How often should menstruation occur when taking continuous combined oral contraceptive (COC) pills?

From the Guidelines

When taking continuous birth control pills, you should typically allow a menstrual cycle (withdrawal bleeding) every 3-4 months, though this can vary based on individual needs and preferences. Most continuous birth control regimens, such as Seasonale or Seasonique, are designed with this timing in mind. To implement this, take active hormone pills continuously for 84 days (12 weeks), then take the placebo pills or no pills for 7 days to allow withdrawal bleeding, before starting the next pack of active pills. Some key points to consider when using continuous birth control pills include:

• The importance of consistent pill use to minimize unscheduled spotting or bleeding, especially during the first 3–6 months of use 1
• The potential for breakthrough bleeding, which may require more frequent breaks or adjustments to the regimen
• The medical safety of having fewer withdrawal bleeds per year, as there is no health requirement to have monthly withdrawal bleeding while on hormonal contraception 1
• The need to consult a healthcare provider if experiencing concerning symptoms like heavy breakthrough bleeding or severe side effects The withdrawal bleeding experienced during the pill-free interval isn't a true menstrual period but rather a response to the temporary drop in hormones. It's also important to note that extended or continuous cycles may be useful for treating medical conditions such as anemia, acne, severe dysmenorrhea, endometriosis, dysfunctional or heavy menstrual bleeding, Von Willebrand disease, and other bleeding diatheses and for adolescents who prefer amenorrhea 1. Ultimately, the frequency of menstrual cycles when taking continuous birth control pills should be determined on an individual basis, taking into account the woman's health, preferences, and any potential side effects or concerns.

From the Research

Menstrual Cycle and Continuous Birth Control Pills

• The frequency of menstrual cycles can be reduced or eliminated when taking continuous birth control pills 2, 3, 4.
• Studies have shown that extended- and continuous-cycle oral contraceptives can decrease the frequency of menses to 4 times/year or completely eliminate menses 2.
• Clinical trials have demonstrated that extended- and continuous-cycle oral contraceptives are as effective in preventing pregnancy as traditional oral contraceptives 2, 4.
• The use of continuous birth control pills can also reduce menstrual symptoms such as bloating and dysmenorrhea 3, 5.

Bleeding Patterns and Cycle Control

• Bleeding patterns can be affected by the use of continuous birth control pills, with some women experiencing more breakthrough bleeding and spotting 2, 4.
• However, the incidence of bleeding problems can decrease with longer use of continuous birth control pills 3, 5.
• Studies have also shown that the duration and intensity of scheduled withdrawal bleeding can be reduced with the use of certain types of continuous birth control pills 6.

Adverse Effects and Satisfaction

• The adverse effects of continuous birth control pills are similar to those of traditional oral contraceptives, with the exception of changes in bleeding patterns 2, 4.
• Women's satisfaction with continuous birth control pills can be high, with some studies showing that women are satisfied with the reduction in menstrual symptoms and bleeding 3, 5, 6.
• However, more research is needed to fully understand the effects of continuous birth control pills on women's health and satisfaction 5.