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Continuous Hormonal Pills


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Continuous hormonal treatment is very effective for treating endometriosis. Hormonal pills don't “cure” endometriosis but they may help with controlling pain by stopping your periods and preventing endometriosis from getting worse. Hormonal pills may also be called “birth control pills” or “oral contraceptive pills” but they are prescribed for many reasons other than to prevent pregnancy.


Hormonal pills contain the hormones estrogen and progestin, which are similar to the hormones that are normally made by the ovaries. There is also another type of pill that contains only one hormone (progestin), and is called either the “progestin-only pill” or the “mini-pill”.


Hormonal pills work by temporarily turning off your ovaries so you don't ovulate (make eggs). When you don't ovulate you don't have regular periods, and when you take hormonal pills continuously you should have periods rarely or not at all. Since periods can cause pain for anyone with endometriosis, stopping it usually improves pain.


Are there different kinds of hormonal pills?

Yes. There are many different hormonal pills that come in a lot of different packages. The shapes and colors of the packages may be different but there are just two categories of pills: combined estrogen and progestin pills (these have both estrogen and progesterone-like hormone medicine in them), and progestin-only pills that contain just progestin.


What is the difference between “active” and “inactive” hormonal pills?

Active pills contain hormone medicine. If your pill pack is in the shape of a rectangle, the pills will be in 4 rows (7 pills in each row). In most birth control pill packs, the active pills are in the first 3 rows of your pill pack. The inactive pills are in the last row of the 28/day pill pack and DO NOT contain hormone medicine. If your pill pack is round, the pills will be in a circle. The active pills are the first 21 pills and the last 7 pills are the inactive ones, and are usually a different color. There are also packages with 24, 26, and 28 pills.


Continuous use means taking active hormone pills every day without a break. Your health care provider may prescribe either the 28-day pill pack or the 21-day pill pack. There are also 24 day, 26 day and even 28 day pill packs.


21 and 28 Day Pill Pack Instructions


Do I need to take the hormonal pills at the same time every day?

Yes. Take the hormonal pill at exactly the same time every day. A good time to take the pill is at 6, 7, or 8pm every day. It's not a good idea to take the pill “when you wake up” or “before going to sleep” as those times probably vary on school nights and weekends.


You may have slight nausea the first month, but this usually goes away with time. Some teens like to take the hormonal pill first thing in the morning but they are more likely to have nausea, especially if they skip breakfast.


Ways to remember to take your pill:

What if I forget to take one or more birth control pills?

If you miss 1 or 2 active birth control pills in a row, you should take the pills(s) as soon as possible and then continue taking 1 pill each day. You can take 2 pills on the same day (one at the moment you remember and the other at the regular time) or even 2 at the same time.


If you miss 3 or more active birth control pills in a row, you should take all 3 hormone pills as soon as possible and then continue taking 1 pill each day. If you missed the pills during the third week, finish the pills in your current pack, throw away the reminder pills (inactive pills), and start a new pack of pills.


If you're sexually active and your partner doesn't use condoms, you should call your gynecologist to find out if you should also take emergency contraception (EC). Use condoms for the next 7 days.


*Note: If you're taking the very low dose hormonal pills with just 20ug of ethinyl estradiol and you miss 2 pills, you should follow the instructions for missing 3 or more hormonal pills.


Will I have a period?

If you are taking the Pill continuously, you will probably not have a period (this is the goal of taking hormonal pills continuously). Some girls may have light spotting caused from break-through bleeding. The spotting may last a few hours or up to 2-3 weeks. The bleeding is usually lighter than a normal period but it could be as heavy as a normal period. If you have break-through bleeding, continue taking the Pill as the bleeding is expected 3-4 times per year and will most likely stop on its own.


Where does the blood go?

When you are on the Pill continuously, the lining of your uterus does not build up. Therefore, you don't get your period and there is no blood. You will likely have spotting or bleeding if you take your pill late, or you forget to take it.


Hormonal pills taken continuously can be an effective treatment for endometriosis. Talk to your health care provider about the pros and cons of taking hormonal medicine. The Center for Young Women's Health offers a monthly online chat for teens and young women with endometriosis.


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Written and reviewed by the CYWH Staff at Boston Children's Hospital


Updated: 7/10/2012

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