Manda asked
Can I skip my inactive pills with my birth control and go straight into my active pills?
Answer
There is no medical need to take inactive birth control pills, unless you are taking a birth control product that contains therapeutic ingredients (such as iron) in the inactive pills. However, there are two situations we are talking about when we discuss "skipping" inactive pills:
- Not taking (i.e. skipping) the inactive pills, but still waiting the appropriate number of days until you are scheduled to take the active pills again.
- Not taking (i.e. skipping) the inactive pills and immediately begin taking active pills. This is known as 'continuous' birth control dosing.
What Are Inactive Birth Control Pills?
Most birth control 'inactive' pills simply contain inert ingredients and are designed to be used a placeholder for days of the week. The majority of birth control pills contain 21 days of active, hormone containing pills and 7 days of inactive, inert "placebo" pills. The 7 inactive pills are included to help individuals stay on schedule and be consistent with taking one tablet every day.
However, some birth control products have replaced the inactive 'placebo' pills with ones that contain therapeutic, non-hormone ingredients to be taken after the active pills. Examples of these products are:
- Lo Loestrin FE
- Beyaz
Lo Loestrin FE contains iron in their placebo pills, which may help replace iron loss from menses and prevent anemia.
Beyaz contains folate, a B vitamin, to reduce the risk of neural tube defects in infants for those who plan on becoming pregnant soon after stopping birth control pills.
So, while most birth control pills have inactive pills that act simply as placeholders, some products do contain therapeutically beneficial ingredients. If you are taking a birth control that does contain inactive pills with additional ingredients, be sure to speak with your doctor before not taking them, as the product may have been prescribed for a specific reason.
Continuous Dosing - No Inactive Pills
The other situation described above is skipping inactive pills and simply continuing on active pills. This is actually a fairly common dosing regimen for birth control pills and is known as continuous dosing. Some birth control products are actually designed to be continuously dosed such as:
- Seasonique
- Amethyst
Seasonique doses active birth control pills for 3 months, which is then followed by 1 week of inactive pills.
Amethyst is dosed continuously, every day, with no inactive pills.
Continuous birth control products are preferred for some women since it results is no menses (i.e. 'period'). In addition, continuous birth control products have some evidence for helping to improve:
- Menorrhagia (heavy bleeding)
- Anemia
- Dysmenorrhea (painful menstruation)
- Endometriosis
- Menstrual headache
However, although continuous birth control pills are considered safe by most, the long-term effects are not well known.
Taking birth control pills continuously (i.e. every day) will expose you to significantly more estrogen and progestin over the course of one year (since there are no weeks where you are taking inactive pills). Although the long-term effects of continuous dosing aren't well known, most studies, such as this one, consider the regimens safe and effective.
Birth Control Pill Products And Continuous Dosing
While there are specific birth control products that are made for the purpose of continuous dosing (as discussed above), it would not be uncommon for your doctor to recommend simply taking a typical birth control product continuously by skipping the placebo (i.e. inactive) pills and continue taking only active pills. This works better for certain birth control pills than others though.
Most continuous birth control products use a low dose of estrogen, either 20 or 30 mcg of ethinyl estradiol.
Many regular interval birth control pills use higher doses, anywhere from 35 mcg to 50 mcg of ethinyl estradiol. It is generally considered safer to use lower doses of estrogen and continuous dosing of these higher estrogen products may increase the risk of certain problems like blood clots, breast tenderness and high blood pressure.
It is important to speak with your doctor before starting continuous dosing on birth control pills. There may be a particular product that is best suited for your situation.
Summary
- Inactive (i.e. placebo) birth control pills commonly contain inert ingredients and are utilized as place holders, to assist individuals in consistently taking one pill every day.
- However, some inactive (i.e. placebo) pills contain therapeutic ingredients such as iron or folate and should not be skipped until speaking with your doctor.
- Continuous birth control pills are taken every day, with no hormone free interval, which will result in no menses.
- Some regular interval birth control pills can be taken continuously, but it is prudent to speak with your doctor beforehand as some are more appropriate (based on estrogen dose) for this than others.
