The New No-Period, No-PMS Birth Control Pills

Are new continuous birth control pills right for you?

From the WebMD Archives

In the beginning, there was Seasonale -- the continuous birth control pill that offered women four periods a year. Women grabbed the chance to opt out of their periods. If you don't need it, why put up with it?

Today, "the pill" has been finessed even more, with lighter-period or no-period birth control pills as well as no-PMS, no-acne pills. Seasonale, Seasonique, Yaz, Beyaz, Yasmin, and Lybrel have changed the face of birth control pills.

All are variations of traditional birth control pills -- combining mini-doses of estrogen and progestin -- and proven safe after decades of research, explains Christopher Estes, MD, assistant professor of obstetrics and gynecology at the University of Miami School of Medicine.

They all contain low doses of estrogen -- and anything less than 50 micrograms of estrogen is considered a low-dose pill, he tells WebMD. "There are no high-dose pills on the market anymore."

What are the key differences in this new wave of pills?

  • There are fewer "non-active" pills, the ones that trigger a period.

  • The hormone formulations are slightly different, creating lighter periods when you do have one.

  • A new form of progestin used in some pills helps reduce severe mood and physical symptoms that some women get before their monthly periods, called premenstrual dysphoric disorder or PMDD. This form of progestin may also help treat acne.

As a general rule, any pill that contains estrogen can help prevent acne and PMS, says Patti J. Ross, MD, a professor of obstetrics, gynecology, and reproductive sciences at The University of Texas Medical School at Houston.

But the type of progestin in Yaz and Yasmin lets them work a bit differently, she tells WebMD. "It has a diuretic effect, so women don't get the bloating, fluid retention, and weight gain."

To help you choose, here are key facts about each brand:

  • Lybrel is a no-period birth control pill. It is the first low dose birth control pill designed to be taken 365 days, without a placebo or pill-free interval.

  • Seasonale has 12 weeks of estrogen/progestin pills, followed by 7 days of no-hormone pills -- which means 4 menstrual periods a year.

  • Seasonique has 12 weeks of estrogen/progestin pills, followed by 7 days of low-estrogen pills -- which results in 4 light, short periods a year. It is similar to Seasonale but has 7 days of low-dose estrogen instead of placebo pills.

  • Yaz is a less-PMS pill. It has a 28-pill monthly pack -- 24 active pills and 4 inactive pills. Your monthly cycle is shorter, lighter, more regular. Beyaz is similar to Yaz but with a form of folic acid added to prevent birth defects should a woman become pregnant.

  • Yasmin is a less-PMS, less-acne pill. It has 28-pill monthly packs -- 21 active pills and 7 inactive pills. Your monthly period is lighter, more regular.


The hormones in today's birth control pills are "a little more forgiving than in the past," Estes tells WebMD. "With standard birth control pills, you really had to take them at the same time every day or risk ovulating. With the new pills, you have a few hours' leniency. If you forget to take your morning pill, you can still take it at lunch time and not worry."

Just as with standard birth control pills, fertility returns within one or two months of stopping, says Estes. But that's not a promise. "Not everyone can get pregnant in one to two months," he tells WebMD. "It can take time, just as with regular birth control pills."

Is It Natural to Stop Your Menstrual Period?

In the early days of extended-cycle birth control pills, women were concerned about the health risks of stopping or suppressing their periods. In fact, monthly bleeding is really not necessary -- and suppressing it has no impact on health, Estes says.

Ross concurs: "There's no risk to suppressing the monthly period. If a woman is having bad menstrual cycles, there's no reason why she needs to have a period. But I have a lot of patients who are reassured by having one every few months, especially if they're worried about pregnancy."

Long-Term Safety of Birth Control Pills

For women taking birth control pills of any type, there is increased risk of blood clots, especially for smokers and women over 35. "The risk is going to be the same whether you're taking a continuous pill or a standard birth control pill," Estes says.

Also, there is increased risk of developing cervical cancer, which drops quickly once the pill is stopped. Taking oral contraceptives for five or more years was associated with a doubling of cervical cancer risk. The risk returns to that of never-users within a decade of stopping oral contraceptives.

What’s the Breast Cancer Risk From Birth Control Pills?

Some women worry: Is there long-term risk of breast or other hormone-fueled cancers?

"The best data we have about birth control pills and breast cancer is that there is no link," Estes says. "We have to extrapolate what we know about conventional birth control pills. But we have no reason to believe your risk of breast cancer will increase over your lifetime because of continuous-use birth control pills."


While hormone replacement therapy (HRT) has been linked to a slight increased risk of breast cancer, the hormones used in birth control pills are different. "These are different estrogens and progestins than are used in HRT, explains Ross. “They have been studied since the 1960s, and good data suggests what's good and not good about them. Breast cancer has never been one of the concerns with birth control pills."

Also, there is no increased risk to the uterus or uterine lining (the endometrium), he says.

In fact, taking birth control pills has health advantages, Ross points out. There is evidence that birth control pills protect against cancers of the ovary and uterus, as well as against pelvic inflammatory disease and iron-deficiency anemia. The combination pill can reduce acne, the risk of an ectopic pregnancy, noncancerous breast cysts, and ovarian cysts.

"People don't talk enough about the decreased risk of ovarian and uterine cancers, decreased acne, decreased formation of ovarian cysts," says Ross.

WebMD Feature Reviewed by Brunilda Nazario, MD on April 13, 2009


SOURCES: Christopher Estes, MD, assistant professor of obstetrics and gynecology, University of Miami School of Medicine. Patti J. Ross, MD, a professor of obstetrics, gynecology, and reproductive sciences, University of Texas Medical School, Houston. Medscape press release: "FDA approves oral contraceptive containing folate."

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