Seasonale: Extended-cycle oral contraceptive overview

Contraceptive Seasonale

Contraceptive: Seasonale

The contraceptive Seasonale is the first product that has been approved to prevent pregnancy on a 91 day cycle, with 84 therapeutically active pills and 7 placeboes. The medication is a combined oral contraceptive, containing a form of both progesterone and estrogen, in this case, levonogestrel 0.15 mg and ethinyl estradiol 0.03 mg. The length of the cycle of the medication attempts to create a situation where the woman taking the medication only has one period every 84 or so days, reducing the number of periods per year from approximately 13, on a normal 28 day cycle to only 4 on a 91 day cycle. (DuraMed, 2003, Seasonale Insert)

Seasonale has a reliability, if taken correctly of 99% with the incidence of unexpected pregnancy with perfect use being less than 1% and with typical use being approximately 5%. (Paulo Alto Medical Foundation Website "Seasonale" 2003) This is comparable to all other forms of combined oral contraceptives a clear indication that the length of the cycle does not deter effectiveness. (DuraMed, 2003, Seasonale Insert) the incidence of unintended pregnancy does go up significantly when doses are missed, especially during crucial cycle days, yet this is also similar to 28 day cycle combined oral contraceptives.

The most significant advantage to taking Seasonale include the obvious, a reduced number of periods per year as well as decreased intensity of symptomatic periods. In a sense the indication that any form of combined oral contraceptive can be taken for such a long cycle without causing unintended or unusual side effects as compared to other COC, is a significant step in the COC offerings of the industry as it effectiveness is a testament to its use.

Some disadvantages to taking Seasonale include: like other forms of oral contraceptives it is essential to take it daily, and usually around the same time every day. Furthermore, like other forms of OCs it can cause serious side effects like, blood clots stroke and heart attack side effects which increase in risk if the patient smokes cigarettes while taking the medication. The disadvantages which are specific to Seasonale include the difficulty of awareness of unintended pregnancy without the monthly reminder of the period and additional break through bleeding in the interim of the cycle. This last disadvantage does seem to decrease with longer use but can be as long as 20 full days of spotting mid cycle with the first cycle. (Paulo Alto Medical Foundation Website "Seasonale" 2003)

Cost of Seasonale, brand medication runs between 160 and 180 dollars per 91 day packet, which works out to be about twice as expensive as typical COCs that are formulated on a 28 day cycle, though one must remember that you are also getting 14 additional therapeutic doses per 91 day cycle. Generic Seasonale has also recently been released on the market the most commonly used brand being Quasense, which costs between 120-130 per cycle, more comparable to 28 day cycle pills but still slightly higher in price. (Online Price Comparison)

Patient teaching about Seasonale must include all the general warnings about any COCs, including common side effects, missed pill complication, rare serious side effects, increased with smoking and the fact that OCs do not protect against STIs as well as detailed descriptions of the cycle difference and bleeding irregularities and what to do if a pill(s) is missed, if one or two is missed and the patient doubles the dosage for one or two days 7 days following restarting the cycle the is risk of unintended pregnancy. If three or more pills are missed the individual is instructed to not take those pills and the risk includes the missed pill days as well as the 7 days after restarting the cycle. (DuraMed, 2003, Seasonale Insert)