Can the Placebo Week Be Skipped with Microgestin 1/20?
Yes, the placebo week can be safely skipped with Microgestin 1/20 (norethindrone acetate 1 mg/ethinyl estradiol 20 mcg) to create extended or continuous cycles, which may provide additional benefits for certain medical conditions and contraceptive efficacy.
Evidence Supporting Extended/Continuous Cycles
Combined hormonal contraceptives like Microgestin 1/20 are traditionally used for 21-24 consecutive days followed by 4-7 hormone-free days, but these methods can be used for extended periods with infrequent or no hormone-free days 1
Extended or continuous cycles may be particularly useful for treating medical conditions including anemia, acne, severe dysmenorrhea, endometriosis, dysfunctional or heavy menstrual bleeding, Von Willebrand disease, and other bleeding disorders 1
These regimens are also beneficial for conditions that can be exacerbated cyclically, such as migraine (without aura), epilepsy, irritable bowel syndrome, inflammatory bowel disease, and some psychiatric and behavioral symptoms 1
Contraceptive Efficacy Considerations
Seven consecutive days of active hormonal pills are necessary to reliably prevent ovulation 1
Extending the hormone-free interval (the placebo week) is considered a particularly risky time for contraceptive failure, as it increases the risk of follicular development and potential ovulation 1
By skipping the placebo week and continuing with active pills, you maintain continuous ovarian suppression and potentially improve contraceptive effectiveness 1
Practical Implementation
When skipping the placebo week, simply start a new pack of active pills immediately after finishing the 21 active pills from the current pack 1
If missed pills occur in the last week of a cycle when planning to skip the placebo week, you can proceed directly to the next pack without taking the hormone-free interval 1
The most common adverse effect of extended or continuous cycles is unscheduled breakthrough bleeding, which typically improves over time 1
Important Caveats
While extended cycles are safe and effective, patients should be counseled that breakthrough bleeding or spotting is more common initially but generally decreases with continued use 1
This approach does not increase health risks compared to traditional cyclic use and may actually provide additional non-contraceptive benefits 1
Patients who prefer to have regular withdrawal bleeding may not find this approach desirable, though amenorrhea is medically safe and preferred by many women 1