Continous Extended Use of Combined Hormonal Contraceptives

What is continuous or extended use of combined hormonal contraception?

  • Extended use refers to use of combined hormonal contraception with hormone-free intervals less often than once a month, such as taking 2 birth control pill packs back to back for two months with no hormone break to avoid having your period while you go on vacation.

  • Continuous use of combined hormonal contraception refers to uninterrupted use without hormone free intervals

All low dose Combined hormonal Contraception including pills, patch and vaginal ring can be used in this manner

How does continuous or extended hormonal contraception work?

It works in the same way as standard use: prevents ovulation (the release of an egg by the ovaries each month) and thickens the mucous in the cervix to make it more difficult for the sperm to enter the uterus while allowing a woman to miss one or more periods.

Advantages

  • Women use continuous or extended hormonal contraceptives (pill, patch or ring) so that they will have fewer bleeding days per year; some women will have no bleeding over time

  • This method can be used for contraception, medical or personal preference, women can choose continuous or extended use of their combined hormonal contraception method using either the pill, patch or ring

  • Increased convenience of not bleeding as much or as often, less pain medication, fewer missed work and school due to menstrual problems

  • May provide improvement of abnormal bleeding, fibroids, endometriosis, peri-menopause side effects and other reproductive health problems and should be discussed in consultation with a physician

  • Convenience-may be used by women working long hours, athletes, those wanting to delay a period for vacation, graduation, honeymoon, etc. and women who find menstruation inconvenient

MYTH: Not having my period is "not safe", or "unnatural"

FACT: Combined Hormonal contraceptive methods cause the lining of the uterus to become very thin, especially with extended or continuous use. As a result there is no significant amount of tissue to shed and no build-up of menstrual blood - therefore there is nothing to shed and no period is required.

Is continuous/extended use as effective as standard use (such as the 21/7 regime)?

  • Yes, they have the same 92% effectiveness with typical use and 99.7% effectiveness with perfect use

  • May be more effective with daily use, easier to remember 

What are the side effects/Disadvantages of Continuous/Extended use?

  • Unscheduled spotting or bleeding should be expected with the frequency decreasing over time, this is not harmful and the contraceptive will continue to work

  • Possible delay in recognition of a pregnancy if already pregnant or not using the method correctly

  • Side effects like headaches, bloating/swelling, pelvic pain, PMS and breast tenderness along with other menstrual related side effects may still exist but tend to be lower with continuous/extended use

Combined hormonal contraception such as the pill, patch, or ring can be used
3 ways:

Standard Use - involves using the contraceptive method for 21 days and having 7 days where placebo or sugar pills/ or no pills are taken or the patch or ring are removed, during this time there will be a withdrawal bleed

Extended Use - involves using the contraceptive method for several months in a row to prevent bleeding and then taking a 7-day pill, patch or ring free interval when there will be a withdrawal bleed. Spotting or bleeding may occur while using the contraceptive method and this should decrease with time

Continuous Use - involves using the contraceptive method every day for as long as desired without taking a break (having a hormone free interval) or using the placebo or sugar pills, during this time there will likely be spotting or bleeding that will decrease over time.

Your health care provider can help you decide the method that will work best for you and your lifestyle

 

References:

JOGC Canadian Consensus Guideline on Continuous and Extended Hormonal Contraception, 2007

www.sexualityandu.ca/teens/contraception-6.aspx "Controlling your periods with contraception", 2008

Contraceptive Technology Update, July 2007, "Continuous use oral contraceptive receives FDA regulatory approval"

Managing Contraception