Endometrial Proliferation and Heavy Menstrual Bleeding Associated With Continuous Oral Contraceptive Use

Continuous oral contraceptives are intended for three months of levonorgestrel/ethinylestradiol use followed by 10 days of low-dose ethinylestradiol. When taken for extended periods without withdrawal bleeds, side effects may include heavy menstrual bleeding and endometrial proliferation. A 41-year-old female presented to the OB-GYN clinic with two months of heavy menstrual bleeding after 10 years of Seasonique use without withdrawal bleeds (10 days of low-dose ethinylestradiol). Her endometrial thickness measured 3 mm, and luteinizing hormone and follicle-stimulating hormone levels were <0.2 mIU/mL and 0.9 mIU/mL, respectively, below the normal range for a reproductive-aged female. The patient's heavy menstrual bleeding and abnormal lab results were attributed to long-term use of Seasonique, a continuous oral contraceptive. Treatment included Nexstellis to regulate her menstrual cycles and Aygestin to induce endometrial atrophy. This case highlights the implications of long-term continuous oral contraceptive use and the importance of adhering to medication guidelines to prevent adverse effects.