Seasonale is an extended-cycle combination oral contraceptive (COC) that pairs two hormones—ethinyl estradiol (an estrogen) and levonorgestrel (a progestin)—to prevent pregnancy. Its hallmark is a 91-day regimen: 84 days of active hormone tablets followed by 7 days of inactive or reminder pills. This approach reduces scheduled bleeding to roughly four times per year, compared with monthly withdrawal bleeds on traditional 28-day pills.
Like other COCs, Seasonale prevents pregnancy primarily by suppressing ovulation. It also thickens cervical mucus to hinder sperm movement and thins the endometrial lining to reduce the likelihood of implantation. When used perfectly, combined pills are among the most effective reversible methods; with typical use, effectiveness remains high but depends on consistency.
Why patients consider Seasonale: fewer periods, predictable cycles, and often lighter or less painful bleeding. Many also report fewer menstrual migraines or endometriosis-related symptoms, though individual response varies. Extended-cycle regimens can be particularly appealing for those with heavy, prolonged, or painful menses; those with anemia from monthly bleeding; athletes or frequent travelers who prefer fewer disruptions; and individuals who simply value convenience and predictability.
Seasonale is not intended to protect against sexually transmitted infections (STIs). Barrier protection such as condoms is the only method that reduces STI risk and also provides a backup contraceptive layer if pills are missed. As with any hormonal method, an individualized risk–benefit assessment with a healthcare professional is essential, especially if you have cardiovascular risk factors or migraine with aura.
Each Seasonale pack contains 91 tablets: 84 active tablets with levonorgestrel and ethinyl estradiol, followed by 7 inactive tablets. Take one tablet by mouth at the same time every day, without interruption between packs. Establishing a routine—setting a daily alarm, linking the dose to a regular activity (brushing teeth, breakfast), or using a pill reminder app—can improve consistency and effectiveness.
Starting Seasonale: There are several acceptable methods. With a Day 1 start, take your first active tablet on the first day of menstrual bleeding; no backup contraception is generally required. With a Sunday start or Quick Start (begin today regardless of cycle timing), use a backup method like condoms for the first 7 days of active pills to ensure pregnancy prevention while ovulation suppression is established. If you had unprotected sex in the past 5 days, discuss emergency contraception as appropriate before starting.
Continue taking one tablet daily through all 84 active pills and then the 7 reminder pills. Most users experience a scheduled withdrawal bleed during the reminder week; however, breakthrough bleeding or spotting can occur anytime, especially during the first cycles. Do not stop taking tablets due to spotting—doing so can compromise contraceptive protection. If you have heavy or prolonged bleeding, contact a clinician.
Transitioning from another contraceptive: If switching from another combined pill, typically start Seasonale the day after your last active pill of the prior pack. If switching from a progestin-only pill, implant, injection, or IUD, timing and backup recommendations vary; your clinician can tailor advice to maintain continuous protection. After childbirth, miscarriage, or abortion, specific start times may be recommended based on individual risk factors, breastfeeding status, and the timing of the event.
Gastrointestinal illness or malabsorption can reduce absorption. If severe vomiting or diarrhea occurs within a few hours of taking an active pill, follow missed pill guidance and use a backup method until you have taken 7 consecutive active pills after recovery. Some medications also reduce efficacy; see Drug Interactions and ask your clinician about the need for backup contraception.
Seasonale is generally safe for many healthy, nonsmoking individuals. However, combined hormonal contraceptives (CHCs) carry specific risks that must be balanced against benefits. The most serious rare risk is venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism. Risk is influenced by age, smoking, obesity, personal or family history of clots, recent surgery or immobilization, inherited thrombophilias, and certain medical conditions. The absolute risk for most healthy users remains low, but careful screening is vital.
Smoking and age: Smoking while on estrogen-containing contraception substantially increases cardiovascular risks, especially heart attack and stroke. Combined pills are contraindicated in individuals 35 years or older who smoke. Those under 35 who smoke should still consider non-estrogen options or smoking cessation support.
Migraine: Migraine with aura is a significant risk factor for ischemic stroke when combined with estrogen. People who experience migraine with aura should avoid CHCs and consider progestin-only or nonhormonal methods. For migraine without aura, risks and benefits can be individualized.
Blood pressure and cardiovascular health: Uncontrolled hypertension, established coronary artery disease, stroke history, or complicated valvular heart disease raise risks with estrogen-containing pills. Blood pressure should be measured before starting and monitored periodically during use.
Liver health and hormone-sensitive conditions: Active liver disease or hepatic tumors, as well as a history of estrogen- or progestin-sensitive cancers (such as certain breast cancers), warrant avoidance of CHCs. Additionally, those with cholestatic jaundice during pregnancy or prior pill use should exercise caution or avoid estrogen-containing formulations.
Postpartum and breastfeeding: Estrogen can reduce milk supply, particularly in the early postpartum period. For those breastfeeding, progestin-only options are usually preferred initially. CHCs are typically deferred for several weeks postpartum due to elevated clot risk; timing depends on personal risk factors and whether breastfeeding.
Diabetes, lipid disorders, and other conditions: Seasonale may be used in many individuals with well-controlled diabetes without vascular disease, but closer monitoring may be appropriate. Estrogen can affect lipid profiles; discuss if you have dyslipidemia. Conditions like systemic lupus erythematosus, inflammatory bowel disease, or immobilization may modify risk profiles.
Medication review: Provide your clinician a full list of prescription drugs, over-the-counter medicines, herbs, and supplements—especially enzyme inducers, antiepileptics, or St. John’s wort—which can lower pill levels and necessitate backup contraception.
Signs that require urgent evaluation include sudden chest pain or shortness of breath, severe leg pain or swelling, sudden severe headache, vision changes, or neurological symptoms (possible stroke or clot), and severe abdominal pain. If these occur, seek emergency care and inform providers that you use a combined oral contraceptive.
Do not use Seasonale (or any combined hormonal contraceptive) if any of the following apply unless a qualified clinician determines benefits outweigh risks and no safer alternative exists:
- Current or history of venous thromboembolism (DVT/PE), thrombophilia, or major surgery with prolonged immobilization
- History of stroke, ischemic heart disease, or serious arrhythmias; complicated valvular heart disease
- Migraine with aura at any age
- Uncontrolled hypertension; severe diabetes with vascular involvement
- Current or past estrogen- or progestin-sensitive cancers, including certain breast cancers
- Active liver disease, hepatic adenomas/carcinomas, or cholestatic jaundice related to pregnancy or prior pill use
- Pregnancy or undiagnosed abnormal uterine bleeding
- Smoking in individuals 35 years or older
Medical eligibility can be nuanced; some conditions listed as precautions or relative contraindications may be acceptable with careful monitoring. An in-depth consultation ensures the safest contraceptive choice for your health profile.
Many users tolerate Seasonale well; side effects, when they occur, are often mild and improve after a few cycles. Common effects include nausea (often reduced by taking pills with food or at night), breast tenderness, mild fluid retention or bloating, and mood changes. Spotting or breakthrough bleeding is especially common early in therapy and during the extended active-pill phase; it typically lessens with continued use. If bleeding is heavy, prolonged, or accompanied by pain, seek medical guidance.
Headaches can occur; distinguish routine mild headaches from severe or unusual headaches. Any new onset of migraine-like symptoms, especially with aura, warrants immediate evaluation and may necessitate discontinuation of estrogen-containing contraception.
Less common effects include changes in libido, acne (can improve or worsen), mild blood pressure elevation, contact lens intolerance, and skin hyperpigmentation (melasma). Maintaining stable pill timing and avoiding smoking help mitigate some risks.
Serious but rare adverse events include blood clots (deep vein thrombosis or pulmonary embolism), stroke, myocardial infarction, liver problems (including cholestatic jaundice), and gallbladder disease. Warning signs include leg swelling or pain, chest pain, sudden shortness of breath, coughing blood, severe headache, vision or speech problems, one-sided weakness or numbness, and severe upper abdominal pain. If these occur, stop taking active pills and seek emergency care immediately. Always inform clinicians you are using a combined oral contraceptive.
Seasonale does not cause infertility. Fertility typically returns quickly after discontinuation, although menstrual cycles may take a short time to normalize. If you plan pregnancy, finishing your current pack before stopping can provide a clearer last menstrual period for dating, but you may stop earlier if advised by your clinician.
Certain medicines and supplements can decrease Seasonale’s effectiveness by increasing the metabolism of ethinyl estradiol and levonorgestrel or by altering gut flora. Notable enzyme inducers include rifampin and rifabutin, some antiepileptics (such as carbamazepine, phenytoin, phenobarbital, primidone, topiramate at higher doses, and oxcarbazepine), and the herbal supplement St. John’s wort (Hypericum perforatum). During use of these agents and for a period after discontinuation (often 28 days, depending on the drug), use a reliable backup method such as condoms.
Antiretroviral therapy for HIV and certain hepatitis C regimens can interact with combined hormonal contraceptives. While many modern agents are compatible, some protease inhibitors and non-nucleoside reverse transcriptase inhibitors may affect hormone levels. Additionally, regimens containing ombitasvir/paritaprevir/ritonavir with or without dasabuvir are associated with elevated liver enzymes when taken with ethinyl estradiol—concomitant use is typically contraindicated.
Lamotrigine levels can be reduced by estrogen, potentially diminishing seizure control; dose adjustments or alternative contraception may be needed. Conversely, combined pills can modestly affect levels of certain medications (e.g., levothyroxine via increased thyroid-binding globulin, warfarin, some benzodiazepines, and corticosteroids), necessitating monitoring and dose changes.
Antibiotics that are not enzyme inducers (e.g., doxycycline, amoxicillin) generally do not reduce COC efficacy, though anecdotal concerns persist; if you prefer added assurance during antibiotic courses, using condoms is reasonable. Always provide a complete medication and supplement list to your clinician and pharmacist and ask specifically about interactions with ethinyl estradiol/levonorgestrel.
Adherence is crucial. If you miss active pills, follow these general principles for combined hormonal contraceptives. When in doubt, use condoms and contact your clinician for personalized guidance.
- If you miss 1 active pill: Take it as soon as you remember, even if that means two pills in one day. Continue the rest of the pack at your usual time. No backup is typically needed if only one active pill was missed.
- If you miss 2 or more active pills in a row: Take the most recent missed pill as soon as you remember (discard earlier missed pills), then continue one pill daily as scheduled. Use backup contraception (e.g., condoms) or abstain from sex until you have taken active pills for 7 consecutive days. If the missed pills occur near the end of the 84 active pills period (i.e., in the last week of active tablets), you may need to skip the 7 reminder pills and start a new pack immediately after finishing the active pills to maintain suppression—consult your clinician or follow package guidance.
- If you miss any of the 7 reminder pills: Discard the missed reminder and continue as scheduled. No backup is needed.
Emergency contraception may be appropriate if you missed 2 or more active pills and had unprotected sex in the previous 5 days, particularly earlier in the active-pill phase. After significant GI illness (vomiting/diarrhea) or interacting medications, treat as a missed-pill scenario and consider backup for at least 7 days of correctly taken active pills.
Accidental ingestion of multiple tablets may cause nausea, vomiting, breast tenderness, and, in females, withdrawal bleeding. Severe toxicity is uncommon. If an overdose is suspected, contact Poison Control (1-800-222-1222 in the U.S.) or seek medical attention for symptom-directed care. Keep all medications out of reach of children and pets.
Store Seasonale at room temperature away from excessive heat, moisture, and direct sunlight (avoid bathrooms). Keep tablets in their original blister packaging until use to protect from humidity and to maintain the labeled dosing order. Do not freeze. Secure the medication out of reach of children and pets. When traveling, keep your pack in a carry-on bag to avoid extreme temperatures, and bring an extra pack if you’ll be away when your next cycle is due.
In the United States, Seasonale and its generics (extended-cycle ethinyl estradiol/levonorgestrel) are FDA-approved prescription medications. Federal law requires a prescription issued by a licensed clinician to dispense these products. Some states permit pharmacists to prescribe or furnish certain hormonal contraceptives after a structured health screening; even in those programs, a clinician or pharmacist prescriber authorizes the medication. Beware of websites that advertise “no-prescription” sales or ship from unverified sources—these pose safety, quality, and legal risks.
Telemedicine has expanded access to safe, legitimate contraceptive care. Physician House Calls of Kansas offers a legal, clinician-directed pathway to obtain Seasonale through telehealth. After a confidential evaluation of your medical history, blood pressure considerations, and risk factors, a licensed provider can determine eligibility and, when appropriate, issue an electronic prescription to a pharmacy. This approach removes the need for an in-person office visit while preserving the safeguards of professional review.
Bottom line: Do not attempt to buy Seasonale without a valid prescription or outside approved channels. Instead, use licensed avenues such as your primary care clinician, gynecologist, participating pharmacists in states that allow furnishing, or reputable telehealth services like Physician House Calls of Kansas. This ensures authentic medication, individualized guidance, and ongoing support for side effects, interactions, and follow-up.
Seasonale is an extended-cycle combined oral contraceptive containing levonorgestrel and ethinyl estradiol. It uses a 91-day regimen (84 active pills followed by 7 inactive pills) so you typically have a scheduled withdrawal bleed just four times a year.
It primarily stops ovulation and also thickens cervical mucus to block sperm and thins the uterine lining, reducing the chance of implantation. These mechanisms are the same as with other combined oral contraceptives.
With perfect use, Seasonale is over 99% effective; with typical use (accounting for missed pills), effectiveness is about 93%. Its contraceptive efficacy is comparable to other combined birth control pills.
Seasonale spaces out withdrawal bleeding to once every three months rather than monthly. You still take a pill every day, but you have fewer hormone-free days and fewer periods.
People who want fewer periods, more predictable cycles, or relief from period-related symptoms like cramps, heavy bleeding, menstrual migraines, or endometriosis-related pain often prefer extended-cycle birth control. Reducing the frequency of hormone withdrawal can help some users feel more stable month-to-month.
Avoid Seasonale if you are pregnant, smoke and are 35 or older, or have a history of blood clots, stroke, certain heart conditions, migraine with aura, uncontrolled high blood pressure, severe liver disease, or estrogen-sensitive cancers. Your clinician will review your medical history to determine if a combined oral contraceptive is safe for you.
No. Seasonale does not protect against STIs; use condoms to reduce the risk of infections like chlamydia, gonorrhea, and HIV.
Common effects include nausea, breast tenderness, mild headaches, mood changes, and breakthrough bleeding or spotting—especially in the first 3–6 months. Most side effects improve with continued use; if they persist or are severe, speak with your clinician.
Though rare, blood clots, stroke, heart attack, severe high blood pressure, and liver problems can occur with combined oral contraceptives. Seek urgent care for leg swelling/pain, chest pain, shortness of breath, sudden severe headache, vision changes, or yellowing of the skin/eyes.
You can start on the first day of your period, the first Sunday after your period starts, or “quick start” on any day after a negative pregnancy test. Use backup contraception (e.g., condoms) for the first 7 days unless you start on day 1 of your period.
If you’re less than 24 hours late or miss one pill, take it as soon as you remember and continue the pack as scheduled—no backup needed. If you miss two or more active pills, take the most recent missed pill ASAP, discard the others, continue daily, and use backup for 7 days; consider emergency contraception if you missed pills in the first week and had unprotected sex. Check the patient insert for extended-cycle–specific guidance or call your pharmacist/clinician.
Most users will have a scheduled withdrawal bleed during the 7 inactive pills every 3 months. Some spotting or unscheduled bleeding can happen, especially early on, but it generally decreases after a few cycles.
Many combined oral contraceptives, including Seasonale, can reduce menstrual cramps and bleeding and may improve acne for some users. Fewer hormone-withdrawal weeks can also help with menstrual-related mood symptoms or migraines, though individual responses vary.
Combined pills can decrease milk supply early postpartum and raise clot risk; they’re generally avoided until at least 3–6 weeks after birth, and often later if breastfeeding. Progestin-only methods are typically preferred while establishing lactation—ask your clinician when it’s safe to start a combined pill like Seasonale.
Yes. Enzyme-inducing drugs (such as rifampin/rifabutin, certain anti-seizure medicines, and St. John’s wort) can reduce effectiveness; severe vomiting or diarrhea can also interfere with absorption. Use backup contraception and talk to your clinician or pharmacist about interactions.
There’s no strong evidence that combined oral contraceptives cause significant long-term weight gain. Some users notice temporary fluid retention or appetite changes, which often settle over time.
Fertility typically returns quickly after stopping Seasonale. You may have a delayed withdrawal bleed when you first stop; tracking ovulation can help if you’re trying to conceive.
Yes, especially during the first 3–6 months while your body adjusts to the extended-cycle regimen. Taking pills at the same time daily helps; if bleeding is heavy, persistent, or accompanied by pain, contact your clinician to rule out other causes.
All combined hormonal contraceptives slightly increase the risk of blood clots compared with not using hormones, but the absolute risk is still low for most healthy, nonsmoking users. Levonorgestrel-containing pills like Seasonale generally have a lower clot risk than some other progestins.
Both are 91-day extended-cycle pills with levonorgestrel 0.15 mg/ethinyl estradiol 0.03 mg for 84 days. Seasonique replaces the 7 placebo days with 7 low-dose estrogen pills (10 mcg EE), which may reduce hormone-withdrawal symptoms and unscheduled bleeding; overall efficacy is similar.
Jolessa and Quasense are generic versions of Seasonale with the same doses and 91-day regimen. They provide equivalent contraceptive effectiveness and safety; inactive ingredients and pill appearance may differ.
LoSeasonique/Camrese Lo use a lower estrogen dose in the active pills (typically 0.02 mg EE with levonorgestrel 0.10–0.15 mg) and include low-dose estrogen during the final week. Lower estrogen can mean fewer estrogenic side effects for some, but may be associated with more breakthrough bleeding.
Yes. Quartette is an extended-cycle pill with levonorgestrel and increasing doses of ethinyl estradiol across the 84 active days, followed by 7 days of 10 mcg EE. Its step-up estrogen design aims to reduce unscheduled bleeding over time; both provide quarterly scheduled bleeding.
Amethyst (formerly Lybrel) is a continuous combined pill taken every day with no placebo or low-dose estrogen week, aiming for no scheduled bleeding at all. Seasonale schedules a bleed every three months; continuous regimens may have more spotting initially but can lead to minimal bleeding long-term.
The hormone doses are similar, but traditional pills have a monthly 7-day hormone-free interval, leading to monthly withdrawal bleeding. Seasonale reduces the number of hormone-withdrawal weeks to four per year, which many users find convenient and symptom-reducing, with comparable effectiveness.
Seasonale is effectively a monophasic extended-cycle approach using the same active dose daily for 84 days. Triphasic monthly pills vary hormone levels week-to-week; neither is proven superior for pregnancy prevention, though bleeding patterns and side effects can differ.
Yaz/Yasmin use drospirenone (with antimineralocorticoid activity) and may help with acne, bloating, or PMDD symptoms for some users. Observational data suggest levonorgestrel pills like Seasonale may have a slightly lower blood clot risk than drospirenone pills; individual tolerability varies.
Ortho Tri-Cyclen (norgestimate/EE) has FDA approval for acne, but many combined pills, including Seasonale, can improve acne. Choice often depends on desired bleeding schedule, side-effect profile, and personal response rather than acne efficacy alone.
Yes. You can typically switch by starting the new pill the day after your last active pill (or after the placebo week if moving to monthly packs). Use backup for the first 7 days when switching outside the first 5 days of a natural period or if pills were missed.
Yes. Taking monophasic packs back-to-back without the placebo week achieves an extended-cycle similar to Seasonale. Seasonale offers a convenient prepackaged 91-day schedule, but stacking is an effective off-label approach many clinicians recommend.
Amethia and Camrese are brand or generic versions of Seasonique-style regimens (84 active levonorgestrel/EE pills + 7 low-dose EE pills). Compared with Seasonale’s 7 inactive pills, they may reduce withdrawal symptoms and spotting for some users; effectiveness is comparable.
Yes. Generics like Jolessa, Quasense, and Introvale are typically less expensive and widely covered by insurance. Most users do well on generics because the active ingredients and doses match the brand-name Seasonale.
Some users report less unscheduled bleeding with Seasonique-style packs that include 7 days of low-dose estrogen instead of placebo. However, individual patterns vary; unscheduled bleeding usually improves after 3–6 months with either regimen.