Some COC users do not follow the usual cycle of 3 weeks taking hormonal pills followed by one week without hormones. Some women take hormonal pills for 12 weeks without a break, followed by one week of nonhormonal pills (or no pills). This is extended use. Other women take hormonal pills without any breaks at all. This is continuous use. Monophasic pills are recommended for such use (see Question 16).

Women easily manage taking COCs in different ways when properly advised how to do so. Many women value controlling when they have monthly bleeding—if any—and tailoring pill use as they wish.

Benefits of Extended and Continuous Use

• Women have vaginal bleeding only 4 times a year or not at all.
• Reduces how often some women suffer headaches, premenstrual syndrome, mood changes, and heavy or painful bleeding during the week without hormonal pills.

Disadvantages of Extended and Continuous Use

• Irregular bleeding may last as long as the first 6 months of use— especially among women who have never before used COCs.
• More supplies needed—15 to 17 packs every year instead of 13.

Extended Use Instructions

• Take 84 hormonal pills in a row, one each day. (These are the hormonal pills in 4 monthly packs.) Users of 28-pill packs do not take the nonhormonal pills.
• After 84 hormonal pills, wait 7 days and start the next pack of pills on the 8th day. (Users of 28-pill packs can take the nonhormonal pills in the 4th pack if they wish and start the hormonal pills the day after the last nonhormonal pill.) Expect some bleeding during this week of not taking the hormonal pills.

Continuous Use Instructions

A woman should take one hormonal pill every day for as long as she wishes to use COCs. If bothersome irregular bleeding occurs, she can stop taking pills for 3 or 4 days and then start taking hormonal pills continuously again.