WHAT CAN CONTINUOUS OR EXTENDED USE OF PILLS MEAN:

A.                        Manipulation of a cycle to delay one period for a trip, honeymoon, or athletic event

B.                        Use of active hormonal pills for more than 21 consecutive days) followed by 2 to 7 hormone-free days.  Seasonale is a COC packaged to produce 4 cycles per year.  The hormones in Seasonale ARE THE SAME 30 mcg EE pills with levonorgestrel: Nordette, Lo-Ovral, etc.  Pills other than Seasonale may be used to accomplish this same end.

C.                        Continuous daily COCs for at least 21 pills, but after that, may break for 2-7 days if spotting or breakthrough bleeding is bothersome.

D.                        Use of a monophasic pill indefinitely.  BTB can occur at any time with this regimen.  Eventually she develops an atrophic endometrium and breakthrough bleeding decreases.

   Cyclic symptoms that may improve from the extended use of pills:

      Symptoms usually occurring at the time of menses: (predicted benefits)

·               Abdominal back or leg pain, dysmenorrhea, endometriosis Sx [Verellini-2003]

·               Bleeding abnormalities including menorrhagia

·               Irritability or depression.  Decreased libido

·               Headaches including both menstrual migraine and other cyclic headaches [Sulak-2000]

·               Nausea, dizziness, vomiting or diarrhea

·               Cyclic yeast or other infections or cyclic nosebleeds

·               Cyclic seizures, arthritis, or recurrences of asthma at the time of menses

·               Changes in insulin requirements

·               Cyclic symptoms associated with polycystic ovarian disease

Symptoms usually occurring at midcycle: (predicted benefits)

·               Spotting due to sudden fall in estradiol

·               Sharp or dull pain (that precedes ovulation and is caused by high midcycle PG levels)

Symptoms usually occurring just prior to menses: (predicted benefits)

·               Slight to more dramatic weight gain, bloating, swollen eyes or ankles

·               Breast fullness or tenderness

·               Anxiety, irritability or depression, nausea or headaches due to dropping estrogen

·               Acne, spotting, discharge, breast fullness or tenderness

·               Pain or cramping or constipation

Most important advantages & disadvantages of taking COCs continuously:

Advantages:

·               May be more effective as a contraceptive when taken daily.  Missed pills become less of a problem in terms of unintended pregnancy.

·               May be easier to remember (do the same thing every day)

·               Women wanting to avoid bleeding for an athletic event, special trip or any other reason

·               Less frequent menstruation [Sulak-2000] [Glasier-2003] and less blood loss

·               Decreased expenses from tampons, pads, pain meds, days missed from work and pregnancy

Disadvantages:

·               More expensive and the extra packs of pills required may not be covered by insurance

·               Unscheduled spotting or bleeding and the absence of regular menses

·               Clinicians must explain that amenorrhea, while taking a progestin every day, is not harmful.