What is Continuous Hormonal Birth Control?
Research has shown it is safe and effective to use some birth control pills or the Nuva Ring continuously without stopping for a “period”. It is an evidence based variation of the standard, FDA approved, way to use hormonal birth control. Continuous hormonal birth control includes birth control pills and the Nuva Ring. These hormonal methods prevent pregnancy by stopping ovulation and preventing the ovaries from releasing eggs. Traditionally these methods are used for three continuous weeks then a one week break during which you would have a “withdrawal bleed”. This withdrawal bleed is different from a usual period. A woman has a period when she is not on hormonal birth control. The lining of the uterus thickens in preparation for a possible pregnancy. When (after ovulation) a pregnancy has not occurred the uterus sheds that thick menstrual lining.

With continuous hormonal use the lining of the uterus does not thicken and thus there is nothing or very little for the uterus to empty. It is possible to use birth control pills and the Nuva Ring in a continuous fashion. Most packages of birth control pills contain 3 weeks of hormone pills and one week of sugar pills, or spacer pills. By only taking the hormone pills and not taking the one week break there will be no withdrawal bleeding. This has been done for years for a variety of reasons. Continuous hormonal birth control can help relieve symptoms of PMS, menstrual migraines, and anemia. Athletes and women planning their wedding or vacation have been using this method to “skip their periods” for many years. A lot of women like the idea of not having the bother with the inconvenience of a period, but the most compelling reason to choose continuous hormonal use is to decrease the risk of unwanted pregnancy.

Use

Birth control pills: Only monophasic birth control pills can be used. Monophasic pills contain the same amount of hormones in each pill. Take a hormonal pill every day. Do not take the spacer pills.

Nuva Ring: Insert one Nuva Ring every three weeks without skipping any days. Never go without a ring inserted.

Your Health

Women who use hormonal birth control have a slightly higher risk of heart attack and stroke. The effects of hormonal birth control on breast cancer are still unknown. Hormonal birth control lowers a woman’s chance of developing ovarian cancer, endometrial cancer, and pelvic inflammatory disease.

Side Effects

As the body adjusts to hormonal changes, women often experience some minor side effects, including:

 

  •  Irregular bleeding or spotting
  •  Nausea
  •  Breast tenderness
  •  Weight gain and/or water retention
  •  Spotty darkening of the skin
  •  Mood changes

Break through bleeding, or bleeding mid cycle is very common in the first six months of continual hormonal
use. Over time your body will get used to the constant level of hormones and this side effect will usually disappear within 4-6 months of continuous hormonal use.

Non-steroidal anti-inflammatory medications (naproxen or ibuprofen) can decrease bleeding and make you more comfortable during this adjustment time. If your bleeding continues after one week on an anti inflammatory, consult your health provider. Some women may not be able to use hormonal birth control because of the risk of serious health problems.

Women who are over 35 and smoke or who have any of the following conditions should not use combination birth control pills or the Ring:

  •  History of heart attack or stroke
  •  Blood clots
  •  Unexplained vaginal bleeding
  •  Known or suspected cancer
  •  Known or suspected pregnancy
  •  Liver disease

Women who are under 35 and smoke, have migraines, gallbladder disease, hypertension, diabetes, epilepsy, sickle cell disease, elective surgery, a history of blood clots, liver or heart disease may not be able to take hormonal birth control. Your clinician or doctor can decide.

Future Fertility

Women who want to become pregnant may stop using hormonal birth control at any time. Fertility may return immediately or after a few months.

Advantages
  •  Decrease risk of unwanted pregnancy
  •  While break through bleeding, or bleeding midcycle is very common, most women will have no monthly bleeding after continuous use for 6 months.
  •  Easy to use.
  •  May relieve some PMS symptoms including menstrual migraines and anemia.
  •  Does not harm future fertility.
  •  Does not interrupt sex play.
  •  May protect against uterine and ovarian cancers.
  •  May reduce acne.
Disadvantages
  • Does not protect against sexually transmitted infections, including HIV/AIDS.
  • Pills must be taken every day.
  • Less effective when taken with some drugs.
  • Raised risk of heart attack and stroke.
  • Requires a prescription.
Drug Interactions

The effectiveness of continuous hormonal birth control is lowered when taken with certain medications, including antibiotics, anti-seizure, tuberculosis, and migraine medications. If you are taking any medications, tell your clinician. When taking medications that may interfere with BC, consider adding a backup method of birth control, like condoms and spermicide. As with all drugs, it is useful to inform all your medical providers if you are using hormonal birth control.

Danger Signs

Women who experience any of the following symptoms while taking hormonal birth control should call the clinic immediately:
Abdominal pains (severe)
Chest pain or shortness of breath
Headaches (severe)
Eye problems, such as blurred vision
Severe leg or arm pain or numbness

Further References
  • www.noperiod.com
  • Feminist Women’s Health Center at www.feministcenter.org 404-728-7900
 

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