What You Should Know About

Extended-Cycle Contraception

Has menstruation changed?

Today’s American woman has more periods in her lifetime than ever before—approximately 450 periods.  Compare this to a century ago when women lived on farms or in rural areas—they had 150 periods in their lifetime. Scientists also believe that prehistoric women had only 50 periods throughout their childbearing years. Why the change? Back then, women entered puberty later in life, had more children, and breast-fed longer. Today’s woman enters puberty earlier, has fewer children, and does not breast-feed for as long a period of time, if at

all.  In the United States, menstrual disorders are the most prevalent gynecologic disorder, affecting 2.5 million women from age 18 to 50 years. Approximately 65% of these women contact their health care provider because of menstrual-related symptoms, and 31% report spending about 10 days in bed each year because of menstrual related symptoms. Surveys among women of all ages show that women want fewer periods.  Researchers have been studying the menstrual cycle for more than 70 years in order to develop therapies to treat these menstrual disorders. Along the way, they also discovered an effective way to suppress ovulation and provide safe contraception. Oral contraception, a.k.a “The Pill,” was first used in the 1960s and it changed the lives of women forever. Since then, lower doses that still provide better cycle control have been introduced and adapted. These options provided women with more choices for birth control and new opportunities for cycle control.  For scientists, the next logical step was to examine the consequences of cycle suppression. One new oral contraceptive has been approved by the US Food and Drug Administration (FDA), which not only provides safe and effective birth control but also allows women to manipulate their menses. Instead of a period every 28 days with conventional pills, this new regimen causes a period after 84 days. You will have 4 periods in a year instead of 13.

Period Pros and Cons

The positive aspects of menstruation include validation of womanhood and reassurance of reproductive  potential. It is a symbol of femininity and confirms that you are not pregnant. Many women incorrectly believe that monthly menstruation is necessary to cleanse or purge the body of toxins. Menstruation can be a nuisance and often causes back and abdominal pain, bloating, headache, breast tenderness, pain in the arms and legs, irritability, depression, and fatigue.  The biological purpose for having a period is to prepare the endometrium for pregnancy. If an egg is not fertilized within a certain amount of time, the levels of female hormones in your body — estrogen and progesterone — gradually lessen. When the levels of these hormones fall, the outer two thirds of the endometrium is shed—thus, your period. The inner third stays to create a new lining in the uterus so that the cycle can begin again.  The Pill artificially induces bleeding during the placebo pill period.  If you stay on an extended cycle of hormones, the hormones will prevent the endometrium from shedding and you will not have a period. The purpose of a period is to prepare the body for pregnancy.  If you do not want to get pregnant, you don’t need to have an artificially induced period.  suppression of ovulation is considered innovative and progressive.  The first oral contraceptives were designed to simulate a woman’s natural cycle. The concept of a “Sunday start” was originally designed to avoid weekend periods.  Now, oral contraceptives can provide women with the opportunity to choose fewer periods. If you are currently taking an oral contraceptive, you are on a 28-day cycle. Most packs contain 28 pills, 21 contain hormone and the other 7 contain no hormone. With the extended-cycle regimen, however, instead of taking a 7-day break, you keep taking active pills for a full 84 days (7 weeks), and then use the 7 inactive pills, at which time your period will occur. The

packaging has been carefully designed to keep track for you and make it as easy as possible to follow the regimen.  If you are not currently taking an oral contraceptive, then you should be aware that there are risks associated with taking oral contraceptives.  These risks increase significantly if you: smoke; are obese; have a clotting disorder; or have high blood pressure, diabetes, and/or high cholesterol.  Extended-cycle contraception has been tested in clinical trials and was found to be safe and effective.  Ninety-nine percent of women who take this regimen as directed will not get pregnant. Extended-cycle contraception has been approved by the FDA and has been shown to be safe and effective

in thousands of women. Most women who can safely take oral contraceptives can most likely take the extended regimen and control the number of menstrual periods they have each year. Ask your health care provider if the extended-cycle regimen is right for you. 

Commonly Asked Questions About

Extended-Cycle Hormonal Contraception

Is the extended regimen safe?

Extended-cycle contraception has been approved by the US Food and Drug Administration and has been shown to be safe and effective in clinical trials of more than 1,000 women. Biopsies of the endometrium were conducted on 50 women who took the regimen for 1 year. Of these, no abnormalities were found. The ingredients in the extended cycle regimen — levonorgestrel and ethinyl estradiol — have been prescribed for over 20 years. Most women who can safely take oral contraceptives can most likely take the extended regimen and control the number of menstrual periods they have each year. Ask your health care provider if the extended-cycle regimen is right for you.

What are the advantages of extended-cycle contraception?

Extended-cycle oral contraception can help alleviate conditions such as painful periods, excessive bleeding, premenstrual syndrome, and menstrual-related migraine headaches. With conventional oral contraceptives, more side effects, such as bloating, headaches, and breast tenderness, occur during the pill-free interval than during the active pill phase. Reducing the number of pill-free intervals may reduce these side effects. Extended-cycle contraception is more convenient in general, especially during particular occasions, such as vacations and athletic activities. You do not need to purchase and carry as many hygiene products.

What are the disadvantages of extended cycle contraception?

You may experience unpredictable breakthrough bleeding as with conventional oral contraceptives. This will decrease over time as your body adjusts to the new hormone balance. Your pill-pack will help you keep track of where you are in your 84/7-day cycle.

Will there be a buildup of blood after months of not menstruating?

There is no buildup of blood or tissues on the extended cycle regimen. The pills provide consistent hormone levels that prevent the shedding of the endometrium. Once the active pills are done and you start taking the placebo pills, you will have an artificial period, just as with other oral contraceptive pills.

How do I use the extended-cycle method?

Use the pills just as you would any other birth control pills. You should adhere to the package instructions for starting the regimen, as the pill pack has been designed to help you keep track of your pills. Decide what time of day you will take your pill and incorporate it into your schedule.

How are the pills to be taken?

You will get a total of 91 pills—84 pink pills contain hormones plus 7 white pills that are sugar pills (placebo). The pills come in 3 dispensers. Take 1 pill at the same time every day until you have taken the last pill in the tablet dispenser. Do not skip pills even if you are spotting or bleeding or feel nauseous. Do not skip pills even if you do not have sex very often. After taking the last white pill, start taking the first pink pill from a newextended-cycle tablet dispenser the very next day regardless of when your period started. This should be on a Sunday. Some women on an extended oral contraceptive regimen may not experience any bleeding while taking the white pills. If you do not get your period when you are taking the white pills, you should contact your health care provider or perform a pregnancy test to rule out that possibility.

What if I miss taking my pills?

If you miss 1 pink “active” pill, take it as soon as you remember. Take the next pill at your regular time. This means you may take 2 pills in 1 day. You do not need to use a back-up birth control method if you have sex. If you miss 2 pink “active” pills in a row, take 2 pills on the day you remember, and 2 pills the next day. Then take 1 pill a day until you finish the pack. You could become pregnant if you have sex in the 7 days after you restart your pills. You must use another birth control method (such as condoms or spermicide) as a backup on the 7 days after you restart your pills. If you miss 3 or more pink “active” pills in a row, refer to the package insert that comes with the pill dispensers or

call your health care provider.

What should I expect when I first take the pills?

Because your body is adjusting to this new regimen, some women may see some breakthrough spotting and bleeding. You may notice that the blood is dark brown (oxidized due to remaining in the vagina longer) rather than red (blood noted with active bleeding) and may have a different texture. You should call your health care provider if you experience such side effects as:

• Heavy bleeding

• Nausea

• Vomiting

• Bloating

• Mood changes

• Headaches.

What about pregnancy?

Extended-cycle contraception has been tested in clinical trials and was found to be safe and effective. Up to 99% of women who take this regimen as directed will not get pregnant. Pregnancies generally occur as a result of missed pills. Your period is a sign that you are not pregnant; with the extended regimen however, it may be more difficult to tell if you are pregnant. Look for other signs of pregnancy, such as breast tenderness, nausea, frequent urination or fatigue. If you suspect that you are pregnant, you should have a pregnancy test.

What if I want to get pregnant?

If you desire pregnancy, stop taking your pills. You should consult your health care provider about this choice as he/she may wish to prescribe a prenatal vitamin and counsel you. You may experience a slight delay in becoming pregnant after you stop taking oral contraceptives, especially if you had irregular menstrual cycles before you used oral contraceptives.

Who should not take oral (or any hormonal) contraceptives?

You should not use the pill if you have any of the following conditions:

• A history of heart attack or stroke

• A history of blood clots in the legs (thrombophlebitis), lungs (pulmonary embolism), or eyes

• A history of blood clots in the deep veins of your legs

• Chest pain (angina pectoris)

• Known or suspected breast cancer or cancer of the lining of the uterus, cervix, vagina, or certain hormonally sensitive cancers

• Unexplained vaginal bleeding (until a diagnosis is reached by your health care provider)

• Yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or during previous use of the pill

• Liver tumor (benign or cancerous)

• Known or suspected pregnancy

• Heart valve or heart rhythm disorders that may be associated with formation of blood clots

• Diabetes affecting your circulation

• Uncontrolled high blood pressure.