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; many women will stop bleeding completely.

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