Contraception

CONTINUOUS PILL USE

What is it?

Continuous birth control pill use is simply another way of using oral contraceptives. Women who adopt this method take only active tablets, without pausing between strips. This method reduces the number of periods per year, while providing benefits to general health.

Is it essential to have a period every 28 days ?

No. Even if regular 28-day cycles have always existed, women from ancestral societies had much less frequent periods in their lifetime than today’s women do.

In fact, menarche (first menses) occurred later and their regular periods were separated by prolonged intervals during which they were pregnant or breastfeeding. Therefore, our ancestors had less frequent menses than modern women. Repetitive cycles appeared with modern civilisation and lifestyles, about 10,000 years ago.

Regular cycles have one sole purpose that is providing a woman with 13 chances of becoming pregnant in one year. For a woman who does not want children in the near future, regular periods are useless.

As soon as a woman takes oral contraceptives, an artificial cycle is created, whether she is using the continuous regimen or the conventional one. Originally, the 21-day active pill followed by a seven-day pill-free pause solely aimed to help market the product, imitating a natural cycle, therefore making the pill more acceptable.

What are the benefits of continuous pill use?

• Increased contraceptive effectiveness
  Pregnancies occurring during pill use often result from women forgetting to take it at the beginning or the end of the package. Since there are no pauses in continuous pill use, there is less risk of pregnancy.
   
• Control over menstrual cycle
  With the conventional use of oral contraceptives, there were already circumstances (trips, vacation, sports competitions) where women could choose not to have their periods by starting a new pack without stoppage after 21 days of taking active pills. Continuous pill use is in fact the extension of this method over many months. It then becomes easy to choose a time for periods at a woman’s convenience.
   
• Decreased adverse effects caused by menstruation
  Periods carry a number of adverse physical and psychological effects: abdominal pain, premenstrual syndrome, painful breasts, migraine, heavy bleeding that can even cause anaemia, etc. By reducing the number of periods, continuous pill use mitigates these adverse effects.
   
• Decreased impact of periods on the quality of life
  Among teenagers, periods cause frequent absenteeism from school. In addition, many women are less physically active during their period. Many women also feel more tired, while others observe they are less productive at work or that their usual tasks require more effort. Continuous pill use prevents such annoyances caused by periods.
   
• Decreased migraines during the stoppage period
  Headaches or symptoms of hypoestrogenism (hot flashes, fatigue, etc.) may occur on days when women take inactive pills. Headaches are caused by a reduced hormonal rate in the blood. With continuous pill use, these rates do not vary and menstrual headaches are therefore eliminated.
   
• Improved quality of life for women reaching menopause
  Oral contraceptives are already used to counter effects of pre-menopause on cycle regularity and hot flashes. Unfortunately, hot flashes often reoccur during the taking of inactive pills. Continuous pill use prevents these hot flashes, while allowing women to regularize their cycles and even to avoid menstruation.

Decreased risk for some cancers

With regard to ovarian and endometrial cancer, continuous pill use brings at least the same benefits as oral contraceptives taken under the 21/7 regimen. In fact, continuous pill use should theoretically protect even more effectively against cancer. Furthermore, increased risks of breast cancer or cardiovascular diseases have not been linked to continuous pill use.

Treating endometriosis

Endometriosis is a disease where tissue similar to the lining of the uterus (the endometrium), which should only be located inside the uterus, is found elsewhere in the body. It is a frequent cause of abdominal pain, infertility and menstrual pain. It is also acknowledged that endometriosis results from, and is aggravated by, repetitive periods. This condition affects between 3 and 10% of women of childbearing age and 25 to 35% of infertile women. Continuous pill use is currently applied as a method to treat this disease and it also helps in reducing menstrual pain.

Side effects of continuous pill use?

How does it work

Continuous pill use allows for better control over the menstrual cycle as it is possible to choose the moment where you wish to pause. Before starting a continuous pill regimen, it is preferable to have taken oral contraceptives under the conventional method for one or two months.

Afterwards, you may progressively increase the number of months without menstruation. When persistent bleeding occurs after one or more months of continuous pill use, you should stop taking the pill for seven days. A four-day pause is also possible. It increases the pill’s effectiveness and reduces adverse effects resulting from periods.

Then, you continue your package, starting where you had stopped. You should always remember that, before a pill-free pause, you must have taken it for at least three weeks for the pill to remain effective.

If having no menstruation is worrisome for you, you can choose to pause every three months. If you have forgotten many pills in a row and had sexual intercourse during that time, you need to make sure you are not pregnant.

All types of pills, whatever the brand, can be taken on a continuous basis.  Once active pills are taken, you only need to start a new package immediately, without pausing.

The above is translated from an excellent text produced by the family planning team of the Centre hospitalier régional de Rimouski.
http://www.planningchrr.com/