Extended-Cycle Birth Control Pills: What do I Have to Consider?

With extended-cycle birth control pills, many women deliberately suppress their bleeding. It’s convenient, but is it healthy? What should you be looking for?

What does it mean to take extended-cycle birth control pills?

If you take the pill, you can delay the bleeding. In contrast to real menstruation, this only begins, in a way that is easy to calculate, when the body suddenly lacks hormones after weeks of daily hormone tablets due to a pill break or sugar pills. Doctors call it a long-term cycle if hormones are not taken for 21 days as usual, but continuously over a period of months. Young women in particular like to use the extended-cycle birth control pills.

What are the advantages of extended-cycle birth control pills?

Especially women with heavy menstrual bleeding or with severe menstrual pain during the days use this possibility to take the pill without a break. This makes bleeding less frequent.

Compared to the conventional rhythm of taking the pill, the long-term cycle also has the advantage of increasing the safety of contraception. The constantly high level of active ingredients suppresses the function of the ovaries even more comprehensively than if a hormone break is taken every three weeks. This means that a forgotten pill or one that remains ineffective due to vomiting or diarrhoea is no longer as important.

Doing without the monthly hormone ups and downs brings the body as a whole into calmer waters: the physical and psychological accompaniments of bleeding, such as migraines, abdominal pain, weight fluctuations, tiredness or mood swings are significantly reduced.

Although there is no preparation in Germany specifically approved for this income scheme, “from a medical point of view there is nothing to be said against taking the pill for more than three weeks in a row,” says gynaecologist and professor Elisabeth Merkle.

Are there also disadvantages with extended-cycle birth control pills?

Yes. Especially in women who start taking the pill every day, bleeding between periods occurs more often. These can occur at any time and are therefore not as predictable as the bleeding during the pill break before. However, these disorders usually resolve themselves over time: little by little, uterine lining builds up, and the bleeding does not occur.

“The women usually take the pill over a period of four to six months,” says Merkle. “If you notice that there is a menstrual bleeding, you should take a break to give the uterine lining an opportunity to bleed.” These withdrawal bleeds are often less after several months than after three weeks, and sometimes they even stop.

Who is for extended-cycle birth control pills?

In principle, every woman can take extended-cycle birth control pills. “I wouldn’t recommend only young girls who don’t yet have a regular cycle,” says Merkle. The gynecologist generally recommends speaking to a doctor before swallowing the small tablets permanently.

Can I take every pill without a break?

No, not every preparation is suitable for this. The extended-cycle is only possible with single-phase pills, in which each tablet contains the same combination of active ingredients. A vaginal ring (Nuva ring) that constantly releases estrogens and gestagens is also suitable for the long cycle. The ring is replaced with a new one immediately after three weeks and not only after seven days.

And what if I want to have children one day?

Then the pill or the ring are simply discontinued – no matter how long they have been taken before. “The probability of getting pregnant does not affect the extended cycle,” says Elisabeth Merkle.

What are the dangers of extended-cycle birth control pills?

Many women have concerns about this. In a survey conducted by the Federal Centre for Health Education, only about one in four women stated that they wanted to do without it for several months. Scientists and doctors have long been arguing about what is natural in the female periodic table. The American Margie Profet, for example, assumes that menstruation serves to cleanse the body by flushing out germs and other pathogens. According to her, it would be harmful to bleed less – a hypothesis that has since been disproved.

At present, some researchers are tending to the contrary: continuous menstruation in a monthly rhythm is a modern invention to which the female body is not at all attuned and which increases the risk of certain forms of cancer such as tumours of the uterus and ovaries. This is because our ancestors were usually either pregnant or breastfeeding mothers for long stretches of their (reproductive) lives and thus menstruation-free. The hormones in the pill would therefore restore a natural state.

Regardless of these discussions, most women who use the pill are mainly concerned with one thing: contraception. And that this has worked is shown not least by the monthly withdrawal bleeding. In this respect, even if it is annoying, it also serves a psychological purpose.