Hormonal contraceptives are among the most common choices for pregnancy prevention. Traditional oral contraceptive pills contain a combination of estrogen and progestin hormones that regulate a woman's menstrual cycle and ovulation. Normally, the pills are taken in 28-day cycles, and a woman has a monthly period. A new option extends the cycle to 91 days, providing safety, convenience, and effectiveness for pregnancy prevention, in addition to other health benefits.
Cycle Control Using Birth Control Pills
Traditional combination oral contraceptive pills are taken daily for 21 days, followed by seven days of inactive placebo pills. A woman's period will usually occur during the week that she takes the placebo pills. Women have 13 cycles per year using traditional birth control regimens. Extended regimen hormonal birth control regimens lengthen a woman's cycle to 84 days of combined oral contraceptives (an estrogen, ethinyl estradiol, and a progestin, levonorgestrel) plus seven days of low-dose estrogen in place of a placebo pill. She has her period during the week of estrogen-only pills, only four times per year.
Extended regimen oral contraceptives are the first to provide continuous low-dose estrogen (usually 10 to 20 micrograms of ethinyl estradiol) in all of the pills, instead of a week of inactive pills. This continuous low dose estrogen shortens periods, decreases bleeding and improves symptoms of painful menstruation, premenstrual symptoms and endometriosis. Additionally, many women simply enjoy the convenience of short, light, infrequent periods.
Risks of Hormonal Contraceptives
All combined hormonal contraceptives present a risk of unwanted side effects. There is an increased risk for stroke, blood clots and liver disease. These risks are more prevalent in women who are older than 35 years, smoke, or have a history of heart disease, obesity or blood clotting disorders. However, the dose of estrogen in extended regimen contraceptives is extremely low, reducing the risks associated with higher doses of estrogen.
Breakthrough bleeding during the first few months of treatment was the most common side effect seen in studies evaluating the safety of extended regimen hormonal contraceptives. Most women reported that the bleeding was tolerable and disappeared after a few months of hormonal contraceptive use.
Effective Pregnancy Prevention
Like all combined oral contraceptives, extended regimen options that provide continuous low-dose estrogen are 99% effective in preventing unintended pregnancy. That is, with perfect, consistent use, only one pregnancy will occur out of every 100 women who use the birth control pill each year. With inconsistent use and missed doses, the failure rate increases to 5% for extended regimen contraceptives.
Contraceptive Options for All Women
Extended regimen oral contraceptives were first designed for women who had severe symptoms associated with their menstrual cycle or who could not tolerate excessive, frequent bleeding. Now, continuous low-dose estrogen contraceptive regimens benefit women who have endometriosis, ovarian cysts and other menstrual symptoms, as well as women seeking cycle control, effective pregnancy prevention and convenience. All women should discuss the risks and benefits of all contraceptive choices with her doctor before choosing a treatment plan.
References:
Anderson FD, Gibbons W, Portman D. Safety and efficacy of an extended-regimen oral contraceptive utilizing continuous low-dose ethinyl estradiol. Contraception. Mar 2006;73(3):229-234.
Dipiro JP, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A pathophysiologic approach. 7th ed. New York, New York: McGraw-Hill;2008.
Kroll R, Reape KZ, Morgolis M. The efficacy and safety of a low-dose, 91-day, extended-regimen oral contraceptive with continuous ethinyl estradiol. Contraception. Jan;81(1):41-48.
Teichmann A, Apter D, Emerich J, et al. Continuous, daily levonorgestrel/ethinyl estradiol vs. 21-day, cyclic levonorgestrel/ethinyl estradiol: efficacy, safety and bleeding in a randomized, open-label trial. Contraception. Dec 2009:80(6);504-511.
Jennifer Gibson - Jennifer Gibson earned a Bachelor’s of Science degree in Biochemistry from Clemson University, with a research emphasis in enzyme ...
