Average Failure Rate: 5%
Extended cycle combined oral contraceptive pills are the same as traditional oral contraceptives, but they are formulated such that menstruation occurs less frequently — only every three months or not at all. Extended cycle combined oral contraceptives are available by prescription only. Like all hormonal contraceptives, the pills have multiple mechanisms of action, some which prevent ovulation and others that occur after fertilization.
The process of ovulation is directed by hormones. Estrogen and progesterone are two hormones which direct many of the processes surrounding the menstrual cycle. Artificial analogues of these have proven an efficient form of birth control. To prevent pregnancy a woman takes a pill daily which contains both of these hormones. Traditional oral contraceptives contain 21 pills with artificial hormones and 7 placebo pills that have no hormones. Menstrual bleeding (withdrawal bleeding) is the body's natural response to the sudden break in receiving hormone-containing pills. The placebo pills are not needed for pregnancy protection, and may be skipped to prevent the withdrawal bleeding. This is basis for the extended cycle combined oral contraceptive pills — the placebo pills are taken less frequently. Some extended cycle combined oral contraceptives induce menstruation every three months; each package has 84 active pills and 7 placebo pills. Other formulations have no placebo pills at all.
"I feel chemical contraceptives have the potential to harm an embryo. And I decided based on moral and ethical grounds that I could no longer prescribe them." -Mary Martin, MD, Ob/Gyn, Midwest City, OK [more about this]
Many women chose extended cycle oral contraceptives because they prefer the convenience of fewer menstrual cycles. Menstruation while taking oral contraceptives tends to be lighter, shorter, and more regular than natural menstruation. Therefore, extended or continuous use oral contraceptives have been a logical treatment for menstrual problems, such as endometriosis, irregular periods, and PMS.
The most common side-effect of extended cycle oral contraceptives is irregular vaginal bleeding or spotting, especially in the first 3-6 months of use. All oral contraceptives have numerous side effects, and these may include loss of sex drive (libido), headaches, acne, weight gain, vaginal infections, and depression.
Serious risks of all birth-control pills that can be life threatening include blood clots, stroke, and heart attack. These risks are increased in women who smoke cigarettes, especially those over 35. Some women should not use oral contraceptives, especially those who have had a heart attack, stroke, blood clots, certain cancers or liver diseases, unexplained vaginal bleeding, and those who are or may become pregnant. Oral contraceptives may increase your risk of breast cancer or cervical cancer. Hormonal contraceptives do not offer any protection against sexually transmitted disease, and current research indicates that oral contraceptives may increase your risk of acquiring HIV if your partner is infected. And, athough most gynecologists believe it is safe, it is not known what the long term effects are of prolonged menstrual suppression.
| Brands | Manufacturer | Active Ingredient | Menstrual Pattern |
|---|---|---|---|
| Seasonale | Duramed Pharmaceuticals | ethinyl estradiol (30 mcg) & levonorgestrel (150 mcg) | Every 3 Months |
| Quasense | Watson Pharmaceuticals | ethinyl estradiol (30 mcg) & levonorgestrel (150 mcg) | Every 3 Months |
| Seasonique | Duramed Pharmaceuticals | ethinyl estradiol (30 mcg) & levonorgestrel (150 mcg) | Every 3 Months |
| Lybrel | Wyeth Pharmaceuticals | ethinyl estradiol (20 mcg) & levonorgestrel (90 mcg) | No Periods |
Post-Fertilization Effects of Hormonal Methods: The Controversy
Frequently Asked Questions about the Pill and Other Hormonal Methods
Lybrel: Patient Package Insert (pdf)
Seasonique: Doctor Package Insert (pdf)
The following links are provided as an informational resource or counterpoint and are not necessarily endorsed by the author:
Ethical Issues Regarding Post-Fertilization Effects of Oral Contraceptives: A physician discusses the ethical reasons he has decided to stop prescribing oral contraceptives, excerpted from Archives of Family Medicine, 2/2000
More about Oral Contraceptives: Christian Contraception
Go to next section [emergency contraceptive pills]
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