Extend the option of extended contraception

Take a poll among your female patients about their preferences surrounding their menstrual cycle. How many would prefer to get their periods less often?

Results of a new national survey show that while about three-quarters of women polled would prefer to get their period less often, just 8% report having tried extended or continuous contraceptive pills.1

What impedes women from considering continuous contraception with birth control pills? Women polled for the survey noted concern about long-term side effects, belief that it is not healthy to have a period less than once a month, and lack of interest in oral contraceptives.1

Continuous contraceptive pills have risks and long-term side effects that are very similar to standard, monthly birth control pills, the most widely used form of contraceptive, says Elizabeth Battaglino Cahill, RN, executive director of the National Women's Health Resource Center, which authorized the survey. Women need to talk with their health care provider and learn more about their options when it comes to managing their menstrual cycle to fit with their lifestyle choices, Cahill notes.

When talking with women about menstrual suppression with oral contraceptives, explain that there is no medical or health reason to bleed while on hormonal contraceptives, advises the Association of Reproductive Health Professionals (ARHP).2 Counsel women that menstrual blood does not build up when they are using hormonal birth control.

What should you tell women when it comes to safety issues? Research on use of extended/continuous methods appears comparable to that of conventional OC regimens, the ARHP states. Women can expect return to fertility after discontinuation of extended/continuous use pills to be the same as that found in conventional pill use.3

What are some of the benefits of suppressing menstruation? It can help manage menstruation-related conditions, such as polycystic ovary syndrome, endometriosis, menstrual migraine, premenstrual syndrome, and seizures in women that occur exclusively or more commonly at the time of menses. Menstrual suppression works well for active lifestyles and athletic activities; also, it reduces/eliminates the need to purchase and carry hygiene products.

Continuous oral contraceptives might be more effective than the standard 28-day birth control pills in suppressing the ovary, according to newly published research.5

What are some of the chief benefits of the continuous OC regimen when it comes to improvement in pain and behavioral changes? "I believe it is due to the constant suppression of endogenous ovarian activity which creates a stable hormonal environment without fluctuations in ovarian hormones and their associated negative mood and physical effects, [such as] discomfort from ovarian cyst development and withdrawal bleeding," says the study's lead author, Richard Legro, MD, professor of obstetrics and gynecology, Penn State College of Medicine.

Talk about bleeding

Women who choose oral contraceptives in extended or continuous regimens should be counseled that unpredictable breakthrough bleeding is initially more common than with conventional pills. according to the ARHP. Bleeding will lessen as the body adjusts to the new hormone balance.4

In using pills in an extended or continuous manner, advise patients that it might be more difficult to detect pregnancy, counsels the ARHP.


  1. Harris Interactive Inc. prepared for The National Women's Health Resource Center. Menstrual Management Survey Report. Aug. 29, 2008. Accessed at www.healthywomen.org/Documents.
  2. Association of Reproductive Health Professionals. What You Need to Know. Menstrual Suppression. Fact sheet. Accessed at www.arhp.org/uploadDocs/menstruationfactsheet.pdf.
  3. Legro RS, Pauli JG, Kunselman AR, et al. Effects of continuous versus cyclical oral contraception: a randomized controlled trial. J Clin Endocrinol Metab 2008; 93:420-429.