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Complementary searches were conducted in grey literature sources and reference lists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 9531 records were identified, from which 18 randomised controlled trials and 10 studies of other designs were included. Overall, findings indicated that: (1) continuous or extended-cycle COCs had contraceptive effectiveness similar to cyclic COCs (unintended pregnancies over 1 year: OR 0.79, 95%\u2009CI 0.41 to 1.52; Pearl Index mean difference \u22120.20, 95%\u2009CI \u22121.31 to 0.92); (2) bleeding outcomes varied, with either no significant difference or fewer total bleeding and\/or spotting days with continuous or extended-cycle COC use, but more unscheduled bleeding; (3) no significant difference was observed in the odds of experiencing at least one adverse event (OR 1.20, 95%\u2009CI 1.03 to 1.41); (4) the relative risk of deep vein thrombosis or venous thromboembolism was low (OR 1.05, 95%\u2009CI 0.16 to 6.79), with a small absolute increase (approximately 0.7 additional cases per 1000 users); and (5) satisfaction was generally high in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Continuous or extended-cycle COC use demonstrates comparable contraceptive effectiveness, safety and overall acceptability to conventional cyclic COC regimens. However, interpretation of acceptability and bleeding-related outcomes should consider higher discontinuation rates and missing outcome data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsrh-2026-203331","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:05:16Z","timestamp":1790179516000},"page":"s33-s48","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness, safety and acceptability of continuous or extended-cycle use of combined oral contraceptives (COCs): a systematic review and meta-analysis"],"prefix":"10.1136","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6736-5969","authenticated-orcid":false,"given":"Li","family":"Jiang","sequence":"first","affiliation":[{"name":"Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0375-1251","authenticated-orcid":false,"given":"Maya","family":"Kshatriya","sequence":"additional","affiliation":[{"name":"Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zulfiqar A","family":"Bhutta","sequence":"additional","affiliation":[{"name":"Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Santesso","sequence":"additional","affiliation":[{"name":"Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asantesana","family":"Kamuyango","sequence":"additional","affiliation":[{"name":"UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual, Reproductive, Maternal, Child, Adolescent and Ageing Health (LHR), World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3447-244X","authenticated-orcid":false,"given":"Nancy","family":"Kidula","sequence":"additional","affiliation":[{"name":"UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual, Reproductive, Maternal, Child, Adolescent and Ageing Health (LHR), World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4180-7858","authenticated-orcid":false,"given":"James N","family":"Kiarie","sequence":"additional","affiliation":[{"name":"UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual, Reproductive, Maternal, Child, Adolescent and Ageing Health (LHR), World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"2026092309050931000_52.Suppl_2.s33.1","unstructured":"United Nations Digital Library System. 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