What is Yaz and how does a standard cycle work?
Yaz is a combined oral contraceptive (COC) containing two hormones: drospirenone (a progestin) and ethinyl estradiol (an estrogen). Its standard 28-day cycle includes 24 active pink tablets containing hormones and four inactive white placebo tablets. A user takes one pill daily, and during the four days of inactive tablets, the drop in hormones causes a withdrawal bleed, which mimics a menstrual period.
Unlike traditional 21-day pill packs that have seven days of placebo, Yaz's shorter placebo interval (four days) helps to maintain more consistent hormone levels. This reduces the severity of hormonal fluctuations and is one of the reasons it is also approved by the FDA for treating Premenstrual Dysphoric Disorder (PMDD) and moderate acne in women who desire contraception.
The practice of continuous Yaz use
Continuous Yaz use involves skipping the four inactive white tablets at the end of each pack and immediately starting a new pack of 24 active pink pills. By maintaining a steady level of hormones without the usual four-day break, a person can prevent the uterine lining from shedding, thereby suppressing the monthly withdrawal bleed.
For some, the goal is to skip periods for specific events or personal preference. For others, the motivation is to manage conditions that are exacerbated by monthly hormonal fluctuations, such as:
- Endometriosis: Less frequent or eliminated periods can reduce the pain associated with this condition.
- Dysmenorrhea: Continuous use can help alleviate painful and heavy menstrual bleeding.
- Premenstrual Dysphoric Disorder (PMDD): By avoiding the hormonal shifts of a regular cycle, continuous use can stabilize mood and reduce other severe PMDD symptoms.
- Menstrual-related migraines: Women who experience migraines triggered by hormonal changes during their period may find relief with continuous contraception.
Transitioning to a continuous cycle
If you are already taking Yaz in a standard cyclical way, transitioning to continuous use is simple. When you finish the 24 active tablets of your current pack, instead of taking the four inactive placebo pills, you simply start a new pack of active tablets the very next day. If you are new to Yaz, a healthcare provider might recommend completing the first month on the standard cycle before beginning continuous use.
- Initial effects: The most common side effect when starting continuous use is breakthrough bleeding or spotting, particularly during the first few months. This is your body adjusting to the new hormonal pattern and typically decreases over time.
- Managing prolonged bleeding: If heavy or prolonged breakthrough bleeding occurs, a doctor might recommend a planned short break (around four days) from the active pills to trigger a withdrawal bleed and reset the cycle. You should not do this more than once in a four-week cycle without a doctor's guidance.
Risks and considerations of continuous Yaz
While continuous use of combination oral contraceptives is generally safe for most healthy women, it is not without risks and important considerations. Because Yaz contains the progestin drospirenone, there are specific factors to be aware of.
Venous Thromboembolism (VTE): Studies have suggested that drospirenone-containing birth control pills may carry a higher risk of blood clots compared to other oral contraceptives. The risk of VTE is increased in all hormonal contraception users, especially those who smoke, are over 35, have a history of blood clots, or have other risk factors. Symptoms of a serious blood clot include chest pain, breathlessness, and swelling in the legs.
Monitoring potassium levels: Drospirenone has a mild anti-mineralocorticoid effect, which can increase potassium levels in the blood, especially for individuals with kidney, liver, or adrenal issues. Patients taking other medications that can increase potassium, such as NSAIDs or ACE inhibitors, may need to have their potassium levels checked by a doctor.
Other potential side effects: Some women may experience common side effects from continuous use similar to cyclical use, such as nausea, headaches, breast tenderness, or changes in mood. For some, these side effects may decrease over time with a consistent hormone level, while others may find they persist.
Comparison: Standard Yaz vs. Continuous Yaz
| Feature | Standard Yaz (28-day cycle) | Continuous Yaz (Skipping placebos) |
|---|---|---|
| Pill Regimen | 24 active pills, 4 placebo pills | Continuous active pills, no placebo |
| Withdrawal Bleed | Occurs monthly during placebo pills | Suppressed, no monthly bleed expected |
| Hormone Levels | Fluctuates with 4-day hormone break | More consistent, uninterrupted levels |
| Breakthrough Bleeding | Less common, usually light | Common initially, tends to decrease |
| Contraceptive Efficacy | Highly effective when used correctly | Highly effective, no less effective than standard use |
| Best For | Women who prefer or need a monthly bleed | Women with menstrual-related issues or who prefer to skip periods |
Conclusion
Yes, Yaz can be taken continuously under the guidance of a healthcare provider to effectively suppress menstrual periods. This practice is common for managing conditions like PMDD and endometriosis, or simply for personal convenience. However, patients must be aware of the specific risks associated with Yaz, particularly the potential for breakthrough bleeding and the slightly higher risk of blood clots due to the drospirenone component. Anyone considering transitioning to continuous Yaz should first consult their doctor to ensure it is the right and safest choice for their individual health profile and needs. Close monitoring for side effects, especially initially, is important for a successful transition.
