the present with human subjects were included. The GRADE system was utilized to assess the quality of each study.
Results: Two studies were included in this systematic review. For women who had discontinued continuous COC for pregnancy intent, the pregnancy rate at 12 months was 81%, comparable to the pregnancy rate of women with previous traditional cyclic COC use. The median time to return of spontaneous menses after cessation of continuous COC use was 1 month. These studies seem to indicate that continuous COC use does not delay the time to fertility. However, the studies utilized were both of very low quality.
Conclusion: Based on current research, continuous COC has a good safety and efficacy profile. Recent studies point towards lack of delay in return to fertility; however, more high quality research is necessary to ascertain the effect of continuous COC use on subsequent fertility. At this time, women should be educated about the limitations of current research to make their own decisions in choosing continuous COC as a contraceptive method.
Keywords: continuous oral contraceptives, time to pregnancy, return to fertility
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