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Dr. med. Regula E.

Brki FACOG
Fachrztin fr Gynkologie
Schnzlistrasse 33
3000 Bern 25
Fax+41 (0)31 337 80 46
Tel.+41 (0)31 337 80 45

Regula.Buerki@hirslanden.com
www.regulaburki.medem.com (English)
www.regulabuerki.ch (Deutsch)

Using Birth Control Pills to Change Your Periods


Is your pill period due on the same day as that marathon you finally qualified to run? Is it
due the same week as your diving vacation or your camping trip? Or do you just hate your
periods and would rather not have any or as few of them as possible?
This article will give you some tips on how to use birth control pills to modify your periods.
The Effect of Birth Control Pills on Menstruation
Every month between menarche, the first period, and menopause, the last period, the
ovaries produce an egg. Before ovulation, while the egg matures, the ovaries secrete the
hormone estrogen; this causes the uterine lining to grow. After ovulation and release of the
egg, the ovaries begin to secrete a different hormone called progesterone. Progesterone
prepares the uterine lining for the arrival of a fertilized egg and aids the early pregnancy in
sticking to the wall of the uterus and continuing to grow. This process is called implantation.
Progesterone also is necessary for the orderly shedding of the uterine lining during
menstruation (if there is no conception in a given month).
Menstruation begins when the ovaries stop producing progesterone as they start growing a
new egg for the next month. The length of this cycle of egg and hormone production is
rather constant for an individual, but can vary from 25 and 35 days between different
women.
Ovarian function is under the control of the pituitary gland, which sends memos in the
form of hormones called gonadotropins (FSH, LH) to the ovaries to tell them what to do.
Birth control pills contain both estrogen and progesterone. When the pituitary gland notices
that there is already estrogen and progesterone in the body, it does not send any
gonadotropins out; the ovaries remain inactive, and produce neither eggs nor any
significant amount of hormones. The hormones contained in the pill also make the uterine
lining grow. Menstrual-like bleeding starts when the woman stops taking the active
hormone containing pills or switches to placebo (sugar) pills. This is not really a menstrual
period, but is called (hormone) withdrawal bleeding.
Because the newer birth control pills contain very low hormone doses, the uterine lining
they produce is thinner. As a consequence, there is less bleeding per cycle and the
duration of bleeding may be shorter as well. Most women experience less cramping on
birth control pills because the amount of prostaglandin released by the uterine lining during
menstruation is reduced. Prostaglandin is a tissue hormone that promotes cramping and
pain.
Birth control pills were invented by a catholic physician, who did not want to emphasize
their effect of suppressing ovulation, but rather stressed their usefulness in regulating the
menstrual cycle, reduce menstrual cramps, and bleeding. In fact, he personally lobbied the
Pope to endorse them for that indication. The Pope did not agree.
To stress the regulation of the menstrual cycle and because women are used to monthly
cycle, the pill cycle was set up as 21 active (hormone containing) pills, followed by 7 days
of no pills or placebo pills. Bleeding is scheduled during this 7 day interval. There is,
however, nothing magic or even particularly natural about this 28 day/4 weeks pill cycle at
all. It is not medically necessary to shed the uterine lining every month.

Using Birth Control Pills to Reduce the Number of Periods a Year:


Many women have known for years that it is possible to skip the placebo pill of a pack of
birth control pills and go directly to the next pack. The active pills can either be used
continuously or for several months at a time, followed by no more than 7 days of no pills or
placebo pills. . For most women, this works perfectly for months and even years at a time,
and the only thing they give up is the monthly bleeding as a reassuring sign that they are
not pregnant.
Doctors have also prescribed extended cycle or continued use regimens for women who
have medical conditions that are made worse by menstruation, such as endometriosis,
clotting disorders, anemia, PMS, certain types of migraines, epilepsy and arthritis.
Over the last few years several studies have been published documenting the safety of
using birth control pills in this manner. The US Food and Drug Administration (FDA)
recently approved a pill packaged for a 91 day extended cycle under the brand name of
Seasonale. It contains 84 active pills (for 12 weeks) and 7 placebo tablets. While only
this one particular product has been packaged this way and is the one that has been tested
most extensively, other birth control pill brands work just as well. Some doctors feel that
monocyclic products containing an identical hormone dose in all pills work better than
triphasic products that contain three different colored pills with different hormone doses.
While these extended cycle or continued use regimens work well for about three quarters of
women, about 25% experience a lot of unscheduled breakthrough bleeding and spotting;
they eventually give up and return to a more predictable 28 day cycle, with 21 active pill
followed by 7 placebo pills. Sometimes the body will adjust to a shorter extended use
regimen of 6 rather than 12 weeks, which is still almost half as many periods a year. The
good news is that the spotting tends to be less and less frequent as time goes on, as long
as you do not miss any pills. Any time you forget to take a pill, you greatly increase your
chance of breakthrough bleeding (and of course pregnancy as well).

Using Birth Control Pills to Move the Menstrual Period to a More Convenient Date
If you are taking your pills on a monthly schedule, because you dont mind having a period
every month and like the reassurance every month that you are not pregnant; or if you tried
taking the pills on a longer cycle, but had too much breakthrough bleeding, you can still use
the pills to move your period off an inconvenient date.
There are two ways to do this: The first is to continue with active pills for another week or
two and thus postpone the pill period. Then you stop for 7 days and have a withdrawal
bleed and start with a new pack of pills. Your next withdrawal bleed should now fall
according to the new pill pack. This generally works well, but some women will start
spotting or even bleeding during the extra week(s) they have added to the first pill pack.
If you do not want to take the chance of any unplanned bleeding or spotting, this second
way may work better for you: Instead of delaying the bleeding, you can have it come a
week early. By stopping the active pills after two weeks instead of taking all 21 pills you
cause the bleeding to start within a couple days of stopping the pills. You wait 5 to 7 days
and start a new pack. Your next period will now come according to the schedule of the new
pack. If you need to move your period by two weeks, you can do this two months in a row.
That will work better than to move it two weeks in one pill cycle.
The effectiveness of the pill as a birth control method will not be compromised by these
modifications in the pill schedule, as long as you do not go longer than 7 days without
active pills. If you start a new pill pack late or miss one or more pills during the first week of
a new pill pack, your chance of ovulating is approximately 25%.
Other non-surgical options of avoiding monthly bleeding include progesterone containing
IUDs and Depo-Provera injections. Both methods take up to a year to stop the bleeding
and neither works for more than about 50% of women.

Non-contraceptive Benefits of
Birth Control Pills
Cycle-related:

Less irregular cycles


Less cramping
Less bleeding
Less anemia
Fewer ovarian cysts

Cancer reduction:
Ovarian
Endometrial
Colorectal

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