Aug 17 2009

Hormonal Birth Control Pills to Control Menstruation

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We all know the feeling – it is the height of summer, you bought that new itsy bitsy white bikini that makes your body look stunning and you were invited to the beach by your favorite boy. It is just perfect. Then you realize that the weekend will probably be right in the middle of your period. What can you do?

Most birth control pills regulate your menstrual cycle by supplying andregulating the amount of hormones in a woman’s body.

The pill works by:

  • Preventing ovulation – No ovulation will mean no natural preparation and shedding of the uterus lining
  • Make cervical mucus sperm unfriendly
  • Make uterus lining unfavorable for implantation – Because you did not ovulate the uterus lining will not thicken naturally but under control of the pill’s hormones

The normal pack of 28 birth control pills contain 21 active pills with hormones and 7 inactive placebo pills with no hormones. When you get to these 7 inactive pills, you get your bleeding. This bleeding is not a real period and it is not necessary for health – remember that you did not ovulate and the uterus lining did not get the signal to prepare for implantation. The uterus bleeds because the hormones that stop it from doing it are withdrawn.

Oral contraceptives mimic a natural menstrual cycle. Some women find them more acceptable that way. Predictable monthly bleeding also reassures women that they aren’t pregnant.

Why would you want to have less frequent periods?

There are menstrual symptoms and medical problems that can be prevented or treated when menstrual bleeding is delayed. The option is worth considering if you have:

  • Heavy, prolonged, frequent or painful periods
  • Breast tenderness, bloating or mood swings in the seven to 10 days before your period
  • Headaches, cramps or other menstrual symptoms during the placebo week of your birth control pill
  • A disability that makes it difficult to use sanitary napkins or tampons
  • A condition worsened by menstruation, such as endometriosis, anemia, asthma, migraine or epilepsy

In addition, menstrual bleeding is sometimes simply inconvenient. You may want to make sure you’re not menstruating during your wedding or honeymoon. Or you may want to postpone your period until after an important exam, athletic event or vacation.

Birth Control Pills to Lengthen Your Cycles

Seasonale is a 91-day oral contraceptive regimen designed to give you only four periods a year. You take the active tablets continuously for 84 days — or 12 weeks — followed by one week of inactive pills (week 13). Your period occurs during week 13, about once every three months.

Seasonique is a similarly formulated oral contraceptive regimen. As with Seasonale, you get your period about once every three months. You take active pills for 84 days followed by seven days of pills containing a very low dose of estrogen, during which you experience menstrual bleeding. Using low-dose estrogen pills instead of inactive pills during week 13 could mean less bleeding, bloating or other side effects associated with a hormone-free interval.

Lybrel is a low-dose extended-use combined oral contraceptive — pills contain low doses of both a progesterone and estrogen — that’s designed to be taken continuously for one year. That means you would take one pill daily for one year, with no breaks for hormone-free intervals, and therefore no periods. However, for the first few months, on and off bleeding can occur. At the end of one year, about half of women will have no periods. Four in 10 women will continue to have spotting or even bleeding that requires wearing protective pads or panty liners.

Do it Yourself (DIY) Extended Cycles

If you want to use a 28-day oral contraceptive to delay your period, which oral contraceptive is best, and what’s the recommended schedule?

The best type of pill and schedule to use for controlling your cycle has yet to be determined. Preferably, you’d use oral contraceptives that contain 20 to 35 micrograms of estrogen (ethinyl estradiol) and that are monophasic — containing the same amount of hormones in every pill.

Delaying your period using a typical 28-day oral contraceptive might follow this schedule:

   1. Take active pills six weeks in a row — you’ll need to use two pill packets and discard the placebo week in the first pill packet.
   2. Take the inactive pills from the second pill packet and have your period during week seven.

If you don’t have any unpredictable bleeding or other significant side effects, you may be able to take the active pills continuously for nine weeks in the next cycle and 12 weeks in the next. Vaginal spotting is common until your body becomes adjusted to this schedule. If menstrual-like bleeding occurs, stop the active pills for three days and then restart them.

However, if you do have persistent unpredictable bleeding or other significant side effects, go back to the previous schedule. Until you stabilize on your new extended oral contraceptives schedule, regular follow-up with your doctor is important to address any problems or concerns you might have.

How To Choose Your Method

There may not be a difference in delaying menstruation using Seasonale, Seasonique or your currently prescribed oral contraceptive.

Seasonique’s low-dose estrogen pills taken during week 13 — the break from taking active pills — may lessen hormonal withdrawal symptoms and breakthrough bleeding. Seasonique also provides better ovarian suppression and therefore reduces pregnancy risk.

Why isn’t the ability to delay your periods promoted more widely?

Not all doctors think it’s a good idea to delay menstrual periods. Even those who support the option may not mention it to their patients. If you want to try it, you may have to take the lead. Also, some women prefer to keep their natural cycle and like the reassurance that they aren’t pregnant.

Will delaying your period cause side effects?

Limited studies have shown that for a small number of women, extended oral contraceptives have the same side effects as conventional oral contraceptives, such as breast tenderness, nausea, headache, mood changes, leg cramps, acne, bloating, weight changes and dark spots on the face.

Bleeding or spotting between periods (breakthrough bleeding) is common during the first three to four months after you start taking any oral contraceptive — particularly when you extend the number of days between periods. As your body adjusts to the hormones, though, this unpredictable bleeding should decrease. If it persists and becomes heavy or bothersome, call your doctor.

The likelihood of breakthrough bleeding increases whenever there’s a fluctuation in the level of contraceptive hormones in your system. That can happen if you miss a pill, start a new medication that may interfere with the pill, or develop an illness with vomiting or diarrhea. The same circumstances may reduce the pill’s contraceptive effect, so be sure to use a backup method of contraception for seven days afterward.

When on an extended schedule, it may be more difficult for you to tell if you’re pregnant. Take a home pregnancy test or visit your doctor if you have morning sickness, breast tenderness or unusual fatigue.

Does delaying your period increase risk of blood clots?

If you take oral contraceptives, whether on a traditional schedule or an extended schedule, you’re at increased risk of blood clots.

Know the warning signs of blood clots:

  • Severe abdominal pain
  • Chest pain
  • Coughing up blood
  • Shortness of breath
  • Sudden and severe headache
  • Eye blurring or loss of vision
  • Severe leg pain

At what age can you begin delaying your period?

You can manipulate the timing of menstruation at any age, as long as you can take oral contraceptives. Reducing the frequency of periods is certainly an option for adolescents who miss school and sports because of frequent, irregular and painful periods.

Is it safe for all women to delay menstruation?

If you can take oral contraceptives and want to reduce the frequency of your periods, it’s probably safe — especially if you have problems associated with menstruation.

Your doctor can screen you for conditions in which oral contraceptives may be risky. These include:

  • High blood pressure
  • A personal history of stroke, heart attack, blood clot or liver disease
  • Migraine with aura
  • Unexplained vaginal bleeding
  • Cancer of the breast or uterus
  • Family history of thrombosis

No oral contraceptive schedule — in fact, no oral contraceptive — is safe for women older than 35 who smoke. Oral contraceptives sharply increase the risk of heart attacks, blood clots and strokes in older women who smoke.

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