Hormone withdrawal symptoms in oral contraceptive users

Objective: To measure the timing, frequency, and severity of hormone-relate d symptoms in oral contraceptive (OC) users, specifically to compare active -pill with hormone-free intervals. Methods: Using daily diaries, women recorded pelvic pain, bleeding, headach es, analgesic use, nausea or vomiting, bloating or swelling, and breast ten derness during active-pill intervals and hormone-free intervals. Participan ts either had no prior OC use, had taken OCs and were restarting, or had be en taking OCs continuously for 12 months or longer. Results: Two hundred sixty-two women, 26 with no previous OC use, 43 prior users, and 193 current users, provided daily records of hormone-related sym ptoms. Subjects with no prior OC use and prior users restarting were simila r in no recent OC use, and because of the small sample, they were pooled fo r analysis as new-start OC users. Current users had patterns of symptoms th at were more frequent during hormone-free intervals than during the three a ctive-pill weeks. These included pelvic pain (70% versus 21%, P < .001), he adaches (70% versus 53%, P < .001), use of pain medication (69% versus 43%, P < .001), bloating or swelling (58% versus 19%, P < .001), and breast ten derness (38% versus 16%, P < .001). Similar patterns were seen in new-start OC users after the first cycle. Among new-start OC users, menstrual now pa tterns, headache, bloating or swelling, and breast-tenderness symptoms decr eased during the three cycles to approach those levels of current users. Conclusion: Almost all symptoms assessed were significantly worse during th e 7-day hormone-free interval than during the 21 days of hormone-containing pills. (Obstet Gynecol 2000;95:261-6. (C) 2000 by The American College of Obstetricians and Gynecologists.).