From the Guidelines
For continuous use of oral contraceptive pills (OCPs), the recommended regimen involves taking active hormone pills daily without breaks for placebo pills, effectively skipping the withdrawal bleeding period, as this approach is equally effective for pregnancy prevention as the traditional 21/7 regimen while offering benefits such as reduced menstrual symptoms, fewer headaches, and management of conditions like endometriosis 1. When using this method, take one active pill at the same time each day without interruption. If breakthrough bleeding occurs and becomes bothersome, you can take a 3-4 day break from pills to allow for a controlled withdrawal bleed before resuming continuous use. Some key points to consider for continuous OCP use include:
- Most combined OCPs can be used continuously, including options like Seasonale, Seasonique, or standard 28-day packs where you simply discard the placebo pills and start a new pack immediately 1.
- Continuous use is safe for most women who can take combined hormonal contraceptives, though some may experience more breakthrough bleeding initially, which typically improves over time as the endometrium thins with sustained hormone exposure.
- It is essential to counsel patients on the importance of adherence and provide strategies to promote daily adherence, such as cell phone alarms and support from a family member or partner 1.
- Patients should be instructed on what to do if pills are missed, with guidance to take a missed pill as soon as it is remembered, and if more than one pill in a row is missed, only the most recently missed pill should be taken as soon as possible, and the remaining pills should be taken at the usual time 1.
From the FDA Drug Label
To achieve maximum contraceptive effectiveness, Kariva® must be taken exactly as directed and at intervals not exceeding 24 hours.
When initiating a Sunday start regimen, another method of contraception should be used until after the first 7 consecutive days of administration
Using a Sunday start, tablets are taken daily without interruption as follows: The first white tablet should be taken on the first Sunday after menstruation begins (if menstruation begins on Sunday, the first white tablet is taken on that day). One white tablet is taken daily for 21 days, followed by 1 light-green (inert) tablet daily for 2 days and 1 light-blue (active) tablet daily for 5 days
For all subsequent cycles, the patient then begins a new 28-tablet regimen on the next day (Sunday) after taking the last light-blue tablet.
The recommended regimen for continuous use of Oral Contraceptive Pills (OCP) for birth control is to take the tablets daily without interruption, following either a Sunday start or a Day 1 start regimen.
- The patient should take one white tablet daily for 21 days,
- followed by 1 light-green (inert) tablet daily for 2 days,
- and then 1 light-blue (active) tablet daily for 5 days.
- For subsequent cycles, the patient should begin a new 28-tablet regimen on the next day after taking the last light-blue tablet 2. Key points to note include:
- Taking the tablets at intervals not exceeding 24 hours,
- Using a back-up method of birth control if pills are missed,
- And following the specific instructions for missed pills.
From the Research
Recommended Regimen for Continuous Use of Oral Contraceptive Pills (OCP)
The recommended regimen for continuous use of Oral Contraceptive Pills (OCP) for birth control involves taking the pills without a break, which can lead to a reduction or elimination of menstrual bleeding 3, 4.
Types of OCPs and Their Effects
There are two main types of OCPs: combination oral contraceptives (COCs) and progestin-only pills (POPs) 5. COCs contain estrogen and progesterone, while POPs contain only progesterone. Both types have similar failure rates, ranging from 7.2% to 9% with typical use 5.
Regimens for Continuous Use
Continuous-cycle oral contraceptives can be given in various regimens, including 24 days followed by placebo for 4 days (24/4), 84 days followed by placebo for 7 days (84/7), or continuously without placebo 3. These regimens can shorten the duration of menses, decrease the frequency of menses, or completely eliminate menses.
Benefits and Adverse Effects
Continuous use of OCPs can have several benefits, including a reduction in menstrual bleeding, improvement in menstruation-related symptoms, and a lower risk of ovarian and endometrial cancers 5, 4. However, it can also lead to breakthrough bleeding and spotting, especially during the initial months of use 3, 4.
Important Considerations
Before initiating continuous use of OCPs, it is essential to assess the patient's medical history, blood pressure, and other factors to ensure safe use 5. Patients with conditions associated with a risk of cardiovascular events should not use COCs due to the increased risk of venous thromboembolism 5.
Efficacy and Safety
Clinical trials have demonstrated that extended- and continuous-cycle oral contraceptives are as effective in preventing pregnancy as traditional oral contraceptives 3, 4. However, long-term effects on efficacy and safety are not well established, as these new products have been used for only a short period 3.
Patient Counseling
High-quality contraceptive counseling is crucial to help patients find the most effective and acceptable method for them 5. Physicians should work collaboratively with patients to identify factors that may assist in or hinder their ability to use the method correctly over time 5.