Extended Dosing of The Pill

Introduction

Research has shown that birth control pills (BCPs) can be taken in a way that can minimize adverse side effects, increase the interval from one period to the next and still maintain the same high degree of contraceptive benefit (1).

BCP packs contain 28 pills. The first 3 weeks of daily pills contain hormones, and the 4th week contains placebo or "sugar" pills (or sometimes iron). This results in a menstrual cycle about every 28 days, similar to a natural cycle. There is no MEDICAL reason for the 28-pill package. The design was intended to increase consumer acceptance by duplicating normal menstrual cycles.

Side effects such as PMS, cramping, heavy bleeding, bloating, breast tenderness, headaches and mood swings can be reduced by extending the 3 weeks of daily active pills to 6, 9 or 12 weeks. Many women believe that there is a build-up of the uterine lining that needs to come out. This is not the case. The menstrual period only occurs because of the week of placebo.

EXTENDED DOSING INSTRUCTIONS

This works only with monophasic pills (same strength pill every day) such as Yasmin, Levlen, Nordette, Norinyl, Lo-Estrin, Ortho-Cyclen, Orthocept, and Desogen. It won't work with triphasic pills such as Estrostep, Tri-Levlen, Tri-Phasil, Ortho Tri-Cyclen, Ortho 7/7/7, Tri-Norinyl.

1. Start a new package of pills as usual, one pill a day for 3 weeks. 
2. On the first day of week 4, discard the previous pack, and start a new package of pills. 
3. Take the second package as usual, one pill a day for 3 more weeks, total 6 weeks. 
4. Starting with week 7, take one week off (or one week of daily placebo). The period usually begins this week. 
5. If side effects were minimal, it's okay to extend another 3 weeks. Take 9 weeks of active pills, and then take one week off (or one week of placebo). 
6. If side effects are still minimal, you can extend to 12 weeks on and one week off.
7. Fear of undetected pregnancy: Long intervals of time between periods eliminate the monthly "relief" which can help to reassure you that you are not pregnant! If you are not a good "pill-taker," then this extended regimen may not be for you. If this regimen is followed carefully, the risk of pregnancy is extremely low and bcp's do not harm an early fetus.
8. Increased Cost: On this regimen, you will use up your pills faster. The pharmacist needs to know what is going on, because many only dispense one package at a time. Ask for 2 packs at a time (more if they'll do it). 
9. Some spotting may occur the first 6 weeks. Call Dr. Jick with any concerns or questions.

DRAWBACKS

(1) Sulak, P.J., et al, Extending the Duration of Active Oral Contraceptive Pills to Manage Hormone Withdrawal Symptoms, Obstet Gynecol 1997; 89: 179-83.

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