Endometriosis: How To Take Continuous Oral Contraceptive Pills


Taking the Pill continuously means that you will take one active pill (containing the female hormones estrogen and progestin) every day without a break. This will help keep the lining of your uterus very thin and treat endometriosis daily. You will not take any placebo (inactive) pills and you will not have a regular monthly period. You may have some irregular spotting or bleeding as your body gets used to this new medicine, especially in the first 3-4 months.

Continuous Pill Diagram

  1. To take the oral contraceptive pill, follow the instructions on the package. Your GYN team will also explain how to use your pill pack. You will be told to start taking the oral contraceptive pill on a Sunday, on the first day of your menstrual period, or on the day of your appointment with your gynecologist.
  2. You should take 1 oral contraceptive pill at the same time each day until you finish the pack. The best time is ½ an hour after a full meal. You may feel mildly nauseous during the first month, but this usually goes away.
  3. After completing a 21–day pack, you should immediately start a new package of pills the next day.

Do I need to take the hormonal pills at the same time every day?

Yes. Take the hormonal pill at exactly the same time* every day. A good time to take the Pill is at 6, 7, or 8pm every evening. It is not a good idea to take the Pill “when you wake up” or “before going to sleep”, as those times will vary on school nights and weekends.

*Tip: If you decide to take the pill in the morning, make sure it is at a time you will be awake on weekdays and weekends. Set your cell phone alarm to remind you to take your pill at exactly the same time every day. If you are even 20 minutes late you may bleed or have pain.

What if I forget to take one or more hormonal pills?

  • If you miss 1 or 2 active (hormone) pills in a row, take the pill(s) as soon as possible and then continue taking 1 pill each day. You may take 2 pills on the same day (one at the moment you remember and the other at the regular time) or even 2 at the same time.
Many teens find creative ways to remember to take the Pill such as writing a reminder on a calendar, or setting an alarm on their cell phone. Try to think of a special way to remember to take your pill.
  • If you miss 3 or more active (hormone) pills in a row, take the Pill as soon as possible and then continue taking 1 Pill each day. If you missed the pills in the third week, finish all the active hormone pills in your current pack, and then start a new pack of pills.
  • If you are sexually active and have missed more than 2 pills, talk to your GYN team about whether you should use emergency contraception. Use condoms or do not have sex until you have taken active (hormone) pills for 7 days in a row.
  • Note: If you are taking very low dose pills with just 20ug of ethinyl estradiol and miss 2 pills, you should follow the instructions for missing 3 or more pills.

You may have breakthrough bleeding (spotting) if you forget to take your pill on time; some people’s bodies are so sensitive that they will bleed if they take their pill just 20 minutes late. If you miss pills you may get an extra menstrual period.

What if I’m not happy with the hormonal pills that I’m taking?

If you are not happy with the hormonal pills that you are taking and the effects they have on your body, talk to your GYN team. Don’t just give up and stop taking the pills. Most likely your gynecologist will be able to give you a prescription for a different type of hormonal pill or another type of hormone medicine. There are many types of hormonal pills and they affect people differently. You may like some but not others. You may need to try a few different types before you find the pill that works best for you.

Hormonal pills can be an effective treatment for endometriosis. Ask questions before you decide to take the Pill and if you have side effects, call your GYN team.