Delaying your period with birth control pills

Rosalina Abboud, M.D.

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Are you interested in delaying your period, or perhaps stopping your period entirely? It's possible with birth control pills. Here, Rosalina Abboud, M.D., an obstetrician and gynecologist at Mayo Clinic, Rochester, Minn., answers common questions about delaying your period with birth control pills.

How can you use birth control pills to delay or stop your period?

A traditional pack of birth control pills contains 28 pills, but only 21 are active — containing hormones to suppress your fertility. The other seven pills are inactive. The bleeding that occurs during the week you take the inactive pills is withdrawal bleeding, which looks like a period. This is your body's response to stopping the hormones. If you skip the inactive pills and start a new pack of active pills right away, you won't have this withdrawal bleeding.

Keep in mind that oral contraceptives only mimic a natural menstrual cycle. The bleeding that occurs while you take the inactive pills isn't the same as a regular period, nor is the bleeding necessary for health. This is good news if you take birth control pills and want more control over your menstrual cycle, either for personal or medical reasons.

What are the benefits of delaying your period?

Delaying your period can treat or prevent various menstrual symptoms. The option might be worth considering at any age 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 or other menstrual symptoms during the week you take inactive birth control pills
• A physical or mental disability that makes it difficult to use sanitary napkins or tampons
• Any condition worsened by menstruation, such as endometriosis, anemia, asthma, migraines or epilepsy

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. Delaying your period may also help you save money, since you may reduce your use of hygiene products or pain relievers, as well as save the cost of missed work or doctor visits for menstrual symptoms.

What are the side effects of delaying your period?

You may notice bleeding or spotting between periods (breakthrough bleeding) when you extend the number of days between periods. Breakthrough bleeding typically decreases within a few months, however, as your body adjusts to the new regimen.

Breakthrough bleeding is especially likely if you:

• Miss a pill
• Smoke
• Start a new medication — such as certain antibiotics — that may interfere with the contraceptive
• Become ill with vomiting or diarrhea, which may impair absorption of the medication

In the meantime, continue taking the medication as directed. As long as you take the medication correctly, it's still working as a contraceptive. If you take the pill irregularly or stop taking the pill for longer than the usual seven-day break, you risk an unplanned pregnancy.

If you routinely delay your period, 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.

What's the recommended schedule for delaying your period with traditional birth control pills?

Delaying your period with 28-day birth control pills works best with pills that are monophasic — have the same amount of hormones in every pill. Your doctor might recommend a schedule such as the following:

• Take active pills six weeks in a row. You'll need to use two pill packets. Take the active pills from the first packet, discard the remaining inactive pills, and then take the active pills from the second packet. Don't take a break between packets.
• Take the inactive pills from the second packet. When you've taken the active pills from the second packet, you'll have taken six weeks of active pills. Take the inactive pills from the second packet during week seven. This is when you'll have your period. To reduce withdrawal symptoms and unscheduled bleeding, your doctor may suggest taking inactive pills for only three or four days rather than the full seven days or replacing the inactive pills with low-dose estrogen pills.

If you don't have unpredictable bleeding or other significant side effects, you might take the active pills continuously for nine weeks in the next cycle and 12 weeks in the next. Breakthrough bleeding is common until your body becomes adjusted to this schedule. If menstrual-like bleeding occurs after taking 21 days of active pills, stop taking the active pills for three days and then restart them.

If you have persistent unpredictable bleeding or other significant side effects, consult your doctor.

Are any birth control pills specifically designed to lengthen the time between periods?

Yes. In addition to manipulating your period with the way you take 28-day birth control pills, you may opt for extended-cycle birth control pills. For example:

• Seasonale. This 91-day oral contraceptive regimen is designed to give you only four periods a year. 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.
• Seasonique. As with Seasonale, this 91-day oral contraceptive regimen is designed to give you only four periods a year. 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 during week 13 helps reduce bleeding, bloating and other side effects sometimes associated with a hormone-free interval.
• Lybrel. This extended-cycle oral contraceptive — which contains a low dose of both progesterone and estrogen — is designed to be taken continuously for one year. There are no breaks for hormone-free intervals, which means no periods. Breakthrough bleeding is likely for the first few months, however. About half the women who continue taking Lybrel after one year have no bleeding as long as they continue taking the medication.

Is it better to delay your period with 28-day birth control pills or an extended-cycle regimen?

Generally, the choice of birth control pill is up to you and your doctor. Keep in mind that you can reduce withdrawal symptoms and unscheduled bleeding by taking inactive pills for only three or four days rather than the full seven days or by replacing inactive pills with low-dose estrogen pills.

Is it safe for all women to delay menstruation?

If your doctor says it's OK for you to take birth control pills, it's probably safe to use oral contraceptives to delay your period — especially if you have problems associated with menstruation. Not all doctors think it's a good idea to delay menstruation, however. Even those who support the option may not mention it unless you bring up the topic. If you want to try delaying your period, you may have to take the lead. Ask your doctor which option might work best for you.

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