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I've heard about taking a pill that lets you have only four cycles per year. Is that safe?

Yes, it is quite safe. Doctors have been prescribing the pill in this fashion for many years. Just recently, Barr pharmaceuticals packaged a pill called Seasonale to take advantage of this. This formulation uses the same drugs and doses we have been prescribing for decades. The same effect may be achieved with any combined contraceptive ring, patch or pill by taking the 21 hormonally active pills or 3 patches and then skipping the 7 placebo pills at the end of the pack and initiating the next pack. The packaging of the pill to provide a monthly cycle was done because marketing experts thought women would feel safer with a familiar pattern to their bleeding. There is no health benefit to this monthly withdrawal bleeding, and for some there may be significant health benefits to the extended dosing regimen. The physician may consider any patient who has symptomatic menstrual cycles a good candidate. Patients with heavy bleeding, cramping and pain should consider this after other causes have been ruled out. Patients with endometriosis, PMS, menstrual migraines and epilepsy should consider this. Ultimately, this represents another opportunity for the modern woman to stay in control. There are some side effects to adopting this regimen. The most significant side effect is breakthrough bleeding. This is also the most frequent reason given for discontinuing. With the extended regimen, greater than 25 percent will have unscheduled bleeding in the first 3-month cycle. By year's end, 80 percent have excellent cycle control, and that number continues to rise with use.

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