What are the continuous cycle birth control pills with 28 active pills per pack?

Continuous Cycle Birth Control Pills with 28 Active Pills Per Pack

The most common continuous cycle birth control pill with 28 active pills per pack is Amethyst (levonorgestrel 90 μg/ethinyl estradiol 20 μg), which provides continuous hormonal contraception with no placebo pills or hormone-free interval. 1

Available Options and Formulations

• Amethyst (levonorgestrel 90 μg/ethinyl estradiol 20 μg) is the primary FDA-approved continuous cycle pill with 28 active pills and no placebo pills 1
• Other extended-cycle pills like Seasonale and Seasonique use 84 active pills followed by 7 placebo days, but do not provide a full 28 active pills per pack 1
• Some traditional 28-day pill packs can be modified for continuous use by skipping the placebo week and starting a new pack immediately, though this is considered off-label use 2

Benefits of Continuous Cycle Pills

• Elimination of monthly withdrawal bleeding, which can improve quality of life and reduce menstruation-associated symptoms 3
• Potentially improved contraceptive effectiveness due to continuous ovulation suppression without the hormone-free interval 4
• Particularly beneficial for women with medical conditions such as:
  • Anemia, severe dysmenorrhea, endometriosis 5
  • Abnormal uterine bleeding and bleeding disorders 5
  • Conditions exacerbated cyclically (migraines without aura, epilepsy, irritable bowel syndrome) 5

Side Effects and Considerations

• The most common adverse effect specific to continuous cycle pills is unscheduled breakthrough bleeding, especially during the first few months of use 5, 3
• Overall safety profile is similar to traditional cyclic combined hormonal contraceptives 3
• Typical use failure rate is approximately 9%, similar to traditional combined oral contraceptives 5
• Contraindications are the same as for all combined hormonal contraceptives (history of VTE, smoking after age 35, etc.) 5

Management of Breakthrough Bleeding

• If breakthrough bleeding becomes problematic, a 3-4 day hormone-free interval may help resolve the issue 5
• Counseling about expected bleeding patterns and reassurance that bleeding irregularities are generally not harmful can improve continuation rates 5
• Bleeding patterns typically improve over time with continued use 3

Missed Pill Instructions

• If one pill is late (<24 hours): Take immediately and continue regular schedule; no backup needed 4
• If one pill is missed (24-48 hours): Take most recent missed pill immediately, continue schedule, use backup for 7 days 4
• If two or more consecutive pills are missed (≥48 hours): Take most recent missed pill, discard others, continue schedule, use backup for 7 days 4
• Emergency contraception should be considered if pills are missed and unprotected intercourse occurred 5

Patient Counseling Points

• Continuous cycle pills eliminate the hormone-free interval, potentially improving contraceptive effectiveness 4
• Higher satisfaction rates are reported with continuous regimens in clinical trials 3
• Breakthrough bleeding is common initially but typically improves with time 5
• The risk of venous thromboembolism is the same as with traditional combined hormonal contraceptives (3-4 per 10,000 woman-years) 5

Continuous cycle birth control pills with 28 active pills provide an effective contraceptive option with the added benefit of reducing or eliminating monthly bleeding, which can significantly improve quality of life for many women while maintaining the same safety profile as traditional combined hormonal contraceptives.