Seasonique and LoSeasonique: Benefits and Risks

Seasonique and LoSeasonique are both forms of extended-cycle or continuous birth control that offer the women the chance to have only four menstrual periods each year. Compared with standard (cyclic) birth control pills, the effectiveness and safety appear similar, and there are no known risks linked to skipping periods in this manner. In contrast, some women may benefit from extended-cycle oral contraception, such as those who have painful periods, heavy periods, or PMS or PMDD. Menstrual migraines may also be reduced compared with cyclic birth control. While many women greatly appreciate the lifestyle aspects of fewer periods (though there may be increased spotting early on), this can be particularly beneficial for physically active women.

Let's look carefully at how Seasonique and LoSeasonique extended-cycle pills are used, the safety and side effects, and the pros and cons of choosing this form of birth control pills.

Both Seasonique and LoSeasonique are FDA-approved continuous cycle birth control pills. While the two medications differ with regard to hormone dosages, they are both combination birth control pills made up of estrogen (ethinyl estradiol) and a progestin (levonorgestrel).

Unlike standard birth control pills, in which people take a pill containing the hormones for three weeks and then have one week off, Seasonique and LoSeasonique are taken daily for three months followed by a low dose of estrogen alone for one week. Each pill pack contains 91 pills.

• Seasonique is made up of 84 pills that contain 30 mcg ethinyl estradiol and 0.15 mg of levonorgestrel. You take one of these pills each day for 84 days. The pills for the last 7 days of the 3-month pill-pack contain a low-dose of 10 mcg ethinyl estradiol. 
• LoSeasonique is also made up of 84 pills. These pills contain 20 mcg ethinyl estradiol and 0.1 mg levonorgestrel. The final 7 days of the 3-month cycle contain 10 mcg ethinyl estradiol.

On average, studies have found that women's periods last only around three days on these pills.

How They Work

Seasonique and Lo Seasonique work like other birth control pills. The primary method is by preventing 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.

Effectiveness

Seasonique and LoSeasonique are just as effective as other brands of combination birth control pills. Combination birth control is 91 percent effective with typical use and 99.7 percent effective with perfect use. This means that out of every 100 women who use these birth control pills for one year, less than one will become pregnant (with perfect use) and nine will become pregnant (with typical use).

Possible reasons for failure include:

• Missing pills: Inconsistent dosing or missing a dose (or more) of birth control pills can reduce their effectiveness, though the risk of pregnancy can vary between different oral contraceptives. What you should do if you miss your birth control pill can vary, but the longer you go without your pill the more likely you are to ovulate.
• Medications: There are medications that decrease the effectiveness of the pill including many antibiotics, some antidepressants, and herbal supplements such as St. John's wort and soy isoflavones.
• Obesity: Weight also affects effectiveness and women who are overweight or obese are more likely to become pregnant while using the pill than women who have a normal body mass index.

There are a number of women who find that they prefer or can benefit from continuous cycle birth control over cyclic pills. Some reasons women may choose Seasonique or LoSeasonique include:

• Athletics: Menstrual periods and the symptoms associated with periods are a common barrier to physical activity in women. A 2018 study of recreationally and competitively active women found that 74 percent had intentionally manipulated their menstrual period at least once in the previous year.
• Painful periods: Women who have dysmenorrhea (painful periods) wouldn't have to cope with the symptoms as often. This may be particularly helpful for women who have painful cramps due to endometriosis.
• Heavy periods: Heavy periods, referred to as menorrhagia, are not only limiting physically but can contribute to anemia in some women.
• Menstrual migraines: Combined birth control pills can trigger migraines for some women. Having fewer periods could help those who have estrogen withdrawal headaches. It's also thought that having stable estrogen levels (as with continuous pills) may reduce migraines that are brought on by hormonal fluctuations.
• Lifestyle: In the above study on athletes, it was found that the women were actually more likely to manipulate their periods due to holidays and special events than for sports events.

The side effects of Seasonique and LoSeasonique are similar to other birth control pills.

Cautions and Contraindications for Any Birth Control Pill

There are some people should not take the pill (either extended or cyclic use). This includes women who have heart disease, have had a stroke, have a history of blood clots (deep vein thrombosis or pulmonary emboli), have diabetes with complications, an estrogen-dependent cancer such as breast cancer, liver disease, kidney disease, or who could be pregnant. Women who smoke or are over the age of 35 should also carefully weigh the risk with their doctors and strongly consider other options.

Safety Compared with Cyclic Birth Control Pills

A 2018 study in JAMA Internal Medicine comparing the safety of continuous to cyclic birth control found that blood clots occurred slightly more often among women in the continuous birth control group. Extended cycle pill users, however, were more likely to have had heart or metabolic issues at the start of the study, and it was concluded that given this information, the data wasn't strong enough to consider the risk of blood clots as a safety difference between the two.

It's noteworthy that the eight different types of progestin have been evaluated as to their association with blood clot risk, and a 2018 review found that levonorgestrel (the progestin found in Seasonique and LoSeasonique) was associated with the lowest risk of all progestins found in oral contraceptives.

The association between birth control pills and stroke is thought to be related to the estrogen dosage, so in theory, Seasonique would carry greater risk than LoSeasonique. It's important to note that while stroke risk is increased in pill users (by 50 percent to 100 percent) the actual risk is extremely low.

Side Effects Compared with Cyclic Birth Control Pills

Differences between Seasonique and LoSeasonique and other birth control pills may include those due to the scheduling as well as those related to the hormones present.

Despite having fewer periods, spotting (breakthrough bleeding) is more common with continuous birth control. Fortunately, this side effect often decreases with time.

Since Seasonique and LoSeasonique differ in the amount of estrogen they contain, they may differ from each other in this aspect but are expected to be similar to other combination birth control pills (all birth control pills contain ethinyl estradiol).

Birth control pills differ with regard to the progestin included. Levonorgestrel has high progestational and high androgenic side effects. Progestational side effects may include a reduced chance of ovulation (which is positive with birth control) as well as less overall menstrual bleeding.

On a less positive note, pills containing levonorgestrel may be less helpful in controlling acne (there are other birth control pills approved for acne) and may actually increase skin concerns. Levonorgestrel may also have a negative effect on cholesterol levels.

A Word From Verywell

Seasonique and LoSeasonique are forms of extended cycle (continuous) birth control pills that allow women to have only four menstrual cycles per year, but with effectiveness and safety similar to cyclic birth control pills.

For those who have heavy periods, having fewer periods reduces your monthly blood loss and may help reduce your risk of anemia.

Finally, there are non-medical reasons why continuous birth control may be a good option for you, as it is is much more convenient than many other birth control methods available. Extended cycle birth control pills appear to be especially beneficial in how they impact performance and participation among young physically active women in a positive way.

It's important to note, however, that birth control pills do not reduce your risk of contracting sexually transmitted diseases, and condoms remain the best option if you could be at risk.