Delaying your period with hormonal birth control

Are you interested in having fewer periods? It's possible with hormonal birth control. Find out how and get answers to common questions about using birth control to delay or prevent periods.

Traditional methods of birth control — including estrogen-progestin birth control pills, the contraceptive skin patch and the vaginal ring — were designed to be used in a way that mimics a natural menstrual cycle. For example, a traditional pill pack contains four weeks — or 28 days — of pills, but only the first three weeks contain hormones that actively suppress your fertility. The pills for the fourth week are inactive. The bleeding that occurs during the week you take the inactive pills is called withdrawal bleeding. This is your body's response to stopping the hormones.

Withdrawal bleeding isn't the same as a regular period. Nor is withdrawal bleeding necessary for health. This is good news if you use birth control and want to have fewer periods, either for personal or medical reasons.

In general, there are two ways to use hormonal birth control to reduce the number of periods you have:

• Continuous-use birth control is when you take active hormones for a year or longer, with no breaks. Because you do not stop taking active hormones, you do not have withdrawal bleeding.
• Extended-use birth control is when you extend the amount of time you take active hormones. You take the active hormone pills for longer than the typical 21 days. Over the course of the year, you can take breaks from the hormones. That's when you might have what seems like a period, also called withdrawal bleeding.

Several types of hormonal birth control can be used to reduce the number of periods you have. The best method for you depends on your goals and preferences — for example, whether you want fewer or no periods and whether you want short- or long-term birth control — and your overall health. Talk to your doctor about the following options.

Birth control pills

It's possible to delay or prevent your period with extended or continuous use of any combined estrogen-progestin birth control pill. Your doctor can recommend the best pill schedule for you, but generally, you skip the inactive pills in your pill pack and start right away on a new pack. However, there are also several types of birth control pills designed specifically to lengthen the time between your periods. Among those currently available in the U.S. are:

• Jolessa (generic version of Seasonale). With this regimen, you take active pills continuously for 84 days — or 12 weeks — followed by one week of inactive pills. Your period occurs during week 13, about once every three months.
• Amethia, Camrese and Simpesse (generic versions of Seasonique). With this regimen, you take active pills for 84 days — or 12 weeks — followed by one week of pills containing a very low dose of estrogen. Your period occurs during week 13, about once every three months. Taking low-dose estrogen pills instead of inactive pills helps reduce bleeding, bloating and other side effects sometimes associated with a hormone-free interval.
• Rivelsa (a generic version of Quartette). With this 91-day regimen, you take active pills for 84 days — or 12 weeks. Each pill contains a constant dose of progestin, but the dose of estrogen gradually increases — starting with 20 micrograms (mcg), moving up to 25 mcg and moving up again to 30 mcg — at three distinct times during the regimen. Then you take one week of pills containing a very low dose of estrogen. Your period occurs during week 13, about once every three months. The gradual increase in estrogen in Rivelsa may decrease episodes of breakthrough bleeding experienced during early cycles of extended-use pills compared with other extended-use pills.
• Amethyst. This pill contains low doses of both progesterone and estrogen and is designed to be taken continuously for one year. There are no breaks for hormone-free intervals.

Vaginal ring (NuvaRing)

Like combined estrogen-progestin birth control pills, it's possible to delay or prevent your period with extended or continuous use of the contraceptive vaginal ring.

Hormonal intrauterine device (Mirena, Liletta, Kyleena, others)

An intrauterine device (IUD) is a form of long-term birth control. After your doctor inserts the device into your uterus, it continuously releases a type of progestin into your body and can remain in place for up to five years. Hormonal IUDs are available in varying doses. Over time, all hormonal IUDs reduce the frequency and duration of menstrual bleeding. However, a higher dose IUD (52 mg of levonorgestrel) appears to be more effective at stopping periods entirely. For example, one year after the insertion of a 52-mg-dose IUD, 20% of women report having no periods. After two years, 30% to 50% of women report having no periods.

DMPA injection (Depo-Provera)

Depot medroxyprogesterone acetate (DMPA) is a type of progestin that you receive by injection every 90 days. It is a form of long-term birth control and also reduces or eliminates monthly bleeding. After one year of DMPA injections, 50% to 75% of women report having no periods. The longer you use DMPA, the more likely it is to stop your periods.

Delaying your period can help you manage various menstrual symptoms. It might be worth considering if you have:

• A physical or mental disability that makes it difficult to use sanitary napkins or tampons
• A condition worsened by menstruation, such as endometriosis or anemia
• Breast tenderness, bloating or mood swings in the seven to 10 days before your period
• Headaches or other menstrual symptoms during the week you take inactive birth control pills
• Heavy, prolonged, frequent or painful periods

In addition, menstrual bleeding is sometimes simply inconvenient. You may want to postpone your period until after an important exam, athletic event, vacation or special occasion, such as your wedding or honeymoon.

If your doctor says it's OK for you to take hormonal birth control, it's probably safe to use it to delay your period. Delaying menstruation remains controversial, however. Even physicians who support the option may not mention it unless you bring up the topic. If you want to try delaying your period, ask your doctor which option might work for you.

Breakthrough bleeding — bleeding or spotting between periods — is common when you use hormonal birth control to delay or prevent periods, especially during the first few months. Breakthrough bleeding typically decreases over time, however, as your body adjusts to the new regimen.

Another drawback of routinely delaying your period is that it may be more difficult to tell if you're pregnant. If you have morning sickness, breast tenderness or unusual fatigue, take a home pregnancy test or consult your doctor.

Breakthrough bleeding usually decreases with time, but there are some things you can do in the meantime:

• Stay on schedule. Missing a pill, forgetting to replace your vaginal ring or scheduling a DMPA injection late makes breakthrough bleeding more likely.
• Track breakthrough bleeding in a calendar or diary. Typically, careful tracking offers reassurance that breakthrough bleeding is decreasing.
• Go back to taking your birth control as typically prescribed. You'll likely have less breakthrough bleeding if you don't try delaying your period by skipping inactive weeks.
• If you smoke, ask your doctor to help you quit. Women who smoke are more likely to experience breakthrough bleeding than are women who don't smoke.

If you use estrogen-progestin birth control pills or the vaginal ring, taking occasional hormone-free days may help manage unscheduled bleeding. As long as you have been taking active hormones for at least 21 to 30 days, you can stop taking the pill or remove the ring whenever breakthrough bleeding becomes a problem. After three or four hormone-free days, restart your pills or reinsert the ring. Over time, the episodes of breakthrough bleeding should space out and eventually stop.

Breakthrough bleeding isn't a sign that your birth control isn't working. Be sure to keep taking your birth control — even if you experience bleeding — to lower your risk of unplanned pregnancy. If breakthrough bleeding becomes heavy or lasts more than seven days in a row, contact your doctor.