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Continuous-use birth control pills: Is it okay not to have a period?
Although many women take their birth control pill in a traditional 28-day cycle which allows them to have a period every month, many women are choosing to use the birth control pill in an extended or continuous fashion so that they have fewer periods. Women are doing this for both medical reasons and for personal reasons.
What does it mean to take a pill in an "extended" or "continuous" fashion?
Traditionally, birth control pills are taken in a 28-day cycles. For 21 days, a woman takes a pill that contains active hormone every day. Then for seven days she either takes no pills (for women that use a 21-day pack) or she takes 7 sugar pills (for women who use a 28-day pill pack). During the time that she is taking no pills or the sugar pills, she will have a period. This is not actually a true period. In fact, the bleeding is brought on by the fact that she is not taking hormones during that time (a “hormone withdrawal bleed”). After the seven days, the woman starts her next pill pack.
An extended pill regimen means that a woman takes the active hormone pills for longer than 21 days. She takes the pill for more than 21 days and plans to take a break at some point. She may choose to take the pill for six weeks in a row, 9 weeks in a row, 12 weeks in a row or more. When she stops taking the birth control, she stops it for 7 days during which time she will have a period (a “hormone withdrawal bleed”).
Some women may choose to take the pill continuously, meaning that they take the pills containing active hormones every single day and do not plan to take a break. This means that they do not have regular withdrawal bleeds (“periods”). They do not have a “pill-free” week and they do not take the sugar pills.
Can I use my birth control pill continuously?
Most oral contraceptive pills that are available in Canada can be used either in an extended fashion or continuously. However, it’s very important to check with your health care provider to make sure that this is a good option for you, and to get advice on how to take the pill this way.
There are currently no birth control pills available in Canada that are made specifically for continuous or extended use. However, two pills have recently been submitted to Health Canada for approval.
One of the pills awaiting approval in Canada is called Seasonale. It is currently available in the United States. It is designed for extended use, meaning that an active hormonal pill is taking for 84 days straight and then a woman takes 7 days of sugar pills. She will usually have a period while she is taking the sugar pills. This means that a woman will have a period four times a year instead of every 28 days.
The other birth control pill that is awaiting approval is Anya. Anya is not currently available in the U.S. or Canada. Anya is meant to be taken continuously. This means that a woman will take a pill that contains hormones every single day. Because she takes a hormone containing pill every single day and she does not take a break or take sugar pills, she would not expect to have a period.
Is it okay not to have periods?
While some women may see menstruation as a nuisance they would rather not have to deal with, others see it as a natural, healthy part of womanhood. The potential of new extended/continuous-use pills that would make periods optional has many people asking “is it really okay not to have a period?”
Medically, the idea of using birth control pills to eliminate periods is far from new. Physicians have long prescribed existing types of birth control pills, contraceptive patches and vaginal rings for this purpose, especially for women who experience difficulties with periods that really affect their quality of life (for example, painful periods, heavy periods, menstrual migraines). It can also be used to improve the symptoms of endometriosis, and control side-effects of periods such as headaches, breast tenderness, bloating, cramps, and mood swings.
It is also common for women to stop having periods when using some other forms of hormonal contraceptives, including the Mirena intrauterine system (IUS) and the injectable contraceptive Depo-Provera®.
Do you need periods?
It is a common myth that menstruation is necessary to shed “toxins” from the body. In fact, the bleeding that women experience while on the pill isn’t really a true period, but rather what is called a “withdrawal bleed”. This is caused by the body’s withdrawal from the hormones in the active pills during the pill-free week or the week on placebo pills.
Originally, birth control pills were developed this way to reassure women that they were still having a normal cycle, and so that women would still be able to use her “period” as a sign that she is not pregnant. Now, continuous-use birth control pills are being developed for women who would choose not to have periods for a variety of medical or quality of life reasons.
As an interesting side note, women now have more periods throughout their lives than ever before. The reason is that these days women tend to have fewer children, and women who are pregnant or regularly breastfeeding typically do not have periods.
Is menstrual suppression safe?
Current evidence suggests that the risks and benefits associated with taking oral contraceptives non-stop are similar to those of regular birth control pill users. These include a lowered risk of endometrial and ovarian cancers, but also a slight increase in the risk of blood clots (approximately one or two extra cases per 10,000 women per year). There may also be a slight increase in the risk of breast cancer, though this is uncertain. The risk, if any, associated with cervical cancer is also unknown.
What are the side effects?
Though the long-term risks of using a birth control pill continuously are not yet known, short-term data suggests that the risks and side-effects are similar to traditional birth control pills. One of the most reported side-effects is breakthrough bleeding, which tends to improve over time.
How effective are non-stop birth control pills?
When taken correctly, continuous-use birth control pills, like all oral contraceptives, are highly effective at preventing unplanned pregnancy.
What if you become pregnant while taking these pills?
One concern with non-stop birth control is that women who use them may become pregnant without knowing it. While most women can rely on their monthly period to signal that they are not pregnant, women on non-stop birth control pills may not realize they are pregnant for some time, and may continue to take their birth control pills during pregnancy. Fortunately, the birth control pill has not been shown to cause birth defects or problems with pregnancy if it is taken accidentally during a pregnancy.
Though the chance of accidental pregnancy is very low for women who use birth control pills correctly, women on continuous-use birth control pills would have to rely on other signs of pregnancy such as nausea, breast tenderness, and fatigue, or a pregnancy test to determine if she has become pregnant.
- Controlling Your Periods With Contraception
- Learn more about birth control pills
- Learn about other contraceptive methods
Last Modified: October 1, 2008
