II. Indications

  1. Menstrual Migraine
  2. Heavy Menstrual Bleeding
  3. Women wanting to reduce Menses to 4 times per year

III. Techique: Seasonal, 84 day regimen

  1. Continue active pills (no Placebo pills) until:
    1. Breakthrough bleeding or
    2. 84 days pass
  2. When active phase completed
    1. Hormone free: 5-7 days

IV. Preparations

  1. Any monophasic Oral Contraceptive may be used
    1. Simply do not take Placebo pills
    2. Much less expensive with generics ($60 per 3 months, compared with $200-300 for trade name preparations)
    3. Typical monophasic Oral Contraceptive used in seasonal Contraception (e.g. Loestrin 1/20 or Alesse)
      1. Low dose Estrogen (20-30 mcg Ethinyl Estradiol) and
      2. Progestin (e.g. Levonorgestrel, Norethindrone)
  2. Preparations marketed for seasonal regimen
    1. Seasonale (84 day regimen, same components as Levlen and Nordette)
      1. Levonorgestrel 150 mcg
      2. Ethinyl Estradiol 30 mcg
    2. Lybrel (365 day regimen without Placebo pills)
      1. Levonorgestrel 90 mcg
      2. Ethinyl Estradiol 30
    3. LoSeasonique or Amethia Lo (84 day regimen)
      1. Includes 7 additional pills containing only 10 mcg Ethinyl Estradiol
      2. Levonorgestrel 100 mcg
      3. Ethinyl Estradiol 20 mcg
    4. Quartette (84 day regimen)
      1. Four phase extended-cycle of varying Estrogen dose
        1. Includes 7 additional pills with only 10 mcg Ethinyl Estradiol
      2. Consider if breakthrough bleeding on seasonal Contraception persists beyond the first 3 months
      3. Similar to LoSeasonique (differs only in the varying Estrogen dose)
        1. Levonorgestrel 150 mcg
        2. Ethinyl Estradiol varies between 20 mcg, 25 mcg, 30 mcg, 10 mcg over 4 phases and 84 days

V. References

  1. (2013) Presc Lett 20(9): 52
  2. (2015) Presc Lett 22(10): 57

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Cost: Medications

loseasonique (on 1/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
LOSEASONIQUE TABLET Generic $1.50 each
quartette (on 1/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
QUARTETTE TABLET $4.14 each