Extended or Continuous Use of Contraceptive Pill, Patch or Ring

What is continuous use?

This means using your birth control pill, patch or ring without any planned hormone-free intervals.

What is extended use?

This means using your birth control pill, patch or ring with planned hormone-free intervals two or more months apart.

Is it safe to use?

• With longer-term use of contraception, the lining of the uterus does not build up as much, so monthly bleeding is not needed.
• It does not affect future fertility.
• Continuous or extended use is not known to increase your risk or heart attack, stroke, or cancer beyond that of regular contraceptive use.

Is it effective?

The failure rate of continuous use is equal to that of regular use (approximately 99 per cent.) It does not protect against sexually transmitted infections (STIs). You need to use a condom every time you have sex to help protect you from STIs.

What are the advantages of extended or continuous use?

• You may experience fewer days of bleeding, lighter flow, and less cramping associated with the hormone-free interval and fewer headaches, mood changes and bloating.
• Many women find this method more convenient.
• The cost of menstrual supplies (tampons, pads etc.) is less.

What are the disadvantages to extended or continuous use?

• Unexpected bleeding and spotting may occur.
• If there is contraceptive failure it may take longer to recognize pregnancy. However, this will not cause harm to a fetus.
• The cost of your prescription is higher.

What do I do if unscheduled bleeding occurs?

If bleeding continues for seven days, take a three to seven day break from your pill, patch or ring then restart. It is safe to do this as often as necessary as long as you have had at least 21 consecutive days of hormonal coverage.

It is more common to have unscheduled bleeding when you first start extended or continuous use of your contraceptive. If bleeding continues to be a problem, contact the Sexual Health Clinic, your health care provider, or a pharmacist.

What do I do if I forget my pill, patch or ring?

During the first 21 days of starting or restarting your contraceptive:

• Take your contraceptive as soon as possible; use a condom if you have sex in the next three weeks. If you had unprotected sex within five days of missing your pill, patch or ring, contact the Sexual Health Clinic, your health care provider or a pharmacist to discuss the need for the emergency contraceptive pill (ECP).

If you have been using your contraceptive for 21 days or longer and:

• you forget or miss up to four days of your pills, patch or ring—take a break for three days and then re-start your contraceptive
• you have missed five to seven days—restart your contraceptive
• it has been more than seven days— contact the Sexual Health Clinic or your health care provider to discuss the need for emergency contraception, restarting birth control, and the need for back up birth control or pregnancy testing