Extended cycle combined hormonal contraceptive Extended cycle combined hormonal contraceptive Extended or continuous cycle combined oral contraceptive pills are a packaging of combined oral contraceptive pills (COCPs) that reduce or eliminate the withdrawal bleeding that would occur once every 28 days in traditionally packaged COCPs. Extended cycle use of COCPs may also be called menstrual suppression. Other combined hormonal contraceptives (those containing both an estrogen and a progestin) may also be used in an extended or continuous cycle. For example, the NuvaRing vaginal ring and the contraceptive patch have been studied for extended cycle use, and the monthly combined injectable contraceptive may similarly eliminate bleeding.
Menstrual cycle maturity is called a tertiary or Graafian follicle, and it contains the ovum. Ovulation is the second phase of the ovarian cycle in which a mature egg is released from the ovarian follicles into the oviduct. During the follicular phase, estradiol suppresses release of luteinizing hormone (LH) from the anterior pituitary gland. When the egg has nearly matured, levels of estradiol reach a threshold above which this effect is reversed and estrogen stimulates the production of a large amount of LH. This process, known as the LH surge, starts around day 12 of the average cycle and may last 48