What Is Extended-Use Birth Control?

Medically Reviewed by Traci C. Johnson, MD on May 28, 2024
4 min read

A major breakthrough in pregnancy prevention happened back in 1960 when the oral contraceptive, or “the pill,” was first approved by the FDA. Depending on the brand, all you had to do was take a tiny pill for 21 days out of the month, and in the fourth week you took seven non-active pills, or no pills at all. Then you had your period. But even this convenient system has changed over time.

Today, there are 91-day oral contraceptive programs that promise to prevent unplanned pregnancy and let you have fewer periods each year. But there are some things you need to know before you make the switch.

There are a number of pills with 91-day plans on the market. But like anything else, the best one for you really depends on cost, your preferences, and what your doctor thinks may be best for you.

These are the types of extended-use pills that you can get now:

Amethia, Camrese, and Simpesse. These are the generic versions of the brand Seasonique. Again, you take active pills for 84 days, followed by 1 week of pills containing a very low dose of estrogen. This may help with things like bloating and other side effects that can happen during the time you take the pills that contain no hormones. Your period will start in week 13.

Jolessa. This is the generic version of the brand named Seasonale. You take this pill for 84 days, followed by 7 days of pills that are inactive. That means they contain no hormones. Some brands do use low-dose estrogen that you take for 7 days. Your period will start in week 13.

Rivelsa. This is the generic version of Quartette. You take this pill for 84 days, too. But this contains a set dose of the hormone progestin. But the estrogen dose increases gradually three times during that 84 days. You start off with pills that contain 20 micrograms, increasing to 25 micrograms and then to 30 micrograms. This is then followed by 1 week of pills containing low-dose estrogen. You get your period in week 13.

For most women, the short answer is “yes.” Periods can be inconvenient if you have a special occasion like a vacation coming up. But there are other reasons, too. For example, you may have a physical issue that makes it hard to use feminine hygiene products. If so, a delayed period might be right for you.

But there are also other issues that can make menstruation a health issue. Endometriosis and anemia are two conditions that get worse when you have your period. Others include breast tenderness, mood issues, and bloating. Some people have headaches and other period symptoms during their inactive pill week. If you’re one of them, it could make sense for you to delay your period as long as possible.

Of course, you need to check with your doctor to see if the 91-day pill is right for you. And even though there don’t seem to be many issues in delaying your period, there could be some potential drawbacks. If you only get your period four times a year, it may be tough to know if you’re pregnant. So it’s important to watch for symptoms like breast tenderness, fatigue, and nausea, especially in the morning. Take a pregnancy test if you think you may be pregnant, and see your health care provider.

Birth control pills are generally safe for most healthy people. But a tiny percentage of those who use combination hormone pills (those that contain estrogen) can be at risk for things like blood clots, heart issues like high blood pressure or heart attacks, deep vein thrombosis, and even stroke.

One of the biggest complaints that women have when taking hormonal birth control is breakthrough bleeding. Like a typical 21-day plan, extended-use birth control can cause some light bleeding. This can go away as your body adjusts to the extended-use cycle.

The problem is also more common among those who smoke. Smoking raises your risk of blood clots and stroke if you take any type of birth control pill, so see your doctor if you need help to quit.

Taking your pills at the same time each day can also help stop breakthrough bleeding.

You and your doctor should discuss your individual risk factors. If you can’t take a pill that combines hormones, there are other birth control options.

The Affordable Care Act has done away with out-of-pocket costs for contraception methods, including extended-use pills, for most people with insurance. But you might have to pay out-of-pocket for certain pill brands and types that have other covered alternatives. Your best bet is to talk to your doctor and your insurance provider about coverage.