Regimens and patient information

Combined hormonal contraceptive regimens

Type of regimen	Period of CHC use	HFI
Standard use	21 days (21 active pills, 1 ring, or 3 patches)	7 days
Tailored use
Shortened hormone-free interval	21 days (21 active pills, 1 ring, or 3 patches)	4 days
Extended use (tricycling)	9 weeks (3 sets of 21 active pills, 3 rings, or 9 patches used consecutively)	4 or 7 days
Flexible extended use	Continuous use (more than 21 days) of active pills, patches, or rings until breakthrough bleeding occurs for 3 to 4 days	4 days
Continuous use	Continuous use of active pills, patches, or rings	None

The above table is reproduced under licence from FSRH.
Copyright Faculty of Sexual & Reproductive Healthcare January 2019.

Key messages for women considering use of tailored regimens

The evidence from studies is that combined hormonal contraception (CHC) is as safe and at least as effective for contraception if it is taken as an extended or continuous regimen as it is when taken in a traditional 21/7 cycle.
A woman who is using CHC does not need to have a monthly withdrawal bleed to be healthy.
There is no build-up of menstrual blood inside a woman who uses CHC for an extended time without a break; extended CHC use keeps the lining of the womb thin.
Withdrawal bleeds during cyclical use of CHC have been reported by women who are pregnant; women should not consider monthly bleeds on CHC to be reassurance that they are not pregnant.
By using extended or continuous CHC the frequency of withdrawal bleeds and associated symptoms, e.g., headache or mood change, is reduced; this could be useful for women who have heavy or painful bleeding or problematic symptoms associated with hormone-free interval (HFI).
The ovaries start to become active during the traditional 7-day HFI. Fewer and/or shorter breaks in CHC use could mean that the risk of pregnancy could theoretically be lower with extended or continuous regimens than if a 7-day break is taken every month.
There can be irregular bleeding or spotting in the first few months of CHC use, particularly with extended or continuous regimens; this does not usually mean that there is any medical problem and usually improves with time.
The evidence from studies is that using extended or continuous regimens of CHC does not affect the return of a woman's fertility when she stops CHC.

The above text is reproduced under licence from FSRH.
Copyright Faculty of Sexual and Reproductive Healthcare 2006 to 2016.