Skipping Your Period With a Triphasic Pill, Update

Skipping your period with a triphasic pill brand, like Ortho Tri-Cyclen Lo or Trivora can be a bit of a challenge, for patient and physician alike.

To help out with this challenge, I have updated and expanded my previous posts on using a triphasic to skip a period.

Skipping Your Period With a Triphasic Pill, Part I is an introduction to the birth control Pill, and the various types of pills. Start with this post if you're not familiar with the basics.

Skipping Your Period With a Triphasic Pill, Part II covers using a triphasic Pill brand to delay, or skip the monthly bleeding. I go over five extended regimens in detail.

If you're a patient, print the regimens from Part II, or email them to your doctor, and use the information to discuss with your Ob/Gyn which regimen would be best suited to your needs.

Skip Period Regimens

Skip a period, or skipping your period on Yasmin, tricyclics, and NuvaRing are among the most common terms used by the people who find my site via search engines. So, to help these visitors, as well as my regular readers, I've decided to do a post on the regimens used to skip a menstrual period. This way, you'll have all the information in one place.

Before we start, note:

I. What follows is just an outline of the "skipping your period" (extended) regimens.

II. If you use the Pill, it's best to use a monophasic brand.

TIP: To find out if the brand you're using is monophasic, look at the pack. For a 28-day pack, if 21 pills are the same color and contain the same amount of estrogen and progestin, and 7 pills are a different color and are inactive (placebo), it's a monophasic brand.

Note: The 28-day pack, shortened placebo interval (24/4), brands Loestrin 24 Fe and YAZ are monophasics. As are the 84-day pack brand Lybrel and the 91-day pack brand Seasonale. The other 91-day pack brand, Seasonique, is a biphasic.

III. Your menstrual period and withdrawal bleeding are not one and the same thing.

When you use a combination birth control method, like the Pill, you are not skipping a menstrual period. That's because, for as long as you use such a method, you don't have a menstrual period. What you are doing is shifting the frequency of the withdrawal bleeding episode from once a month to once every few months.

The monthly menstrual period and the monthly withdrawal bleed are distinct, unrelated events.

The monthly period is the body-directed shedding of a thickened uterine lining, under the influence of fluctuating endogenous hormone levels, at set intervals (~21 days). The monthly withdrawal bleed is the user-directed artificial destabilization of a thin uterine lining, as a result of deliberately manipulating the dosage of exogenous hormones in the Pill, at arbitrarily set intervals (21 days, 49 days, 84 days, 168 days, or 336 days).

A monthly menstrual period has a [single] biological purpose: to prepare the uterine lining for pregnancy. A monthly withdrawal bleed has no physiological or biological purpose. It's a designer trick, intended mostly to appease politicians and Popes. It's a historical artifact, not a biological requirement.

IV. The most common side effect with an extended regimen is breakthrough bleeding/spotting (BTB).

V. If you plan to skip your period for a special event, it's best to plan ahead.

Extended regimens work best (less/no BTB) if you plan ahead and give your body at least three months to get used to the new regimen. This applies to both these scenarios: a) you're already using one of the methods on a regular regimen and plan to switch to an extended regimen, or b) you're not using any method and plan to start using an extended regimen.

Of course, it's not always possible to plan ahead. So, if you need to skip your period sooner rather than later, ask your doctor about the high dose, progestin-only regimen (e.g., 5 mg norethindrone acetate, 1-3 times daily). This regimen can be started anywhere from 3 weeks (preferably), to 1 week before the event.

VI. Extended regimens offer the same pregnancy protection as regular regimens.

VII. The .pdf links used in the post are to a method's prescribing information.

VIII. Most of the regimens are based on clinical experience.

IX. Finally, your doctor gives you medical advice, your blogger gives you educational information.

Here are the methods and the regimens.

MONOPHASIC PILL (Yasmin)

Yasmin (.pdf) is a combination, monophasic--estrogen (0.03 mg ethinyl estradiol) + progestin (3 mg drospirenone)--birth control pill. All active pills (21 yellow pills) contain the same amount of hormones. The placebo pills, or "sugar" pills (7 white pills) are inert.

Regular regimen: To bleed once a month

Take one active pill [yellow pill for Yasmin] per day for 21 days, followed by one placebo pill [white pill for Yasmin] for 7 days (bleeding). After the last placebo pill start a new pack.

Extended regimen: To bleed once every three months

Take one active pill [yellow pill for Yasmin] per day for 84 days, followed by one placebo pill [white pill for Yasim] for 7 days (bleeding). After the last placebo pill start another 84-day, active pill, cycle. [You'll need four pill packs per cycle for this regimen.]

TIP: To vary the bleeding interval, vary the number of packs you use. For example, to bleed every month and a half you'll need two pill packs. Take one active pill per day for 42 days, followed by one placebo pill per day for 7 days (bleeding). Or, you can start with three pill packs, and take one active pill per day for 63 days, followed by one placebo pill for 7 days (bleeding).

TRIPHASIC PILL (Ortho Tri-Cyclen Lo)

Ortho Tri-Cyclen Lo (.pdf) is a combination, triphasic--estrogen (0.025 mg ethinyl estradiol) + progestin (0.180 mg/0.215 mg/0.250 mg norgestimate)--birth control pill. All 21 active pills (7 white, 7 light blue, and 7 blue) contain the same amount of estrogen. The amount of progestin varies: the 7 white pills have 0.180 mg; the 7 light blue pills have 0.215mg; and the 7 blue pills have 0.250 mg. The placebo pills, or "sugar" pills (7 green pills) are inert.

Regular regimen: To bleed once a month

Take one active pill [7 white + 7 light blue + 7 blue pills for Orto Tri-Cyclen] per day for 21 days, followed by one placebo pill [green pill for Ortho Tri-Cyclen] for 7 days (bleeding). After the last placebo pill start a new pack.

Extended regimen:

To skip one "period" (or delay the bleeding by one week)

A) Take one active pill [7 white + 7 light blue + 7 blue pills for Orto Tri-Cyclen Lo/Ortho Tri-Cyclen] per day for 21 days. When you get to the 7 placebo pills [green pill for Ortho Tri-Cyclen Lo/Ortho Tri-Cyclen] throw them out and instead take the third week of active pills from a new pack [7 blue pills for Ortho Tri-Cyclen Lo/Ortho Tri-Cyclen].

Once you're done, either start a new pack right away (skip bleeding) or wait one week and then start a new pack (delays bleeding by one week).

[Pack #1] 7 white pills + 7 light blue pills + 7 blue pills + [Pack #2] 7 blue pills.
Start a new pack right away/Wait one week, then start a new pack.

B) Take one active pill [7 white + 7 light blue + 7 blue pills for Orto Tri-Cyclen Lo/Ortho Tri-Cyclen] per day for 21 days, followed by one placebo pill [green pill for Ortho Tri-Cyclen Lo/Ortho Tri-Cyclen] for 7 days (bleeding). After the last placebo pill wait for one week*; don't take any pills. Then start a new pack and take the 21 active pills, followed by the 7 placebo pills. [This regimen shifts the bleeding episode by one week during the second month.]

*VERY IMPORTANT: You are not protected against pregnancy during the week you delay taking the next pack. You must use an alternate birth control method (condom, diaphragm, sponge, etc.).

7 white pills + 7 light blue pills + 7 blue pills + 7 green pills.
Wait one week (no pills). [No Pregnancy Protection!]
Start a new pack.

To bleed once every three months

1. Take one active pill [7 white + 7 light blue + 7 blue pills for Orto Tri-Cyclen Lo/Ortho Tri-Cyclen] per day for 21 days. When you get to the 7 placebo pills [green pill for Ortho Tri-Cyclen Lo/Ortho Tri-Cyclen] throw them out and instead start a new pack. Repeat the regimen with the new pack; use 4 packs total. Stop for one week [either don't take any pills, or take the 7 green pills] (bleeding) then restart.

7 white pills + 7 light blue pills + 7 blue pills.
Start a new pack (take active pills only). Repeat [4 packs total].
Wait one week, then start a new pack.

TIP: To vary the bleeding interval, vary the number of packs you use.

Note: This is the regimen most likely to trigger BTB.

2. Take one active pill [7 white + 7 light blue + 7 blue pills for Orto Tri-Cyclen Lo/Ortho Tri-Cyclen] per day for 21 days. When you get to the 7 placebo pills [green pill for Ortho Tri-Cyclen Lo/Ortho Tri-Cyclen] throw them out. Start a new pack backwards, after first discarding the 7 placebo pills from this new pack [7 blue + 7 light blue + 7 white pills for Orto Tri-Cyclen Lo/Ortho Tri-Cyclen]. Repeat the regimen with the next two packs; use 4 packs total. Stop for one week [either don't take any pills, or take the 7 green pills] (bleeding) then restart.

[Pack #1] 7 white pills + 7 light blue pills + 7 blue pills + [Pack #2] 7 blue pills + 7 light blue pills + 7 white pills + [Pack #3] 7 white pills + 7 light blue pills + 7 blue pills + [Pack #4] 7 blue pills + 7 light blue pills + 7 white pills.
Start a new pack backwards (take active pills only). Repeat [4 packs total].
Wait one week, then start a new pack.

3. Start with three new packs (or two). Take the first 7 active pills [white pills for Ortho Tri-Cyclen Lo/Ortho Tri-Cyclen] from each of the three packs, for a total of 21 pills. Then take the next 7 active pills [light blue for Ortho Tri-Cyclen Lo/Ortho Tri-Cyclen] from each of the three packs, or 21 pills total. Finally, take the last set of 7 active pills [blue pills for Ortho Tri-Cyclen Lo/Ortho Tri-Cyclen] from the three packs, or 21 pills total. Stop for one week [either don't take any pills, or take the 7 green pills] (bleeding) then restart.

[Pack #1] 7 white pills + [Pack #2] 7 white pills + [Pack #3] 7 white pills + [Pack #1] 7 light blue pills + [Pack #2] 7 light blue pills + [Pack #3] 7 light blue pills + [Pack #1] 7 blue pills + [Pack #2] 7 blue pills + [Pack #3] 7 blue pills.
Stop for one week, then restart.

SKIN PATCH (Ortho Evra)

Ortho Evra (.pdf) is a combination--estrogen (0.75 mg ethinyl estradiol) + progestin (6.00 mg norelgestromin)--birth control skin patch. It releases 0.020 mg of estrogen and 0.150 mg of progestin per day.

Regular regimen: To bleed once a month

Apply one patch and leave it on for 1 week. At the end of the week, remove the patch, discard it and replace it with a new patch. Do this for 3 weeks in a row. At the end of the third week, remove and discard the last patch and wait for one week; that's the patch-free week (bleeding). Once the week is over, restart the regular [3 weeks:3 patches on/1 week off] patch regimen.

Extended regimen: To bleed every few months

Apply one patch and leave it on for 1 week. At the end of the week, remove the patch, discard it and replace it with a new patch. Do this for 8 weeks (or 12 weeks) in a row. At the end of the eighth week (or twelfth week), remove and discard the last patch and wait for one week; that's the patch-free week (bleeding). Once the week is over, restart the the extended-use [8 weeks:8 patches (or 12 weeks:12 patches) on/1 week off] patch regimen.

Note: Use of the regular patch regimen [3 weeks:3 patches on/1 week off] entails a 60% higher exposure to estrogen than use of a typical combination Pill brand containing 35 μg of estrogen on a regular regimen [21 days on/7 days off]. Although the clinical relevance of this finding is unknown, you should be aware of it before starting an extended patch regimen.

VAGINAL RING (NuvaRing)

NuvaRing (.pdf) is a combination--estrogen (2.7 mg ethinyl estradiol) + progestin (11.7 mg etonogestrel)--birth control vaginal ring. It releases 0.015 mg of estrogen and 0.120 mg of progestin per day.

Regular regimen: To bleed once a month

Insert one ring and leave it in place for 3 weeks in a row. At the end of the third week, remove the ring, discard it and wait for one week; that's the ring-free week (bleeding). Once the week is over, restart the regular [3 weeks on/1 week off] ring regimen.

Extended regimen: To bleed every few months

Insert one ring and leave it in place for 3 weeks in a row. At the end of the third week, remove the ring, discard it and replace it with a new ring right away. Keep the new ring in for 3 weeks in a row. [That's 6 weeks total.] At the end of the third week, remove the ring, discard it and either:

a) wait for one week; that's the ring-free week (bleeding). Once the week is over, restart the extended-use [6 weeks on/1 week off] ring regimen.

b) replace it with a new ring right away. Leave the new ring in place for 3 weeks in a row. At the end of the third week, remove the ring, discard it and replace it with a new ring right away. Keep the new ring in for 3 weeks in a row. [That's 12 weeks total.] At the end of the third week, remove the ring, discard it and wait for one week; that's the ring-free week (bleeding). Once the week is over, restart the extended-use [12 weeks on/1 week off] ring regimen.

TIP: You can also insert one ring and leave it in for 4 weeks in a row, instead of 3 weeks.

[At the end of the fourth week, remove the ring, discard it and replace it with a new ring right away. The rest of the extended regimen is the same as above, except you leave the ring in for 4 weeks, instead of 3 weeks, in a row.]

Note: Use of the regular ring regimen [3 weeks on/1 week off] entails a 50% lower exposure to estrogen than use of a typical combined Pill brand containing 30 μg of estrogen on a regular regimen [21 days on/7 days off]. Although the clinical relevance of this finding is unknown, you should be aware of it before starting an extended ring regimen.


UPDATE: Right after I finished posting I noticed someone found this by using the search term "secrets to delaying menstrual period". Heh, there are no secrets. Just information.

ETA: I've updated the post.

Skipping Your Period With a Triphasic Pill, Part II

You can use a triphasic pill brand to skip a period. Before we review the regimens used to skip a period with a triphasic pill brand, let me clarify a few terms.

Triphasic, Skip a Period

Combination birth control pill - each active pill has a combination of estrogen (ethinyl estradiol) and progestin (synthetic progesterone). Each placebo ("sugar") pill is inactive; it does not have hormones.

Pill brands came in 21-, 28-, and 91-day packs. The 21-day pack has only active pills. The 28- and 91-day packs have an extra 7 inactive, or placebo pills.

The placebo pills are reminder pills. They're put in the pack to get you into the habit of taking a pill every day. They serve no other purpose.

Monophasic brand - all active pills have the same amount of estrogen and progestin. All active pills are the same color. In 28-day packs, the 7 placebo pills are a different color. That's two different colored groups of pills per 28-day pack.

Triphasic brand - the active pills have either the same, or two different amounts of estrogen, and two or three different progestin amounts. All active pills with the same amount of estrogen and progestin are the same color--usually three groups of colors per 28-day pack. The 7 placebo pills are a different color. That's four different colored groups of pills per 28-day pack.

For more on monophasic vs. triphasic, see Skipping Your Period With a Triphasic Pill, Part I.

Skipping a period - when you use a combination birth control pill--monophasic or triphasic--you don't have a menstrual period for the entire time you take the pill.

The monthly bleeding you experience while on the Pill is withdrawal bleeding, a chemically induced event. This artifice was introduced for political, religious, etc. reasons by the Pill inventors; it serves no known medical function.

The menstrual period and withdrawal bleeding are not one and the same thing.

Bottom line: When you use the Pill and you modify the regular 21/7 (21 days of active pills/7 days of placebo pills during which you experience withdrawal bleeding) to an extended regimen, like the 84/7 one, you are only changing the frequency of withdrawal bleeding; from monthly, to once every three months. The regimen change has no effect on your menstrual period since, while on the Pill, you don't have a menstrual period.

Triphasic, Extended Regimen

If you want to skip your period, using a monophasic Pill brand is best.

Why? Because all monophasic active pills have the same amount of hormones. This means steady hormone levels and less likelihood of nuisance side effects like breakthrough bleeding/spotting (BTB).

BTB is not dangerous to your health (for most women) but it's a significant inconvenience (not to mention a major reason women discontinue Pill use).

Because triphasic pill brands have varying hormone levels which fluctuate--usually, from week to week--you're more likely to experience BTB if you use a triphasic brand to skip your period.

So, what are you to do?

If you're not already on the Pill, start using a monophasic brand to skip your period.

If you're already using a triphasic brand and it suits you, no need to switch to a monophasic. Go ahead and use your existing triphasic brand. If it works, great! If not, you can always change to a monophasic brand later.

Now, if you're already on the Pill, a triphasic one, you're most likely on the regular regimen: 21 days of active pills, followed by 7 days of placebo pills during which time you experience an episode of bleeding.

In order to eliminate that monthly bleeding episode, or shift its frequency (to, say, once every three months) you have to modify the regular 21/7 regimen you've been using. You need to use an extended regimen, and you have several options to chose from.

Before we go on to the actual regimens, note the following:

- no matter which regimen you chose, you're still protected against pregnancy (provided you don't miss any pills, of course)

- the regimen recommendations to follow are based on clinical experience (there are no formal studies on triphasic extended regimens)

- since Ortho Tri-Cyclen* is a commonly used triphasic brand, I'll use it to illustrate the various extended regimens

*There are 28 pills in the pack. Four groups of 7 pills, each group a different color:

White pills (seven)- each pill has 0.035 mg estrogen (ethinyl estradiol) and 0.180 mg progestin (norgestimate)

Light blue pills (seven)- each pill has 0.035 mg estrogen and 0.215 mg progestin

Blue pills (seven)- each pill has 0.035 mg estrogen and 0.250 mg progestin

Green pills (seven)- each pill is a placebo pill (no hormones)

Notice how the amount of estrogen is the same throughout the month, while the progestin amount keeps increasing.

And now, without further ado, the triphasic regimens.

Triphasic Regimens

To skip one period or delay it by one week:

A) Take the 21 active pills (first three weeks of pills). When you get to the 7 placebo pills (last week of pills) throw them out and instead take the third week of active pills from a new pack.

(Ortho Tri-Cyclen) Take 7 white pills + 7 light blue pills + 7 blue pills. That's 3 weeks and 21 pills. When you get to the 7 green pills, discard them, and take 7 blue pills from a new pack instead. Once you're done, either wait one week and then start a new pack (delays bleeding by one week), or start a new pack right away (skip bleeding).

7 white pills + 7 light blue pills + 7 blue pills + 7 blue pills (from a new pack)
Wait one week, then start a new pack/Start a new pack right away.

B) Take the 21 active pills and the 7 placebo pills (four weeks). Wait for one week**. Start a new pack and take the 21 active pills, followed by the 7 placebo pills. [This regimen shifts the bleeding episode by one week during the second month.]

**VERY IMPORTANT: You are not protected against pregnancy during the week you delay taking the next pack. You must use an alternate birth control method (condom, diaphragm, sponge, etc.).

7 white pills + 7 light blue pills + 7 blue pills + 7 green pills
Wait one week (no pills). [No Pregnancy Protection!]
Start a new pack.

To delay bleeding for months:

1. Take the 21 active pills (first three weeks of pills). When you get to the 7 placebo pills (last week of pills) throw them out and instead start a new pack.***

7 white pills + 7 light blue pills + 7 blue pills
Start a new pack (take active pills only).

***This is the regimen most likely to trigger BTB.

2. Take the 21 active pills (first three weeks of pills). When you get to the 7 placebo pills (last week of pills) throw them out. Start a new pack backwards, after first discarding the 7 placebo pills from this new pack.

[Pack #1] 7 white pills + 7 light blue pills + 7 blue pills + [Pack #2] 7 blue pills + 7 light blue pills + 7 white pills {+ [Pack #3] 7 white pills + 7 light blue pills + 7 blue pills}

3. Start with three new packs (or two). Take the first 7 active pills from each of the three packs (three weeks total). Then take the next 7 active pills from each of the three packs (three weeks). Finally, take the last set of 7 active pills from the three packs (three weeks). Stop for one week, then restart.

[Pack #1] 7 white pills + [Pack #2] 7 white pills + [Pack #3] 7 white pills + [Pack #1] 7 light blue pills + [Pack #2] 7 light blue pills + [Pack #3] 7 light blue pills + [Pack #1] 7 blue pills + [Pack #2] 7 blue pills + [Pack #3] 7 blue pills
Stop for one week, then restart.

So, there you have it. These are some of the regimen options you have if you want to use a triphasic Pill brand to skip your period.

As you can see, using a triphasic for an extended regimen can be a bit confusing. Also, you're more likely to experience BTB. So, even if you're already using a triphasic on a regular 21/7 regimen, consulting with your physician about switching to an extended regimen is most helpful.

Skipping Your Period With a Triphasic Pill, Part I

I've been getting a lot of questions about using a triphasic birth control pill brand and skipping a period. Before we discuss what regimen you use to skip your period with a triphasic Pill brand, let's make sure we're all clear on the differences between the various pill brands.

We'll discuss extended triphasic regimens in a subsequent post.

There are two groups of birth control pills:

A. Nonsteroidal (centchroman)

B. Steroidal (estrogen/progestin)

A. Nonsteroidal Birth Control Pill

This type of birth control pill contains a substance called centchroman.

The pill is taken once-a-week (twice-a-week for the first 3 months of use), the brand names are Centron or Saheli, and its main advantage is that users don't experience the side effects associated with the steroid (estrogen/progestin) pill. Its main side effect is delayed menses (in less than 10% of cycles). Of course, if the reason you're using a birth control pill is to skip your period, this is a feature not a drawback.

In any case, since this pill isn't available in the U.S., let's move on to the other Pill group, the steroidal one.

B. Steroidal Birth Control Pill

Pills in this group contain estrogen and/or progestin. The pill is taken once-a-day, and there are many brand names. More importantly, pills in this group can be further subdivided, based on what type of hormone (estrogen/progestin) they contain.

There are two main types of birth control pills in this group:

B.1. Progestin-only Pill (progestin)

B.2. Combination Pill (estrogen and progestin)

B.1. Progestin-only Pill

As the name implies, these pills have only one hormone, a progestin. A progestin is either a natural or man-made (synthetic) hormone with properties similar to the natural hormone progesterone.

Progestin-only pill brands are divided into "mini" pill brands, and full-dose brands (not available in the U.S.). As a rule, "mini" pill brands come in 28-day packs, and full-dose ones come in 20-day packs.

Progestin-only brands are not your first choice when it comes to skipping your period.

B.2. Combination Pill

These pills have two hormones, a combination of estrogen and progestin.

Combination Pill brands are further subdivided into mono-, bi-, and triphasic; some come in a 21-day pack, others in a 28-day one, and the newer ones, Seasonale and Seasonique, comes in a 91-day pack. Finally, based on the amount of estrogen, brands are classified as very low-dose (15 mcg or 20 mcg), low dose (35 mcg), and high dose (50 mcg).

All the pills in a 21-day pack are active. An active pill is a pill which has hormones. The 28- and 91-day packs have 7 days of inactive or placebo ("sugar") pills. These pills don't have hormones.

The mono-, bi-, and triphasic designation refers to the amount of hormones in the pill pack.

Monophasic

Brevicon

Each active pill in the pack has the same amount of estrogen and progestin. Also, all the active pills are the same color. This color is a different color than that of the 7 placebo pills found in the 28- and 91-day packs.

Biphasic

Mircette

For most brands, all the active pills in the pack have the same amount of estrogen, but two strengths of progestin.

A 21-day biphasic pack has pills of one strength and color taken for seven or 10 days, then a second pill with a different strength and color for the remainder of the cycle.

A 28-day biphasic pack has an extra seven placebo pills of a third color.

For a 28-day brand like Mircette, a pack has 21 pills of one strength [20 mcg ethinyl estradiol (EE)/0.15 mg desogestrel] and color, 2 placebo pills of a different color, and 5 pills with only estrogen, of a different strength [10 mcg (EE)] and color.

Of note, Mircette is one of the few available sequential brands with a shortened placebo interval: 2 days vs. 7 days. The shortened placebo interval has to do with withdrawal bleeding (fake period) which is different from menses (real period). [More on birth control pill brands with no or shortened placebo interval.]

Triphasic

Ortho Tri-Cyclen Lo

The active pills have either the same or varying amounts of estrogen, and varying amounts of progestin.

A 21-day pack has pills with three different colors and strengths. First, pills of one strength and color are taken for five to seven days. Then pills of a different strength and color are taken for the next five to seven days. Finally, a third strength and color pill is taken for the reminder of the cycle.

A 28-day pack (look under triphasics) has an extra seven placebo pills of a fourth color.

So, there you have it. Lots of birth control pill types, and brands. The important thing to remember is this:

To skip a period a monophasic brand is best.

A monophasic combination Pill brand is best because all active pills contain the same amount of hormones. Less hormonal fluctuation, due to the steady hormone levels, means you're less likely to experience nuisance side effects like irregular bleeding (breakthrough bleeding/spotting).

TIP: Regardless of which type of brand you use--monophasic or triphasic--starting an extended regimen at least three months in advance of the time you plan to skip your period allows your body to get used to the new regimen, and minimizes irregular bleeding.

If you use a monophasic Pill brand, to skip a period you take the 21 active pills, discard the 7 placebo pills, and start a new pack right away.

If you use a triphasic Pill brand you have several regimen options. One of them is to use the same regimen used for the monophasic brands--take the 21 active pills, discard the 7 placebo pills, and start a new pack right away. [Note: this regimen is mostly likely to be associated with irregular bleeding.]