Iranian Society of Gynecology Oncology


1 MD, Taleghani Hospital, Genomic Research Center, Obstetrics and Gynecology Department, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

2 MD, MPH, Community Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

3 Master of Control Engineering, Department of Electrical, Biomedical and Mechatronics Engineering, Qazvin Branch, Islamic Azad University, Qazvin, IR Iran


Background: Women’s activity in many social and religious events necessitates them to have their menstruation suppressed, including in yearly Hajj rites for Muslim women. According to the Islamic religious set-ups, Muslim women must be physically and morally clean during the Hajj rites in Mecca. In this research, the efficiency and side effects of extended consumption of hormonal agents in Iranian women during the Hajj rites in Mecca were examined.
Methods: The retrospective cross-sectional study involved a sum of 212 participants of pilgrim women recruited from 30 Sep. to 4 Nov. 2013, already prescribed with different types of hormonal agents for 35 - 36 days. Thereafter, they were assessed by questionnaires for the sake of success and side effects throughout the approach.
Results: Out of 212 subjects, 161 (75.9%) had experienced menstrual delay during Hajj rites with no spotting. Women taking combined oral contraceptives within the first half of their menstrual cycle had a significant postponement of menstrual bleeding.
Conclusions: Majority of the pilgrim women who completed the Hajj rites thoroughly with no spotting were satisfied with the extended consumption of hormonal agents.


  1. Piccinino LJ, Mosher WD. Trends in contraceptive use in the United States, 1982-1995. Fam Plann Perspect. 1998;30(1):4-10. 46. [DOI:10.2307/2991517] [PMID]
  2. Rosenberg MJ, Burnhill MS, Waugh MS, Grimes DA, Hillard PJ. Compliance and oral contraceptives: a review. Contraception. 1995;52(3):137-41. [DOI:10.1016/0010-7824(95)00161-3]
  3. Rosenberg MJ, Waugh MS, Meehan TE. Use and misuse of oral contraceptives: risk indicators for poor pill taking and discontinuation. Contraception. 1995;51(5):283-8. [DOI:10.1016/0010-7824(95)00074-K]
  4. Christopher LA, Miller L. Women in war: operational issues of menstruation and unintended pregnancy. Mil Med. 2007;172(1):9-16. [DOI:10.7205/MILMED.172.1.9] [PMID]
  5. Hitchcock CL, Prior JC. Evidence about extending the duration of oral contraceptive use to suppress menstruation. Womens Health Issues. 2004;14(6):201-11. [DOI:10.1016/j.whi.2004.08.005] [PMID]
  6. Powell-Dunford N, Cuda AS, Moore JL, Crago MS, Deuster PA. Menstrual suppression using oral contraceptives: survey of deployed female aviation personnel. Aviat Space Environ Med. 2009;80(11):971-5. [DOI:10.3357/ASEM.2566.2009] [PMID]
  7. Archer DF. Menstrual-cycle-related symptoms: a review of the rationale for continuous use of oral contraceptives. Contraception. 2006;74(5):359-66. [DOI:10.1016/j.contraception.2006.06.003] [PMID]
  8. Benagiano G, Carrara S, Filippi V. Safety, efficacy and patient satisfaction with continuous daily administration of levonorgestrel/ethinylestradiol oral contraceptives. Patient Prefer Adherence. 2009;3:131-43. [DOI:10.2147/PPA.S3692] [PMID]
  9. De Voogd WS. Postponement of withdrawal bleeding with a monophasic oral contraceptive containing desogestrel and ethinylestradiol. Contraception. 1991;44(2):107-12. [DOI:10.1016/0010-7824(91)90111-R]
  10. Edelman AB, Gallo MF, Jensen JT, Nichols MD, Schulz KF, Grimes DA. Continuous or extended cycle vs, cyclic use of combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2005;(3):4695. [DOI:10.1002/14651858.CD004695.pub2]
  11. Kaunitz AM. Menstruation: choosing whether...and when. Contraception. 2000;62(6):277-84. [DOI:10.1016/S0010-7824(00)00182-7]
  12. Kwiecien M, Edelman A, Nichols MD, Jensen JT. Bleeding patterns and patient acceptability of standard or continuous dosing regimens of a low-dose oral contraceptive: a randomized trial. Contraception. 2003;67(1):9-13. [DOI:10.1016/S0010-7824(02)00445-6]
  13. Lin K, Barnhart K. The clinical rationale for menses-free contraception. J Womens Health (Larchmt). 2007;16(8):1171-80. [DOI:10.1089/jwh.2007.0332] [PMID]
  14. Wiegratz I, Kuhl H. Long-cycle treatment with oral contraceptives. Drugs. 2004;64(21):2447-62. [DOI:10.2165/00003495-200464210-00006] [PMID]
  15. Anderson FD, Hait H. A multicenter, randomized study of an extended cycle oral contraceptive. Contraception. 2003;68(2):89-96. [DOI:10.1016/S0010-7824(03)00141-0]
  16. Coffee AL, Sulak PJ, Kuehl TJ. Long-term assessment of symptomatology and satisfaction of an extended oral contraceptive regimen. Contraception. 2007;75(6):444-9. [DOI:10.1016/j.contraception.2007.01.014] [PMID]
  17. Hee L, Kettner LO, Vejtorp M. Continuous use of oral contraceptives: an overview of effects and side-effects. Acta Obstet Gynecol Scand. 2013;92(2):125-36. [DOI:10.1111/aogs.12036] [PMID]
  18. Jacobson JC, Likis FE, Murphy PA. Extended and continuous combined contraceptive regimens for menstrual suppression. J Midwifery Womens Health. 2012;57(6):585-92. [DOI:10.1111/j.1542-2011.2012.00250.x] [PMID]
  19. Lambert J, Newton W. Continuous use of oral contraceptives reduces bleeding. J Fam Pract. 2003;52(8):601-2.
  20. Loudon NB, Foxwell M, Potts DM, Guild AL, Short RV. Acceptability of an oral contraceptive that reduces the frequency of menstruation: the tri-cycle pill regimen. Br Med J. 1977;2(6085):487-90. [DOI:10.1136/bmj.2.6085.487] [PMID]
  21. Machado RB, de Melo NR, Maia HJ. Bleeding patterns and menstrual-related symptoms with the continuous use of a contraceptive combination of ethinylestradiol and drospirenone: a randomized study. Contraception. 2010;81(3):215-22. [DOI:10.1016/j.contraception.2009.10.010] [PMID]
  22. Mendoza N, Lobo P, Lertxundi R, Correa M, Gonzalez E, Salamanca A, et al. Extended regimens of combined hormonal contraception to reduce symptoms related to withdrawal bleeding and the hormonefree interval: a systematic review of randomised and observational studies. Eur J Contracept Reprod Health Care. 2014;19(5):321-39. [DOI:10.3109/13625187.2014.927423] [PMID]
  23. Portman DJ, Reape KZ, Hait H, Howard BK. Reduction in dysmenorrhea severity in women using a 91 day extended regimen oral contraceptive compared to a 28 day regimen oral contraceptive for the treatment of cyclic pelvic pain. Fertil Steril. 2011;96(3):110-1. [DOI:10.1016/j.fertnstert.2011.07.433]
  24. Seidman DS, Yeshaya A, Ber A, Amodai I, Feinstein I, Finkel I, et al. A prospective follow-up of two 21/7 cycles followed by two extended regimen 84/7 cycles with contraceptive pills containing ethinyl estradiol and drospirenone. Isr Med Assoc J. 2010;12(7):400-5.
  25. Sulak PJ, Kuehl TJ, Ortiz M, Shull BL. Acceptance of altering the standard 21-day/7-day oral contraceptive regimen to delay menses and reduce hormone withdrawal symptoms. Am J Obstet Gynecol. 2002;186(6):1142-9. [DOI:10.1067/mob.2002.122988] [PMID]
  26. This P. [Reducing the frequency of menses: extended contraception, a review]. Gynecol Obstet Fertil. 2013;41(6):381-7. [DOI:10.1016/j.gyobfe.2013.05.003] [PMID]
  27. Wiegratz I, Stahlberg S, Manthey T, Sanger N, Mittmann K, Lange E, et al. Effect of extended-cycle regimen with an oral contraceptive containing 30 mcg ethinylestradiol and 2 mg dienogest on bleeding patterns, safety, acceptance and contraceptive efficacy. Contraception. 2011;84(2):133-43. [DOI:10.1016/j.contraception.2011.01.002] [PMID]
  28. Miller L, Hughes JP. Continuous combination oral contraceptive pills to eliminate withdrawal bleeding: a randomized trial. Obstet Gynecol. 2003;101(4):653-61. [DOI:10.1016/S0029-7844(03)00014-0] [PMID]
  29. Likis FE. Contraceptive applications of estrogen. J Midwifery Womens Health. 2002;47(3):139-56. [DOI:10.1016/S1526-9523(02)00234-9]