Extended and Continuous Use of Combined Oral Contraceptives
Yes, Daysee and Seasonique (both containing levonorgestrel/ethinyl estradiol) can be used continuously without hormone-free days indefinitely, with no maximum duration limit specified in current guidelines. 1
Continuous Use Without Hormone-Free Intervals
Both medications can be used continuously for as long as desired, eliminating all hormone-free intervals. The evidence supports this practice:
Continuous use (uninterrupted hormonal contraception without any hormone-free interval) is a safe and established regimen that has been studied extensively for contraception and management of menstrual-related conditions 2, 1
No maximum time limit exists for continuous use - women can use estrogen-based contraceptives safely throughout their reproductive years with no specified duration limit 1
Studies demonstrate that continuous use for 10-12 months induces amenorrhea in 80-100% of women, and this can be maintained indefinitely 3
Practical Implementation
When using these medications continuously:
Simply skip all placebo/hormone-free pills and start the next pack of active hormonal pills immediately after finishing the active pills from the current pack 2
For Seasonique specifically: Instead of taking the 7 low-dose estrogen pills at the end of each 91-day cycle, immediately start a new pack of active hormonal pills 4
No backup contraception is needed when transitioning to continuous use if you've been taking the pills correctly 2
Managing Breakthrough Bleeding
The main challenge with continuous use is unscheduled bleeding:
Breakthrough bleeding is common during the first 3-6 months but decreases with continued use 2, 1
If breakthrough bleeding becomes bothersome, take a planned 3-4 day hormone-free interval to allow withdrawal bleeding, then resume continuous use 2
This hormone-free interval should NOT occur during the first 21 days of starting continuous use, and should not be done more than once per month to maintain contraceptive effectiveness 2
The total number of bleeding days is typically lower with continuous use compared to traditional cyclic regimens, despite more irregular spotting 5, 6
Benefits of Continuous Use
Continuous regimens offer several advantages beyond convenience:
Enhanced contraceptive effectiveness, particularly for women who frequently miss pills, since there's no extended hormone-free interval that increases ovulation risk 2, 1
Improved management of menstrual-related conditions including dysmenorrhea, menorrhagia, endometriosis, migraines without aura, and anemia 1, 3, 5
Reduced menstrual symptoms including headaches, bloating, menstrual pain, and tiredness 6
Safety Considerations
The safety profile of continuous use is equivalent to traditional cyclic use:
Pregnancy rates, side effects, and discontinuation rates are similar between continuous and cyclic regimens 4, 6, 7
No increased health risks have been identified with continuous versus cyclic use 5, 6
Regular follow-up visits are not required for continued use, though patients should return if they experience concerning side effects 1
Common Pitfall to Avoid
Do not recommend a hormone-free interval if breakthrough bleeding occurs within the first 21 days of continuous use, as this may compromise contraceptive effectiveness 2. Instead, counsel the patient that early breakthrough bleeding is expected and will likely improve with continued use.