Demystifying extended menstrual cycling (CME)

August 1, 2008

The buzz surrounding extended cycling is prompting more young girls to ask if they too can have fewer or no periods. But given the nuances of each method, pediatricians may find that fulfilling these requests may be easier said than done.

Which patients fit the bill?

Young women experiencing unwanted menstrual symptoms often benefit from contraceptives that can alter the amount of blood loss (menorrhagia), suppress ovulation (ovarian cysts, mittelschmertz), and limit the degree of cramping and other physical and emotional symptoms related to menstrual cycles (eg, dysmenorrhea, premenstrual syndrome, premenstrual dysphoric disorder). Other non-menstrual disorders that may have cyclic exacerbations include acne, migraine headache, and epilepsy. There is recent evidence to suggest that menstrual cycles may also contribute to asthma exacerbations.2

Of course, not all young women are able to articulate their menstrual difficulties to fit a specific indication for extended cycling.4 However, with appropriate counseling about contraceptive risks, and in the absence of contraindications, extended contraceptive cycling may indeed be appropriate for any young woman who prefers less frequent menstruation.

Extended cycling with COCs

Most combined oral contraceptives (COCs) are packaged in 28-day pill packs with 21 days of active hormone-containing pills, and seven days of placebo pills. The 21 hormone pills can each contain equal doses of estrogen and progestin (monophasic pills), or the dose can vary, with each of the three sets of seven pills containing different doses (triphasic pills).