They say that the continuous pill also causes a significant improvement in pain and behavioral changes.

"We have provided a biological proof of concept that both the ovary and the lining of the uterus are suppressed better and quicker with the continuous pill than with the cyclic pill. And there is no harmful effect on the lining of the uterus either," said Richard Legro, M.D., professor of obstetrics and gynecology, Penn State College of Medicine and lead author of the study.

Standard 28-day birth control pills mimic a woman's natural menstrual cycle, while preventing pregnancy. A standard dose includes 21 hormone pills to suppress growth in the endometrium, the lining of the uterus, and seven placeholder placebo pills.

Continuous oral contraceptives may be more effective in treating several medical conditions, where continuous ovarian suppression is desired, such as acne, hirsutism, premenstrual syndrome, endometriosis and polycystic ovary syndrome. But there have been few detailed studies of ovarian function on the pill to demonstrate this effect.

Legro and his colleagues compared the effectiveness of continuous oral contraceptives with that of the cyclical pills. The researchers monitored 62 healthy women, randomly assigned to receive either cyclical or continuous birth control pills, for six months with both researchers and participants blinded to the study group.

"We monitored vaginal bleeding, quality of life, and ovarian and endometrial suppression," said Legro, whose team's findings appeared in a recent issue of the Journal of Clinical Endocrinology and Metabolism.

The researchers found a significant decrease in moderate to heavy bleeding days among women who received the continuous birth control regimen. Women in the continuous group also had a significant decline in circulating and urinary estrogen levels, total ovarian volume and lead follicle size “ all biomarkers that indicate the ovary is less active “ and reported less pain and behavioral changes compared to women in the cyclic group.

However, results from the study also indicate greater breakthrough bleeding, or spotting, among women in the continuous group. Legro says that while greater breakthrough bleeding may be a truly objectionable side effect for many women, it does not seem to affect their quality of life.

"That is one of the unique things of this study. The quality of life did not necessarily decrease as it was counterbalanced by improvements in other areas such as pain and mood swings," the Penn State researcher added.

According to Legro, the study suggests that there may be diverse mechanisms of breakthrough bleeding depending on whether a woman is using either a cyclical or continuous regimen of birth control pills.

In the case of cyclic pills, the ovary comes back into the equation during the pill free interval leading to a rebound increased secretion of ovarian hormones, which in turn contributes to some breakthrough bleeding, he explained.

"Breakthrough bleeding in the continuous group, in our opinion, is most likely due to the fact that the pill does too good of a job in suppressing the ovary and the lining of the uterus gets a little bit thin and fragile so that from time to time there is a little bit of bleeding," added Legro, whose work is funded by the National Institutes of Health.

The study provides a physical reason for continuous oral contraceptive pills to treat such chronic medical conditions such as polycystic ovary syndrome, endometriosis and premenstrual syndrome, where additional suppression of the ovary or the endometrium is desired, and Legro noted that other chronic conditions such as hypertension or diabetes are treated continuously, not three weeks out of four. Further studies showing a favorable risk benefit ratio of continuous oral contraceptives on these disorders are the next step.

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Training for Neonatologists Key to properly caring for these fragile infants is the advanced medical training of UC San Diego's health care practitioners. Fourteen pediatrics residents from across the U.S. receive training at UCSD Medical Center every year, the only place in the region where doctors can train to become a neonatologist. The UCSD NICU is also one of the most active in the state of California for clinical research with more than 15 active clinical trials to date.

The NICU's largest current research effort is the national SUPPORT Trial funded by the National Institute of Child Health and Human Development. Finer, the principal investigator of the multi-center trial, is comparing two methods of early respiratory support for extremely premature infants and attempting to determine the appropriate oxygen levels needed by such infants. The UCSD Neonatal Program is also evaluating early nutritional interventions, and expanding the role of ultrasound of the heart and bowel to assist in the care of very compromised newborn infants.

Every day we look for ways to develop better evidence-based treatments for the care of premature infants. We ask ourselves, What is the best way to assist the baby's breathing and to maintain appropriate oxygen levels? What is the best way to feed the baby and to optimize the use of maternal breast milk and prevent disease? said Finer. This is truly 24-hour care for the tiniest and most delicate of humans.

About Women and Infant Care at UCSD The UC San Diego Medical Center labor and delivery service, specializing in high-risk pregnancies, and the NICU, are nationally recognized centers of excellence providing the highest level of care available for pregnant women and newborns. UCSD Medical Center became accredited as a Baby Friendly Hospital in 2006; one of a handful of academic hospitals to achieve this prestigious award.

Baby Friendly Hospitals support and promote breastfeeding as the preferred method of infant nutrition. In efforts to extend this support of human milk nutrition to the smallest, most vulnerable infants, UCSD is launching a nutrition program called SPIN, Supporting Premature Infant Nutrition. The new program is focused on the provision, analysis, and research of human milk to improve nutritional and neurodevelopmental outcomes in preterm babies. The program is the first of its kind in the United States.

In July 2008, hundreds of families whose infants have graduated from the NICU will reunite with the staff of UC San Diego Medical Center. The annual Little Grad Picnic in Mission Bay Park brings together families throughout California whose children enjoy a celebration of life and friendship.

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