Extended-cycle birth control pills involve taking one “active” pill daily for around 84 days before pausing for a 7-day break for withdrawal bleeding. After the break, the person begins taking the active pills again.
Withdrawal bleeding refers to the bleeding that resembles menstruation during the hormone-free interval when taking hormonal birth control.
This article covers what to expect when taking the extended-cyle pill. It also goes through its benefits, safety, and how people can talk about birth control with a healthcare professional.
Like traditional birth control pills, extended-cycle pills are combination oral contraceptives (COCs). They contain synthetic (human-made), versions of the hormones estrogen and progestin, which work to prevent ovulation and pregnancy.
Extended-cycle pills deviate from the usual monthly cycle, enabling longer gaps between vaginal bleeding and creating an “extended” cycle.
Unlike traditional pills, which have 21 active and 7 inactive pills, extended-cycle pills maintain active hormone dosage for longer periods of time, often up to 84 days or more, before allowing a brief break for withdrawal bleeding.
Each brand of extended-cycle pills has its own instructions. Two examples include Seasonique and Jolessa.
Typically, someone taking this type of birth control will take an active pill every day for an extended period, usually 84 days, and then take a 7-day break during which a person experiences withdrawal bleeding.
During those 7 days, the person may take a placebo, low dose estrogen, or no pill, depending on the specific brand. After the 7-day break, the person will resume taking the active pills.
Note that some extended-cycle pills are more of a continuous cycle pill, meaning there is no break for withdrawal bleeding. Amethyst is an example of a continuous cycle pill.
Because the extended-cycle pill reduces the number of menstrual cycles per year, people taking this birth control may experience relief from:
- menorrhagia (heavy or prolonged menstrual bleeding)
- dysmenorrhea (excessive period pain)
- uncomfortable menstrual-related symptoms, including cramps, bloating, and breast tenderness
- premenstrual syndrome (PMS)
- premenstrual dysphoric disorder (PMDD)
- a health condition with symptoms that can become worse during a period, such as endometriosis or polycystic ovary syndrome (PCOS)
The extended-cycle pill may also be beneficial for individuals with disabilities or conditions that make it difficult to use menstrual hygiene products like pads, tampons, or menstrual cups.
Extended-cycle pills are
Common side effects include:
- headaches
- mood changes
- nausea
- breast tenderness
- spotting or breakthrough bleeding
- weight gain
Learn more about the side effects of birth control pills.
More severe risks include:
increased risk of some cancers, including breast and cervical- high blood pressure
- blood clots
- cardiovascular complications, such as heart attack and stroke
Factors such as age, smoking, and overweight or obesity can increase these risks.
Learn about the side effects of long-term birth control use.
There are various forms of oral contraceptives, most of which require a prescription. The United States
Extended-cycle pills do require a prescription, so the first step is to make an appointment with a healthcare professional.
This may be a gynecologist, primary care or family physician, a doctor with a family planning clinic, or even a licensed physician online.
During the appointment, the person can expect the doctor to talk with them about their medical history, sexual activity, and contraceptive preferences.
Depending on the situation or appointment method, they may also perform a physical exam.
If the person is a good candidate for extended birth control pills, the doctor will prescribe the appropriate pills and explain how to take them correctly, including potential side effects and what to do if they miss a dose.
Questions to ask the doctor
Someone talking with a doctor about extended-cycle pills might wish to ask them about:
- potential side effects and risks
- how the pills compare to other forms of birth control regarding their effectiveness, convenience, accessibility
- any medical conditions or lifestyle factors that may affect whether the extended-cycle pills are suitable for them
- interactions between extended-cycle pills and other medications or supplements they take
- what to do if they miss a pill or multiple pills
- what to do when they wish to stop birth control, if and when they want to conceive
The cost of extended-cycle pills can vary depending on factors such as insurance coverage, generic versus brand-name medications, and pharmacy pricing.
Some insurance plans may cover the full cost of prescription birth control, while others may require a copayment or coinsurance.
Financial aid
For people without insurance or facing financial barriers, several options may be available to reduce out-of-pocket costs, including:
- accessing birth control through government-funded programs like Medicaid or Title X Family Planning clinics
- exploring low cost or sliding-scale fee clinics in the community, such as a Federally Qualified Health Center (FQHC)
- checking for manufacturer discounts or patient assistance programs
- comparing prescription prices at different pharmacies
- using prescription discount cards
- choosing a generic option over a brand name option
Learn more about getting free or low cost birth control.
Extended-cycle pills and continuous-cycle pills are both combination birth control pills, meaning they both contain synthetic versions of estrogen and progestin. Additionally, they both reduce the frequency of withdrawal bleeding.
However, they take different approaches. Extended-cycle pills typically involve taking active hormones for an extended period, followed by a short break for withdrawal bleeding.
In contrast, continuous cycle pills involve skipping the placebo or inactive pills altogether, resulting in continuous hormone exposure and no scheduled vaginal bleeding.
Extended-cycle pills offer a convenient option for contraception, allowing individuals to reduce the frequency of vaginal bleeding while providing additional benefits such as menstrual symptom relief.
While generally safe, it is important for people considering extended-cycle pills to discuss their options, as well as weigh the benefits and potential risks, with a healthcare professional.