What to Know About Seasonique (Levonorgestrel/Ethinyl Estradiol)

Seasonique is an extended-cycle, continuous birth control pill that gives users only four periods per year, or one a season, as the name implies. If you want to avoid painful or heavy periods, or if you just don't want a period every single month, Seasonique may be a birth control method to consider.

Seasonique is an FDA-approved, continuous-cycle birth control pill containing estrogen (ethinyl estradiol) and a progestin (levonorgestrel).

It has been known for a long time that skipping periods with birth control pills is safe, and there are currently no known risks associated with only having four periods each year.

Uses

Like other birth control pills, Seasonique prevents pregnancy by stopping ovulation so that an egg is not released to be fertilized. Combination birth control pills also cause the cervical mucus to be thicker (making it more difficult for sperm to pass through the cervix) and change the lining of the uterus so that, if fertilization does occur, implantation is unlikely.

Birth control pills often help women with problematic periods to manage their symptoms, and continuous cycle birth control that lasts over a three-month period can sometimes be preferable to traditional pills that have a period monthly.

Women who have dysmenorrhea (painful periods) only have to cope with related symptoms a few times a year if they take Seasonique. This may be particularly helpful for those who have painful cramps due to endometriosis.

Heavy periods, referred to as menorrhagia, are not only limiting physically but can contribute to anemia in some women. Periods are typically lighter and shorter while using oral contraceptives.

Before Taking

Before taking Seasonique, it's important to let your healthcare provider know about any medical conditions you have had, now or in the past.

You should also tell your healthcare provider and pharmacist about any other medications or supplements you are taking, as combination oral contraceptives (COCs) can often have interactions with other substances that can make Seasonique or your other medications less effective.

For the first seven days of using Seasonique, you should use a second form of birth control, such as condoms. Although Seasonique helps prevent pregnancy, it will not prevent sexually transmitted infections.

Precautions and Contraindications

Women who smoke and are over 35 years old should not take combination oral contraceptives, as they are at higher risk for serious cardiovascular events, like blood clots, heart attacks, and strokes.

In addition, you should not take Seasonique if you:

• Have a high risk of blood clots or a history of blood clots
• Have vascular disease from diabetes
• Have given birth in the last four to six weeks
• Have headaches with neurological symptoms or have migraine headaches
• Have uncontrolled hypertension
• Have liver tumors or liver disease
• Have abnormal vaginal bleeding where the cause is unknown
• Have breast cancer or other other estrogen or progestin-sensitive cancer, now or in the past

Other Combination Oral Contraceptives (COCs)

Combination oral contraceptives (COCs) have synthetic estrogen and progestin, mimicking women's natural hormones. Only people who can tolerate estrogen should take COCs. Although there are many different kinds and doses of COCs, they are collectively usually referred to as "birth control pills" or simply "the pill."

Combination pills are monophasic (where the active pills all have the same dose) or multiphasic (where the dose in the active pills varies by location in the cycle). Seasonique is monophasic, with 84 active pills and seven inactive pills.

Other monophasic oral contraceptives include:

• Yaz, Gianvi, Loryna, Nikki, Vestura, Jasmiel (drospirenone and ethinyl estradiol)
• Brevicon, Modicon, Wera, Balziva, Briellyn, Gildagia, Philith, Zenchent (ethinyl estradiol and norethindrone)
• Estarylla, Previfem, Sprintec (ethinyl estradiol and norgestimate)
• Safyral, Beyaz (drospirenone, ethinylestradiol, and levomefolate)
• Cryselle, Elinest, Ogestrel (ethinylestradiol and norgestrel)
• Apri, Desogen, Juleber, Reclipsen, Solia (ethinyl estradiol and desogestrel)
• Levora, Altavera, Daysee, Lessina (ethinyl estradiol and levonorgestrel)
• Amethyst (a 365-day ethinyl estradiol and levonogestrel pill, previously marketed as Lybrel)

Dosage

Unlike 28-day combination birth control pills that include 21 days of hormones and seven days of placebo pills, each package of Seasonique contains 91 pills. The first 84 pills are light blue-green and contain 30 micrograms (mcg) of ethinyl estradiol and 0.15 mcg of levonorgestrel, while the last seven days of the three-month pill pack contain a yellow pill that is a low dose of 10 mcg of ethinyl estradiol.

The extended hormone dosing is what leads to periods only occurring quarterly.

In clinical trials, one to three women out of 100 who used these birth control pills got pregnant in the first year of use.

Possible reasons for failure include:

• Missing pills
• Medications, including certain antidepressants and antibiotics
• Being overweight or obese

How to Take and Store

Store Seasonique at 68 to 77 degrees F (20 to 25 degrees C).

It's important to take your pill at the same time every day, so you should decide at the outset what time of day will be easiest to incorporate the pill into your routine. You should start Seasonique on the first Sunday after you start your period, even if you are still bleeding. The pill packets are labeled with the day of the week, so that will help you stay on track.

You should use an alternative form of birth control (like condoms or spermicides) in addition to Seasonique for the first seven days. Seasonique takes a week to become fully effective. In addition, the effectiveness can be compromised if you miss two or more doses at any point in the pill package.

Here's what to do if you miss any doses of Seasonique:

If you miss one light blue-green pill: Take it as soon as you remember, then take the next pill at your regular time. This means you may take two pills in one day. If you have only missed one pill, you do not need to use a back-up birth control method. Taking more than one pill a day can make some women nauseated; taking the pill with food can help.

If you miss two of the light blue-green pills in a row: Take two pills on the day you remember (your scheduled pill and one of the missed pills), and two pills the next day (your scheduled pill and the other missed pill). Then, you'll take one pill a day like normal until you finish the pack.

You can become pregnant if you have sex in the seven days after you miss two pills. You must use another birth control method (such as condoms or spermicide) for a week after you restart your pills.

If you miss three or more of the light blue-green pills in a row: Do not take the missed pills. Keep taking your scheduled one pill daily until you have completed all of the remaining pills in the pack. You may experience bleeding during the week following the missed pills.

You could become pregnant if you have sex during the days of missed pills or during the first seven days after restarting your pills. You must use a non-hormonal birth control method (such as condoms or spermicide) as a back-up for when you miss pills and for the first seven days after you restart them.

Normally, you will have your period when taking the seven yellow pills at the end of pack. If you have missed doses and you don't have your period then, call your healthcare provider because you may be pregnant.

If you miss any of the seven yellow pills: Throw away the missed pills, then keep taking the scheduled pills until the pack is finished. According to the manufacturer's instructions, you do not need a back-up method of birth control. 

Side Effects

Side effects of combination birth control pills like Seasonique are usually mild and often resolve with time, but some of the side effects can be serious.

Common

Common side effects include:

• Irregular or heavy bleeding
• Nausea
• Breast tenderness
• Headache
• Weight gain

Most of these side effects go away in the first few months of taking Seasonique. If the effects are causing impacts on your quality of life or if the headaches are severe, talk to your healthcare provider to discuss alternatives to Seasonique.

Serious

More serious side effects of Seasonique can include:

• Migraines
• Gallbladder inflammation and gallstones
• Pancreatitis
• Abdominal pain
• Major depressive disorder
• Inability to tolerate contact lenses

If you have any of these side effects, contact your healthcare provider right away to see whether you should stop taking Seasonique immediately.

Warnings and Interactions

If you experience any of the following, you should stop taking Seasonique and contact your healthcare provider right away:

• Jaundice (yellowing of the eyes or skin)
• An increase in blood pressure or uncontrolled blood pressure
• Headaches that are new, recurrent, or severe, or migraines that are more frequent
• Increases in blood sugar in women with diabetes
• Worsening depression among women with a history of depression

Your healthcare provider may also take you off Seasonique if they find:

• Increases in blood lipids, including high triglycerides
• Blood clots in your arteries or veins
• Suspected or confirmed breast cancer
• Symptoms of gallbladder disease or gallstones

Seasonique has potential interactions with many different medications. Be aware that the following medications can make Seasonique less effective, so you may want to use a second form of birth control:

• Barbiturates
• Tracleer (bosentan)
• Tegretol (carbamazepine)
• Felbatol (felbamate)
• Griseofulvin
• Trileptal (oxcarbazepine)
• Dilantin (phenytoin)
• Rifampin
• St. John's wort
• Topamax (topiramate)
• Possibly some medications for HIV
• Possibly some other antibiotics

Alternatively, Seasonique might make some of your other medications less effective, including:

• Lamictal (lamotrigine)
• Thyroid hormones