Ann M. Wurst, MD
Obstetrics/Gynecology
Professionals for Women's Health, Inc.
921B Jasonway Ave
Columbus, OH 43214
Phone (614) 268-8800

Q: Is it safe to use birth control pills continuously?

A: First, a bit of background information:  birth control pills are a popular choice among women both for their contraceptive and non-contraceptive benefits.  Birth control pills that contain both estrogen and progesterone are usually given for 21 days followed by a 7 day pill free interval, during which the menstrual cycle occurs.  Besides the prevention of pregnancy, birth control pills are useful in controlling the symptoms of many medical conditions, including irregular, painful or heavy menses, endometriosis, acne, and other conditions.  Long-term use of birth control pills is associated with a diminished lifetime risk of cancer of the ovary.  Women who have a personal history of severe hypertension, breast cancer, liver disease, or have a history of a blood clot in a vein or lung, are not candidates for the use of birth control pills.  In addition, women who smoke and are 35 or over face a significantly increased risk of stroke while using birth control pills, and therefore are not candidates for their use.  In addition, other medical conditions may exist that exclude a patient from using birth control pills.  Most non-smoking women over 35 who are in good health remain candidates for the use of the pill despite their age. 
 
As women progress through their reproductive years, their gynecological needs may become even more complex.  It is not unusual for women to request both birth control and cycle control.  Especially in the later 30's and through their 40's, irregular or unpredictable menses occur more frequently, as does the patient's desire to avoid an unintended pregnancy. The pill becomes an even more appealing choice as it prevents pregnancy and offers cycle control. 
 
Recently, both the delivery systems and dosing schedules for birth control pills have evolved.  In fact, the medication is not always delivered via a pill-the Ortho Evra patch and the intravaginal Nuvaring represent alternative methods of delivering both estrogen and progesterone to achieve both contraceptive and non-contraceptive benefits.  In addition, the traditional 21 days of active medication followed by 7 days of placebo pills schedule found in most birth control pills has changed to afford women fewer cycles per year.  Some newer formulations (Mircette, Loestrin 24) have shortened the pill-free placebo week in an effort to diminish some symptoms that may occur during the pill free interval.  Because of personal preference in having fewer cycles per year, or the avoidance of bothersome symptoms associated with menses in general, many women are choosing newer medications that offer 84 active pills followed by 7 days of placebo pills.  (Seasonale, Seasonique.)    Even more recently, Lybrel has come on to the market, offering 28 days of active pills with no placebo pills.
 
The use of extended active pill or continuous oral contraceptives is as safe as the use of traditional pill formulations.  The criterion for who is or is not a candidate for birth control pills is the same for either a traditional formulation or the newer dosing regimens.  However, prolonged dosing schedule medications carry an increased incidence of unpredictable bleeding.  This is especially bothersome for patients who started the medication to achieve cycle control in the first place.  Unscheduled bleeding is not harmful, nor does it put the patient at increased risk for contraceptive failure.  It is annoying, but the incidence does diminish with time with prolonged use of the medication.