Can oral contraceptive (OC) pills be taken continuously?

From the Guidelines

Oral birth control can be taken continuously, and this approach is considered safe and effective for preventing pregnancy and managing various menstrual-related symptoms. This method, often referred to as continuous or extended-cycle use, involves skipping the placebo pills and starting a new pack immediately to avoid having a monthly withdrawal bleed 1. Medications specifically designed for extended use include Seasonale, Seasonique, and Amethyst, but most traditional birth control pills can be used this way by skipping the placebo week.

Key Considerations

• When taking pills continuously, you simply take the active hormone pills without breaks.
• Some spotting or breakthrough bleeding may occur initially, but this typically decreases over time.
• Continuous use offers benefits like fewer periods, reduced menstrual symptoms, and consistent hormone levels.
• It can be particularly helpful for those with conditions like endometriosis, menstrual migraines, or anemia.
• The hormones in birth control pills prevent pregnancy by stopping ovulation and thickening cervical mucus, regardless of whether you take breaks for withdrawal bleeding.

Important Guidance

• If you're interested in this approach, consult with your healthcare provider to determine the best method for your specific needs and health history.
• Patients should be informed that common transient adverse effects of COCs include irregular bleeding, headache, and nausea 1.
• Drug interactions should also be avoided, and patients may benefit from choosing an alternative method or dosing if medications that decrease COC effectiveness are being used 1.
• Typical use failure rates are 9% in adults and may be higher in adolescents, so counseling should include strategies to promote daily adherence 1.

Safety and Efficacy

• Continuous use of oral birth control is considered safe and does not increase the risk of infertility or breast cancer 1.
• Use of COCs for more than 4 years provides significant protection against endometrial and ovarian cancers 1.
• The most serious adverse event associated with COC use is the increased risk of blood clots, which increases from 1 per 10,000 to 3 to 4 per 10,000 woman-years during COC use 1.

From the Research

Oral Birth Control Continuous Use

• Oral birth control can be taken continuously, as shown in studies 2, 3, 4, 5, 6.
• Continuous use of oral contraceptives has been found to be safe and effective in preventing pregnancy 2, 3.
• This method of use can reduce the frequency of menstrual cycles, with some women experiencing no menstrual bleeding at all 2, 5.
• Common regimens for continuous use include 24 days of active pills followed by 4 days of placebo, 84 days of active pills followed by 7 days of placebo, or continuous use without placebo 2.
• Women using continuous oral contraceptives may experience more breakthrough bleeding and spotting, especially in the initial cycles, but these symptoms tend to decrease over time 2, 3, 4, 6.

Benefits of Continuous Use

• Continuous use of oral contraceptives can alleviate symptoms of coexisting medical conditions, such as endometriosis 3, 5.
• It can also reduce menstrual cycle-related symptoms, such as bloating and dysmenorrhea 3.
• Some women may find continuous use convenient and preferable to traditional cyclic use 6.

Adverse Effects

• The most common adverse effect of continuous oral contraceptive use is breakthrough bleeding and spotting 2, 3, 4, 6.
• Other potential side effects include changes in bleeding patterns, but long-term effects on efficacy and safety are not well understood due to limited studies 2, 5.