Taking Birth Control Continuously And Spotting

In our latest question and answer, the pharmacist discusses taking birth control pills continuously and spotting or bleeding.

Taking Birth Control Continuously And Spotting
Apr 25, 2018

Ry99 asked

Hi! So I am on Levlen combined oral contraceptive and have been for nearly 2 years. I have taken 3 pill packets back to back (having no sugar pill free week) which I know many do not recommend as I am now experiencing dark spotting. I also just finished a 7 day course of antibiotics so I do not know what to do? Is it possible to take the pill free break now, to get my withdrawal bleed and stop my spotting or is this a bad idea? What does this mean in terms of the pills efficiency in preventing pregnancy if I do do this? Any help would be greatly appreciated!!! Thank you!! :) xx


Levlen is a combined hormone oral contraceptive (i.e. birth control pill) that contains both an estrogen and a progestin.

Continuous Dosing Of Birth Control

While Levlen is not indicated for continuous dosing (i.e. taking only active pills and skipping the inactive ones), it is not uncommon for it to be dosed this way. In fact, most birth control pills that contain an estrogen and a progestin can be continuously dosed if preferred by the patient or doctor. However, you should not dose your birth control continuously without first speaking with your doctor.

There are actually a few extended or even continuous regimen birth control pill products available by prescription. Continuous birth control products may be an option for some women since it results is no menses (i.e. 'period'). Amethyst is an example of a continuous birth control product that contains no pill free interval. You take an active pill every day.

While data is lacking, most studies that have evaluated the safety of continuous dosing regimens believe it to be safe and puts women at no more risk of side effects when compared to non-continuous cycles.

Nevertheless, the long term effects are not well known as no pill free period will result in an individual being exposed to significantly more estrogen and progestin over the course of one year (since there are no weeks where you are taking inactive pills). 

Some birth control pill products are preferred for continuous dosing over others. Generally, you want a birth control pill that is relatively low in estrogen to decrease the risk of side effects. As there are many considerations for continuous dose birth control pills, it is important to talk to your doctor to find the best one.

Spotting Or Bleeding On Continuous Birth Control

Spotting and bleeding are the most common side effects when taking birth control pills on an extended or continuous cycle. To illustrate this, below is a graphic from the package insert of Seasonique, a birth control product in which you take 84 days of active pills in a row.

Continuous Dosing Spotting

As seen above, bleeding and spotting are very common, even 4 cycles (one year!) into the Seasonique product. Therefore, it is reasonable to expect breakthrough bleeding and spotting with most, if not all, continuous birth control pill regimens.

In terms of withdrawal bleeding, when you take birth control pills continuously and stop taking them, you will generally begin menses (i.e. withdrawal bleeding). As long as you are taking your pills consistently and do not miss doses (besides from your scheduled withdrawal period), you should not be at an increased risk of pregnancy. However, if you stop taking your pills mid-month (i.e. not at the end of the pack), you may be at an increased risk of pregnancy.

In general, if you miss birth control pills, are not taking them consistently or after you finish taking certain antibiotics, you need to be taking active pills for 7 consecutive days to be protected from pregnancy. As everyone's situation is different, be sure to reach out to your doctor to discuss your situation.

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