Endometriosis: How To Take Continuous Oral Contraceptive Pills

Taking the Pill continuously means that your child will take one active pill (containing the female hormones estrogen and progesterone) every day without a break. This will help keep the lining of their uterus very thin. They will not take any placebo (inactive) pills and they will not have a regular monthly period. They may have some irregular spotting or bleeding as their body gets used to this new medicine, especially in the first six months of treatment.

The GYN team will explain to your child how to use the Pill pack. They will be told to start taking the Pill on a Sunday, on the first day of their menstrual period, or on the day of their appointment with their gynecologist.

They should take 1 pill at the same time each day until they finishes the pack. The best time is ½ an hour after a full meal. They may feel mildly nauseous during the first month, but this usually goes away.
After completing a 21–day pack, they should immediately start a new package of pills the next day.

Please remind your child: to take their 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 tell them to take the Pill when they wakes up or before they go to sleep, as those times will likely vary on school nights and weekends.

Teens have shared creative ways to remember to take their pill such as writing a reminder on a calendar, or setting a cell phone alarm, which ensures that they take their pill at a consistent time each day. Try to think of a special way that your child can remember to take their pill.

What if my child forgets to take one or more hormonal pills?

If they miss 1 or 2 active (hormone) pills in a row, they should take the pill(s) as soon as possible and then continue taking 1 pill each day. They can take 2 pills on the same day (one at the moment they remembers and the other at the regular time) or even 2 at the same time.
If they miss 3 or more active (hormone) pills in a row, they should take all 3 hormone pills as soon as possible and then continue taking 1 pill each day.
If your child is sexually active and does not use condoms, they should call the GYN team to find out if they should also take emergency contraception (EC). They should use condoms for the next 7 days.

Note: If they are taking very low dose hormone pills with just 20ug of ethinyl estradiol and misses 2 pills, they should follow the instructions for missing 3 or more pills.

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

What if my child complains about the oral contraceptive pills that they were prescribed?

If your child is not happy with the Pill that they are taking and the effects they have on their body, please encourage them to talk to the GYN team. They should NOT just give up and stop taking the pills. Most likely their gynecologist will be able to give them a prescription for a different type of oral contraceptive pill or another type of hormonal medication. There are many types of hormonal pills and they affect people differently. Your child may like some, but not others. Be prepared that they might need to try a few different types of hormonal pills until they find the one that works best for them.

Hormonal pills (also called oral contraceptive pills) can be a very effective treatment for endometriosis. Encourage your child to ask questions about the Pill before they considers taking it.

Our health guides are developed through a systematic, rigorous process to ensure accuracy, reliability, and trustworthiness. Written and reviewed by experienced healthcare clinicians from Boston Children's Hospital, a Harvard Medical School teaching hospital and consistently ranked as a top hospital by Newsweek and U.S. News & World Report, these guides combine clinical expertise, specialized knowledge, and evidence-based medicine. We also incorporate research and best practices from authoritative sources such as the CDC, NIH, PubMed, top medical journals, and UpToDate.com. Clinical specialists and subject matter experts review and edit each guide, reinforcing our commitment to high-quality, factual, scientifically accurate health information for young people.