Oral Contraceptive Pills for Continuous Use

Preferred Options for Continuous Use

The Centers for Disease Control and Prevention recommends monophasic combined hormonal contraceptives containing 20-30 mcg ethinyl estradiol with levonorgestrel, drospirenone, or dienogest for continuous use, taken continuously without the hormone-free interval 1, 2
17β-estradiol-based pills with dienogest or nomegestrol acetate can be used continuously and may offer improved side effect profiles compared to ethinyl estradiol formulations 3

The Centers for Disease Control and Prevention recommends taking one active hormonal pill daily without interruption (skip the placebo/inactive pills) 1
When starting a new pack, begin with the active pills immediately after finishing the active pills from the previous pack 1

If breakthrough bleeding occurs, the Centers for Disease Control and Prevention recommends continuing to take pills daily without interruption 1, 2
For persistent breakthrough bleeding that is bothersome to the patient, a 3-4 day hormone-free interval can be implemented (not during the first 21 days of continuous use and not more than once per month) 2
After the brief hormone-free interval, resume continuous active pill use 2
The Centers for Disease Control and Prevention suggests that NSAIDs taken for 5-7 days may help reduce breakthrough bleeding 2
Breakthrough bleeding typically improves over time with continued use 1

If pills are missed, the Centers for Disease Control and Prevention recommends following standard missed pill protocols - take the missed pill as soon as remembered and use backup contraception if 2 or more consecutive pills are missed 4
In case of vomiting or diarrhea lasting >48 hours, use backup contraception until 7 consecutive days of pill-taking after symptoms resolve 5

Breakthrough bleeding is more common with continuous regimens, especially during the first 3-6 months, but typically improves with time 1
Patient counseling about expected bleeding patterns is essential to improve adherence 1
If breakthrough bleeding persists despite management strategies, consider switching to a different formulation or returning to cyclic use 2