Using combined pills continuously has 3 advantages that you might find positive and helpful:
- 1. They are more effective.
- 2. Missing pills means virtually nothing in terms of contraceptive effectiveness (although it definitely can lead to spotting).
- 3. You can stop pills at any time to have a withdrawal bleed and manipulate your cycle for the convenience of a trip, athletic adventure or whatever.
WHAT CAN CONTINUOUS OR EXTENDED USE OF PILLS MEAN?:
A. Manipulation of a cycle to delay one period for a trip, honeymoon, or athletic event
B. Use of active hormonal pills (for more than 21 consecutive days) followed by 2 to 7 hormone-free days. Seasonale is a COC packaged to produce 4 cycles per year. The hormones in Seasonale ARE THE SAME 30 mcg EE pills with levonorgestrel: Nordette, Lo-Ovral, etc. Pills other than Seasonale may be used to accomplish this same end.
C. Continuous daily COCs for at least 21 pills, but after that, may break for 2-7 days if spotting or breakthrough bleeding is bothersome.
D. Use of a monophasic pill indefinitely. BTB can occur at any time with this regimen. Eventually she develops an atrophic endometrium and breakthrough bleeding decreases; many women will stop bleeding completely.
Cyclic symptoms that may improve from the extended use of pills:
Symptoms usually occurring at the time of menses: (predicted benefits)
- Abdominal back or leg pain, dysmenorrhea, endometriosis Sx [Verellini-2003]
- Bleeding abnormalities including menorrhagia
- Irritability or depression. Decreased libido
- Headaches including both menstrual migraine and other cyclic headaches [Sulak-2000]
- Nausea, dizziness, vomiting or diarrhea
- Cyclic yeast or other infections or cyclic nosebleeds
- Cyclic seizures, arthritis, or recurrences of asthma at the time of menses
- Changes in insulin requirements
- Cyclic symptoms associated with polycystic ovarian disease
Symptoms usually occurring at midcycle: (predicted benefits)
- Spotting due to sudden fall in estradiol
- Sharp or dull pain (that precedes ovulation and is caused by high midcycle PG levels)
Symptoms usually occurring just prior to menses: (predicted benefits)
- Slight to more dramatic weight gain, bloating, swollen eyes or ankles
- Breast fullness or tenderness
- Anxiety, irritability or depression, nausea or headaches due to dropping estrogen
- Acne, spotting, discharge, breast fullness or tenderness
- Pain or cramping or constipation
Most important advantages & disadvantages of taking COCs continuously:
- May be more effective as a contraceptive when taken daily. Missed pills become less of a problem in terms of unintended pregnancy.
- May be easier to remember (do the same thing every day)
- Women wanting to avoid bleeding for an athletic event, special trip or any other reason
- Less frequent menstruation [Sulak-2000] [Glasier-2003] and less blood loss
- Decreased expenses from tampons, pads, pain meds, days missed from work and pregnancy
- More expensive and the extra packs of pills required may not be covered by insurance
- Unscheduled spotting or bleeding and the absence of regular menses