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Extended and Continuous Use of Contraceptives to Reduce Menstruation

(Published September 2004)

Choices About Menstruation

Advances in contraception are allowing women more choices: whether to alter their menstrual cycle, the type of hormonal contraceptive they use to accomplish this, how often or whether to have a menstrual period at all (extended versus continuous use), and the number of days to menstruate. Some women may want to stop their period for a few months; others, for years. They can also decide to adjust their cycle during particular times and purposes, such as for a vacation, honeymoon, or athletic event; for menstrual conditions that can benefit from amenorrhea (see Table 1);1-3 to relieve discomfort; to reduce the costs associated with hygiene products; or simply for convenience. Women who could benefit from hormonal methods to suppress menstruation include the following:4-8

  • TABLE 1. Conditions That Can Benefit from Amenorrhea
    • Iron deficiency anemia
    • Menstrual-related migraine headaches
    • Menstrual-related seizures
    • Dysmenorrhea
    • Premenstrual syndrome and premenstrual dysphoric disorder
    • Menorrhagia
    • Idiopathic menorrhagia
    • Uterine fibroids
    • Adenomyosis
    • Coagulation/hematologic problem
    Women with menstrual-related medical or gynecologic problems
  • Adolescents
  • Perimenopausal women
  • Athletes
  • Females in the military
  • Women with mental disabilities
  • Women who choose to menstruate less frequently

“In 1977, I started to extend the use of active oral contraceptives because I had periods every 21–23 days for 7 days. My pattern was to use oral contraceptives continuously for about 4–6 months and then to have a pill-free week. Later, I was diagnosed with endometriosis, so my physician prescribed pills for extended use. I haven’t had a period for 4–5 years and have had no side effects. I really cannot think of a good reason to have a period.”
—Stella, women’s health physician assistant, age 51
__________________________
“I had been on the pill for 10 years, and then I started on an extended oral contraceptive regimen to get through my third year of medical school. I have used the extended regimen ever since, taking a pill-free week about every 3 months. And I have never had breakthrough bleeding or a rebound period. It’s convenient for me and also great for overseas travel.”
- Sybil, family practice resident, age 27

References

  1. Coutinho EM, Segal SJ. Is Menstruation Obsolete? New York, NY: Oxford University Press, 1999.
  2. Kaunitz AM. Menstruation: choosing whether…and when. Contraception 2000;62:277-284.
  3. MacGregor EA. Menstruation, sex hormones, and migraine. Neurol Clin 1997;15(1):125-141.
  4. Schneider MB, Fisher M, Friedman SB, et al. Menstrual and premenstrual issues in female military cadets: a unique population with significant concerns. J Pediatr Adolesc Gynecol 1999;12:195-201.
  5. Bennell K, White S, Crossley K. The oral contraceptive pill: a revolution for sportswomen? Br J Sports Med 1999;33:231-238.
  6. Kaunitz AM. Long-acting contraceptive options. Int J Fertil Menopausal Stud 1996;41:69-76.
  7. Kaplowitz PB, Oberfield SE. Reexamination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society. Pediatrics 1999;104(4):936-941.
  8. Kaunitz AM. Oral contraceptive use in perimenopause. Am J Obstet Gynecol 2001;185(2 Suppl):32-37.