Types of Continuous vs. Extended Cycle Birth Control

How They Work, Brands, and Spotting

There are many types of birth control pills available on the market today. The more recent evolution of the birth control pill includes continuous-cycle pills and extended-cycle pills.

Continuous-cycle pills are taken without any hormone-free breaks, resulting in fewer or no periods. Extended-cycle pills are taken for two or more cycles without stopping, followed by a planned, hormone-free break during which you have a period.

Continuous- and extended-cycle birth control pills are types of combination birth control, meaning that they contain both estrogen and progestin. Continuous cycle pills contain more pills per pack, which means that they can, depending on how they're used:

  • Shorten your monthly periods.
  • Lower the frequency of your period.
  • Completely eliminate periods.
Oral contraceptive pills with alarm clock background in time reminder for taking pills
areeya_ann / Getty Images

Types of Continuous Birth Control Pills

There are three categories of extended-cycle birth control pills.

  • 91-Day: These continuous birth control pills include the pill brands Seasonale, Quasense, Seasonique, and LoSeasonique. Each pack contains 84 active/hormone pills, which equals 12 weeks of continuous birth control. The pack also has seven inactive pills. In Seasonale and Quasense, these are placebo pills. In Seasonique and LoSeasonique, these are low-dose estrogen pills. When you use a 91-day continuous-cycle pill pack, your period (or withdrawal bleed) usually occurs during Week 13. This means that you only have a period every three months (that's just four periods a year). Plus, the lower dose of estrogen in the last week of the pills helps to make your period lighter and shorter. Most women say that their period only lasts about 3 days.
  • 365-Day: The only continuous birth control pill FDA-approved for 365 days of use is Amethyst (this is the generic version of Lybrel, which is no longer being made). These continuous pill packs come with 28 active/hormone pills. Over 12 months, this equals one pill for each day of the year. There are no placebo pills. While using this extended-cycle pill, you should not have any periods for the entire year.
  • Mini Continuous-Cycle Pills: Because these extended-cycle pill packs have more hormone pills than the typical 28-day pill packs, they are also considered to be continuous birth control. You may also have fewer hormone fluctuations on these pills because they contain more hormone pills. These mini extended-cycle pills include the 24-day and 26-day versions below.
  • 24-Day: These are the pill brands Yaz, Beyaz, and Safyral. Each pack has 24 days of active pills and only four placebo pills.
  • 26-Day: This includes the pill brand Lo Loestrin Fe. This pill brand pack contains 26 days of estrogen/progestin pills, two days of estrogen-only pills, and two days of placebo pills. Studies show that these extra two days of estrogen can lead to lighter and shorter periods.

How Continuous Birth Control Works

Extended-cycle birth control works the same way as other hormonal contraception that contains estrogen and progestin (such as combination oral contraceptives, NuvaRing, and the Ortho-Evra patch). If you don't have a prescription for one of the extended-cycle pill types listed above, you can also use your regular 28-day combination pills or combination hormonal contraception as continuous birth control.

Safety

Research shows that continuous-cycle pills are safe to use. Experts assert that there's no biological need to have a monthly period if you are using hormonal contraception. In fact, when you use hormonal birth control, you're not getting a true period, but rather what's termed a "pill bleed" or "withdrawal bleed."

Continuous birth control pills have the same side effects and risks as your regular 28-day birth control pill packs—this is because they contain the same types of hormones. Continuous pills also offer the same high effectiveness.

One 2018 study found no clinically significant difference in the risk of venous thromboembolism (blood clots) with the continuous-cycle pills versus traditional cycle pills.

Benefits

Extended-cycle birth control pills offer you the same non-contraceptive benefits that hormonal contraception does. But continuous birth control pills may be able to do even more. If you have period-related issues, continuous cycle pills can greatly improve your quality of life. They give you the control to lower the number of periods you have as well as how long your periods last. This could provide a lot of relief if you suffer from:

  • Menorrhagia (heavy bleeding)
  • Long and/or frequent periods
  • Dysmenorrhea (painful periods)
  • Uncomfortable menstrual-related bloating, breast tenderness, or mood swings
  • PMS or PMDD
  • A disability that makes it difficult to use pads and/or tampons
  • A health condition that becomes worse during your period (like anemia, endometriosis, or migraines)

Even if you do not have difficult symptoms during your period, you may still want to choose to use continuous birth control for the following reasons:

  • Having shorter, fewer, or no periods is more convenient
  • To save money on the cost of pain relievers, pads, liners and/or tampons (every dollar counts!)
  • As part of a greener, more environmentally-conscious lifestyle (you'll have less waste because you won't be using period products every month)

A Word From Verywell

As with other hormonal contraceptives, you will need a doctor’s prescription to get continuous birth control pills. If you have certain health conditions, extended cycle pills may not be the safest contraceptive method for you to use. And remember that, even though these pills are effective at preventing pregnancy, continuous birth control pills do not provide you with any protection against sexually transmitted infections.

Frequently Asked Questions

  • Does continuous birth control cause infertility?

    Continuous birth control does not cause infertility. Studies show that long-term use of birth control does not have any negative effect on a woman's ability to get pregnant. Once she stops taking birth control, her fertility will return to normal.

  • What birth control only gives you four periods a year?

    The continuous birth control pill brands Seasonale, Quasense, Seasonique, and LoSeasonique give you one period every three months (four periods per year).

  • What are the side effects of continuous birth control?

    Continuous birth control pills have the same side effects and risks that other 28-day birth control pills have. Side effects tend to occur during the first three months after starting new birth control pills and may include nausea, headaches, breast tenderness, spotting, and mood changes.

  • Is spotting while on birth control normal?

    Breakthrough bleeding while on birth control can happen when starting a new oral contraceptive or switching to a different one. It's most likely nothing to be concerned about, but you should still tell your healthcare provider so that they can ensure there is not another underlying cause.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lo Loestrin Fe prescribing information. Irvine, CA: Allergan USA, Inc.; 2017. 

  2. Nappi RE, Kaunitz AM, Bitzer J. Extended regimen combined oral contraception: A review of evolving concepts and acceptance by women and clinicians. The European Journal of Contraception & Reproductive Health Care. 2016 Mar 3;21(2):106-15. doi:10.3109/13625187.2015.1107894

  3. Li J, Panucci G, Moeny D, Liu W, Maro JC, Toh S, Huang TY. Association of risk for venous thromboembolism with use of low-dose extended- and continuous-cycle combined oral contraceptives: A safety study using the Sentinel Distributed Database. JAMA Internal Medicine. 2018 Nov 1;178(11):1482-8. doi:10.1001%2Fjamainternmed.2018.4251

  4. Girum T, Wasie A. Return of fertility after discontinuation of contraception: A systematic review and meta-analysis. Contracept Reprod Med. 2018 Jul;3(1):9. doi:10.1186/s40834-018-0064-y

  5. Brown. What are the side effects of birth control pills?.

By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.