Approximately 14 million American women currently use
oral contraceptives. This represents only 32% of those at risk for pregnancy. Many studies suggest that
bleeding irregularities are a primary reason for discontinuation of
oral contraceptives, especially among adolescents. The Triphasic Randomized Clinical Trial study and several others suggest that
intermenstrual bleeding may be experienced by at least one third of women taking
oral contraceptives at one time or another. The socioeconomic costs of these episodes, realized in calls and visits to physicians, as well as pill discontinuation, pregnancy, and perhaps abortion, carry their own unique set of risks. Absence of withdrawal
bleeding, or
amenorrhea, is another concern because, to the woman, it signals pregnancy. Roughly two thirds of patients who have
amenorrhea while taking
oral contraceptives will consult a physician. Physicians should select
oral contraceptives with the lowest doses of
hormones and fewest side effects such as
breakthrough bleeding or
amenorrhea, which are major obstacles to compliance.