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Delaying your period through oral contraceptives
Wish your period didn't come every month? It doesn't have to if you adjust your schedule of birth control pills. A Mayo Clinic expert explains about delaying your period.
By Mayo Clinic staff
Here's how delaying your period with oral contraceptives works: A pack of oral contraceptives contains 28 pills, but only 21 are active — containing hormones to suppress your fertility. The other seven pills are inactive (placebo), and the bleeding that occurs during this week is your body's response to having the hormones taken away. If you take active pills all month, you won't bleed.
Want to know more? Rosalina Abboud, M.D., an obstetrician and gynecologist at Mayo Clinic, Rochester, Minn., answers common questions about delaying your period.
Controlling the timing of a menstrual period is sometimes called menstrual manipulation. What, exactly, does that mean?
Menstrual manipulation refers to changing the way you take birth control pills (oral contraceptives) so that you delay your period or stop menstruation. This is good news for women who are able to take oral contraceptives and who want more control over their menstrual cycles.
Most women live comfortably with monthly menstruation and even appreciate the predictability of a cycle that reassures them their bodies are working as they should. But for some, avoiding menstruation has some medical or personal benefits.
When you take traditional 28-day oral contraceptives, you experience monthly bleeding as the result of stopping the hormones. This bleeding is not the same as having a regular period, nor is the bleeding necessary for health. 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.
Are there any oral contraceptives on the market that you can take that lengthen your menstrual cycle?
Yes. 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.
Finally, there's Lybrel. 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.
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:
- 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.
- 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.
Does it make a difference whether you take Seasonale, Seasonique or your currently prescribed oral contraceptive for delaying your periods?
There may not be a difference in delaying menstruation. However, 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.
Next page(1 of 2)
- Steinauer J, et al. Extended cycle combined hormonal contraception. Obstetrics and Gynecology Clinics of North America. 2007;34(1):43-55.
- Sulak J. Continuous oral contraception: Changing times. Best Practice & Research Clinical Obstetrics and Gynaecology. 2008;22(2):355-374.
- Nelson A. Communicating with patients about extended-cycle and continuous use of oral contraceptives. Journal of Women's Health. 2007;16(4):463-470.
- Archer DF. Menstrual-cycle-related symptoms: A review of the rationale for continuous use of oral contraceptives. Contraception. 2006;74(5):359-366.
- Memmel L, et al. Contraception. In: Gibbs RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:567-585.
- Anderson FD, et al. Long-term safety of an extended-cycle oral contraceptive (Seasonale): A 2-year multicenter open-label extension trial. American Journal of Obstetrics & Gynecology. 2006;195(1):92-96.
- McCarthy L, et al. Levonorgestrel/ethinyl estradiol (Lybrel) for continuous contraception. American Family Physician. 2008;77(2):222.
- Contraception. The Merck Manuals Online Medical Library: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec18/ch255/ch255b.html. Accessed Sept. 4, 2008.
