Continuous Use of Vestura to Avoid Menstruation
Yes, Vestura (ethinyl estradiol 0.02 mg/levonorgestrel 0.03 mg) can be used continuously by skipping all placebo pills and immediately starting the next pack of active pills to suppress menstruation. 1
How to Implement Continuous Use
Simply skip all hormone-free/placebo pills and start the next pack of active hormonal pills immediately after finishing the active pills from the current pack. 1 This approach is safe, established, and requires no backup contraception if pills have been taken correctly. 1
What to Expect with Continuous Use
Bleeding Patterns
- Breakthrough bleeding is common during the first 3-6 months but decreases significantly with continued use. 1, 2
- Amenorrhea (no bleeding) and absence of breakthrough bleeding increase progressively with extended administration. 3
- By 7 months of continuous use, approximately 50% of women achieve amenorrhea, increasing to 53% by 13 months. 4
- The percentage of women with no bleeding requiring sanitary protection reaches 50% by 3 months, 69% by 7 months, and 79% by 13 months. 4
Managing Breakthrough Bleeding
If breakthrough bleeding becomes bothersome during continuous use:
- Take a planned 3-4 day hormone-free interval to allow withdrawal bleeding, then resume continuous use. 1, 2
- Do not take this hormone-free interval during the first 21 days of starting continuous use. 1
- Do not take hormone-free intervals more than once per month to maintain contraceptive effectiveness. 1
- For mild breakthrough bleeding, NSAIDs for 5-7 days during bleeding days can reduce blood flow. 2
Contraceptive Effectiveness
Continuous use may actually enhance contraceptive effectiveness compared to cyclic use, particularly for women who frequently miss pills, since there is no extended hormone-free interval that increases ovulation risk. 1 The Pearl index for continuous levonorgestrel/ethinyl estradiol is 0.00-1.26 per 100 woman-years, comparable to or better than cyclic regimens. 3, 4
Safety Considerations
- Continuous use of combined oral contraceptives is safe with no maximum duration limit specified in current CDC guidelines. 1
- The side effect profile is similar between continuous and cyclic regimens, except for increased metrorrhagia in the first 6 months of continuous use. 3, 4
- Regular follow-up visits are not required for continued use, though patients should return if they experience concerning side effects. 1
Important Caveats
- If irregular bleeding persists or becomes heavy, rule out pregnancy, STDs, medication interactions, or pathologic uterine conditions before continuing treatment. 2, 5
- Counsel the patient beforehand that breakthrough bleeding is expected initially and generally improves with continued use. 1, 2
- Warning signs requiring immediate medical attention include severe headache, chest pain, severe leg pain, or shortness of breath (signs of potential thromboembolism). 1