The practice of skipping a period on hormonal contraception, known as continuous or extended use, is common among users seeking greater control over their monthly cycles. This involves intentionally bypassing the hormone-free week built into the standard dosing schedule of combined oral contraceptives, the patch, or the vaginal ring. Instead of taking placebo pills or removing the device, a new cycle of active hormones is immediately started. This approach prevents the withdrawal bleeding that normally occurs, reducing the frequency of bleeding for personal preference or to manage medical conditions.
Understanding the Withdrawal Bleed
The bleeding experienced during the hormone-free interval of combined hormonal contraception is physiologically distinct from a true menstrual period. A true menstrual period is the shedding of a thick uterine lining, or endometrium, that built up following ovulation. Hormonal contraceptives suppress ovulation and keep the uterine lining much thinner than it would be in a natural cycle.
The monthly bleeding on birth control is termed a withdrawal bleed because it is triggered by the withdrawal of synthetic hormones, not the natural hormonal fluctuations of an unsuppressed cycle. This bleed was originally incorporated into the pill’s design for historical, non-medical reasons. The 21-day active pill and 7-day break schedule was devised to mimic a natural cycle when the pill was introduced in the 1960s. Since this bleed is not medically necessary, skipping it does not pose a medical risk.
Safety and Health Implications of Continuous Use
Medical consensus supports the safety of using combined hormonal contraceptives continuously to eliminate or reduce the frequency of withdrawal bleeding. The hormones, particularly the progestin component, maintain a thin and stable endometrial lining. This continuous hormonal exposure prevents the buildup of the uterine lining, meaning a monthly bleed is not medically required for health.
Concerns about long-term health consequences, such as an increased risk of cancer or impaired fertility, are not supported by evidence regarding continuous use. The effects of continuous dosing are similar to those of cyclic use. Continuous use does not negatively affect a person’s ability to become pregnant later; fertility returns to the baseline rate once the contraceptive is stopped.
Continuous dosing can be beneficial for those with conditions like endometriosis, severe premenstrual syndrome, or menstrual migraines. Reducing the number of bleeding episodes lessens the frequency of associated symptoms like pain, headaches, and bloating. The potential risks associated with continuous use are the same as those for standard cyclic use, such as a slight increase in the risk of blood clots, which depends on individual risk factors, age, and medical history.
Methods for Skipping and Managing Side Effects
Methods for Continuous Use
The method for skipping a period depends on the type of hormonal contraceptive being used. For traditional 28-day pill packs, users skip the seven placebo pills and immediately begin a new pack of active hormone pills. For the vaginal ring, continuous use involves inserting a new ring immediately after removing the old one. Similarly, for the patch, users forgo the patch-free week and immediately apply a new patch.
Managing Breakthrough Bleeding
The most common side effect of continuous use is unscheduled bleeding, often called breakthrough bleeding or spotting. This occurs because continuous hormone exposure may cause the thin endometrial lining to become unstable and shed irregularly. Breakthrough bleeding is most frequent during the first three to six months as the body adjusts, but it typically decreases over time, sometimes leading to complete cessation of bleeding.
If bothersome breakthrough bleeding occurs, a short hormone-free interval can help stabilize the lining. This involves stopping the active hormones for three to four days, which triggers a short withdrawal bleed, and then immediately resuming continuous active hormone use. If bleeding is heavy, persistent, or accompanied by severe symptoms, consultation with a healthcare provider is necessary to rule out other causes or adjust the hormone dosage.