Sexual Health Birth Control Prescription Options Seasonique Birth Control Pills What you should know about the pill that gives you four periods a year By Dawn Stacey, PhD, LMHC twitter linkedin Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience. Learn about our editorial process Dawn Stacey, PhD, LMHC Medically reviewed by Medically reviewed by Brian Levine, MD on September 23, 2019 linkedin Brian Levine, MD, MS, FACOG, is board-certified in obstetrics and gynecology, as well as in reproductive endocrinology and infertility. Learn about our Medical Review Board Brian Levine, MD Updated on October 28, 2019 Print Seasonique is an extended-cycle, or continuous birth control, that gives users only four periods per year, or one a season, as the name implies. If you experience painful or heavy periods, PMS or PMDD, or menstrual migraines—or you just wish your period didn't need to come every single month, Seasonique may be a birth control method to consider. aicragarual / Getty Images If you're thinking about making the switch, here's what you should know about Seasonique effectiveness, uses, and side effects. How Seasonique Works Seasonique is an FDA-approved continuous cycle birth control pills containing estrogen (ethinyl estradiol) and a progestin (levonorgestrel). Like other birth control pills, Seasonique prevents pregnancy 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. 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 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 low-dose of 10 mcg ethinyl estradiol. The extended hormone dosing is what leads to periods only occurring only quarterly. Effectiveness Like other combination birth control pills, Seasonique is 91% effective with typical use and 99.7% effective with perfect use. This means that, of every 100 women who use these birth control pills for one year, less than one will become pregnant with perfect use; nine will become pregnant with typical use. Possible reasons for failure include: Missing pillsMedications, including certain antidepressants and antibioticsBeing overweight or obese Comparing Birth Control Effectiveness Advantages There are a number of reasons some people prefer or can benefit from continuous cycle birth control over cyclic pills. Painful Periods Women who have dysmenorrhea (painful periods) would only have to cope with related symptoms a few times a year if they took Seasonique. This may be particularly helpful for those 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. Periods are typically lighter and shorter while using Seasonique. 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, which continuous pills allow for, may reduce migraines that are brought on by hormonal fluctuations. Athletics Menstrual periods and the symptoms associated with them are a common barrier to physical activity in women. A 2018 study of recreationally and competitively active women found that 74% had intentionally manipulated their period at least once in the previous year. A pill that allows for fewer periods may make athletic participation easier for some women. Lifestyle The study reveals that women were even more likely to manipulate their periods due to holidays and special events than for sporting events. Safety and Side Effects It has been known for a long time that occasionally skipping periods with birth control pills is safe, and there are currently no known risks associated with only having four periods each year. Overall, Seasonique is as safe and effective as other forms of birth control pills. That said, the side effects of Seasonique are similar to any other birth control pills too, and it should not be used by women who have: Heart diseaseA history of blood clotsDiabetes with complicationsEstrogen-dependent cancerLiver diseaseKidney diseaseHad a stroke Additionally, Seasonique should not be used by women who could be pregnant. Women who smoke or are over age 35 should also carefully weigh the risks with their doctors and strongly consider other options. Despite having fewer periods, spotting (breakthrough bleeding) is more common with continuous birth control. Fortunately, this side effect often decreases with time. Pros vs. Cons of Birth Control Pills A Word From Verywell Deciding what form of birth control to use is a deeply personal decision. Always consider your own lifestyle and health, and talk with your doctor about pros and cons specific to you, before making a switch. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article 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. Bonnema RA, Spencer AL. The new extended-cycle levonorgestrel-ethinyl estradiol oral contraceptives. Clin Med Insights Reprod Health. 2011;5:49–54. Published 2011 Sep 19. doi:10.4137/CMRH.S5030 Krishnan S, Kiley J. The lowest-dose, extended-cycle combined oral contraceptive pill with continuous ethinyl estradiol in the United States: a review of the literature on ethinyl estradiol 20 μg/levonorgestrel 100 μg + ethinyl estradiol 10 μg. Int J Womens Health. 2010;2:235–239. Published 2010 Aug 10. PMID: 21151728 Bronson RA. Oral contraception: mechanism of action. Clin Obstet Gynecol. 1981;24(3):869-77. doi:10.1097/00003081-198109000-00014 Wright KP, Johnson JV. Evaluation of extended and continuous use oral contraceptives. Ther Clin Risk Manag. 2008;4(5):905–911. doi:10.2147/tcrm.s2143 Cooper DB. Oral Contraceptive Pills. StatPearls [Internet]. Published August 14, 2019. D'arcy PF. Drug interactions with oral contraceptives. Drug Intell Clin Pharm. 1986;20(5):353-62. doi:10.1177/106002808602000504 Robinson JA, Burke AE. Obesity and hormonal contraceptive efficacy. Womens Health (Lond). 2013;9(5):453–466. doi:10.2217/whe.13.41 Bloski T, Pierson R. Endometriosis and Chronic Pelvic Pain: Unraveling the Mystery Behind this Complex Condition. Nurs Womens Health. 2008;12(5):382–395. doi:10.1111/j.1751-486X.2008.00362.x Kocaoz S, Cirpan R, Degirmencioglu AZ. The prevalence and impacts heavy menstrual bleeding on anemia, fatigue and quality of life in women of reproductive age. Pak J Med Sci. 2019;35(2):365–370. doi:10.12669/pjms.35.2.644 Nappi RE, Merki-Feld GS, Terreno E, Pellegrinelli A, Viana M. Hormonal contraception in women with migraine: is progestogen-only contraception a better choice?. J Headache Pain. 2013;14(1):66. Published 2013 Aug 1. doi:10.1186/1129-2377-14-66 Schaumberg MA, Emmerton LM, Jenkins DG, Burton NW, Janse de jonge XAK, Skinner TL. Use of Oral Contraceptives to Manipulate Menstruation in Young, Physically Active Women. Int J Sports Physiol Perform. 2018;13(1):82-87. doi:10.1123/ijspp.2016-0689 Hillard PA. Menstrual suppression: current perspectives. Int J Womens Health. 2014;6:631–637. Published 2014 Jun 23. doi:10.2147/IJWH.S46680 Gourdy P. Diabetes and oral contraception. Best Pract Res Clin Endocrinol Metab. 2013;27(1):67-76. doi:10.1016/j.beem.2012.11.001 Stenchever MA. Risks of oral contraceptive use in women over 35. J Reprod Med. 1993;38(12 Suppl):1030-5. PMID: 8120860 Additional Reading Benson, L., and E. Micks. Why Stop Now? Extended and Continuous Regimens of Combined Hormonal Contraceptive Methods. Obstetrics and Gynecology Clinics of North America. 2015. 42(4):669-81. doi:10.1016/j.ogc.2015.07.009 Burness, C. Extended-Cycle Levonorgestrel/Ethinylestradiol and Low Dose Ethinylestradiol (Seasonique): Review of Its Use as an Oral Contraceptive. Drugs. 2015. 75(9):1019-26. doi:10.1007/s40265-015-0407-9 Li, J., Panucci, G., Moeny, D. et al. 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. 178(11):1482-1488. doi:10.1001/jamainternmed.2018.4251 Oedingen, C., Scholz, S., and O. Razum. Systematic Review and Meta-Analysis of the Association of Combined Oral Contraceptives on the Risk of Venous Thromboembolism: The Role of the Progestogen Type and Estrogen Dose. Thrombotic Research. 2018. 165:68.78. doi:10.1016/j.thromres.2018.03.005