Indications for the tri-cycle regimen of OCs

British family planner John Guillebaud, MA, FRCSE, FRCOG, MFFP, medical director at the Margaret Pyke Family Planning Centre in London, has advocated tri-cycling — using three consecutive 21-day packs of monophasic OCs — for the following indications:

• headaches, including non-focal migraine, and other bothersome symptoms if they occur regularly in the withdrawal week;

• unacceptably heavy or painful withdrawal bleeds;

• epilepsy, which benefits from relatively more sustained levels of the administered hormones;

• endometriosis, where a progestin-dominant monophasic pill may be tricycled for maintenance treatment after primary therapy;

• suspicion of decreased efficacy.¹

This regimen calls for 63 consecutive days of pill-taking, followed by seven days of no pills, then resuming the dose.

Reference

1. Guillebaud J. Tri-cycling, bi-cycling, late starts, and missed pills: Creative ways to manage OC problems. Presented at Contraceptive Technology conference. San Francisco and Washington, DC; March 1996.