Birth Control Pills - Extended Use

Birth control pills (oral contraceptives) are usually taken for 21 days, followed by 7 days "off" the pill. This standard 21/7 regimen was first introduced in the 1960's so that  menstrual bleeding would occur monthly and seem more "natural". However, there is no known medical benefit to routine monthly bleeding.

The continuous use of contraception (COC) may be used so that menstruation occurs less frequently.

Continuous contraception may be prescribed in the following circumstances:

  • to treat women with menorrhagia, dysmenorrhea, endometriosis, chronic pelvic pain, and/or anemia. 
  • to reduce menstrual migraines and acne.
  • for women who want the convenience of fewer menstrual periods, including those who travel, are on deployment in the military, or seek more control of the timing of their menstruation.

Treatment options

TTraditional oral contraceptives, the vaginal ring, and the transdermal patch may be dosed continuously. When conventional birth control pills are used, three pill packs (63 active pills followed by a 7-day hormone-free interval) are usually prescribed. However, only the following medications have been FDA approved specifically for continuous use. These are:

  • 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.

Risks and Benefits

The extended use of oral contraceptives is safe. The continuous use of oral contraceptives can lead to an increase in breakthrough bleeding during the first few cycles of use as the body adjusts to the new hormone balance.

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Last updated: 3/26/2020