Intentions to Continuous Cycle and/or Adopt a Shorter Hormone-Free Interval among Women Initiating the Pill or Vaginal Ring

Background. In an effort to reduce menstrual symptoms as well as user and method-related errors, continuous cycling and/or shortening the hormone-free interval is recommended for women using the pill or vaginal ring. Little is known about the extent to which women are being counseled on this practice or women’s intentions to adopt this behavior when initiating pill or ring use.   

Methods. Women ages 14 to 45 who were starting a new contraceptive method were recruited at 30 family planning clinics located in four US states. Participants completed an online survey after the visit and a follow-up survey after three months.

Results. Of the 221 women starting the pill, 58% were counseled on continuous cycling and approximately 41% of all pill users intended to embrace this practice. Only 40% of women who experienced moderate to extreme discomfort with heavy menstrual flow in the past 30 days were instructed on adopting the shorter hormone-free interval, with less than half (45%) intending to continuous cycle with the pill. Among ring users, a greater percentage (73%) were counseled on shortening the hormone-free interval and 61% intended to do so. After three months, 45% of ring users reported continuous cycling with their ring.

Conclusions. Counseling on continuous cycling appears sporadic among pill users and surprisingly, more common among women starting the ring. Efforts to increase awareness of the benefits of shortening the hormone-free interval would promote optimal method use and favorable health outcomes, particularly among overweight women and women experiencing painful periods.