A continuous regimen of levonorgestrel/ethinyl estradiol for contraception and elimination of menstruation

Clinicians and patients desiring amenorrhea for therapeutic or social reasons will find continuous-use 90 μg levonorgestrel/20 μg ethinyl estradiol to be an attractive oral contraceptive dosing option. Although other formulations of oral contraceptives can be dosed in a continuous manner off-label, the convenience of a 28-day dose pack represents a major advance that will likely increase acceptability of the strategy. The availability of FDA-approved continuous-use 90 μg levonorgestrel/20 μg ethinyl estradiol will help mainstream continuous oral contraception in the same way that Preveri™ and Plan B® helped legitimize and mainstream emergency contraception. Patients wishing to use continuous 90 μg levonorgestrel/20 μg ethinyl estradiol must recognize and accept that unscheduled breakthrough bleeding is typical during the first four to six cycles of use. Control of cycle-related symptoms may emerge as an off-label indication for use.