Extended or Continuous Use of Combined Hormonal Contraceptive Pills

(Updated June 2014)

Description

• Extended hormonal contraception delays menstruation; continuous use eliminates menstruation. When COCs were first introduced in the 1960s, social, cultural, and religious pressures favored associating pills with a “natural” cycle whereby hormone withdrawal for 7 days was followed by bleeding. The standard 21/7 COC regimen continues to be prescribed, although there is no known medical benefit to routine monthly bleeding.
• Pregnancy risk is highest when a woman misses more than 7 days of pills.
• Extended-regimen contraception has been used for years to relieve menstrual-related complaints and to treat women with menorrhagia, dysmenorrhea, endometriosis, chronic pelvic pain, and anemia.²² Menstrual suppression through continuous COC use is associated with reduction in menstrual migraines, endometriosis, and acne and an improved sense of well-being.²³
• Extended or continuous regimens are useful for women who want convenience for their menstruation, including women who travel, are on deployment in the military, or seek more control regarding the timing of menstruation.

Use

• Seasonale^®, Seasonique^®, and Lybrel^® are products approved for extended or continuous contraception.
• Seasonale contains 84 days of active pills and 7 days of inactive pills.
• Seasonique contains 84 days of active pills and 7 days of low-dose estrogen pills.
• Lybrel contains a full year of active pills with no inactive pills.
• Traditional COCs, vaginal ring, and transdermal patch also can be dosed continuously, but the Food and Drug Administration (FDA) has not approved this indication for these methods. When conventional COCs are used, three pill packs (63 active pills followed by a 7-day hormone-free interval) are usually prescribed.

Effectiveness

As described previously for combined oral contraceptive pills.

Risks, Side Effects, and Contraindications

As described previously for all combined hormonal contraception. In addition, there is an increase in breakthrough bleeding during the first few cycles of use as the body adjusts to the new hormone balance.²⁴

Advantages

As described previously for all combined hormonal contraception, plus:

• Delay or elimination of menstruation
• Ability to adjust cycle at particular times, for life events, or based on preference

Disadvantages

As described previously for all combined hormonal contraception.

Counseling Messages

• It is not necessary to bleed every month when using hormonal contraceptives. Neither menstrual blood nor iron builds up with hormonal methods.²⁵
• Extended use of COCs is safe.
• Monthly menses is not proof of lack of pregnancy; accurate pregnancy tests are available for those who need reassurance.
• Unscheduled bleeding will lessen over time.
• This method does not protect against STIs.