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Health Matters Fact Sheets

Understanding Menstrual Suppression

(Updated April 2008; Also available in Spanish)

What is menstrual suppression?

Menstrual Suppression: What it is, and how to do it
To learn more about menstrual suppression and to see how it works in your body, visit ARHP’s interactive patient tool.
Menstrual suppression, sometimes called “skipping your period,” is a way of using certain types of hormonal birth control to avoid having monthly bleeding. With many birth control pills, women take three weeks of pills containing active hormones, which prevent pregnancy by stopping ovulation (when an egg is released from a woman’s ovaries) and keeping the uterine lining thin. During the fourth week of their cycle, women take pills that do not contain active hormones; this is the time when they experience bleeding. This monthly bleeding is not a “true” period; instead, this is withdrawal bleeding – the body’s reaction to not having the hormones it gets the other three weeks of the cycle. For this reason, this fact sheet will use the term “monthly withdrawal bleeding” rather than “period.”

Hormonal contraceptives can be used by women to decide when, or if, they get their monthly withdrawal bleeding. Women may choose to have shorter or less frequent withdrawal bleeding, skip bleeding when it’s inconvenient, or eliminate bleeding completely for up to a year or more. Menstrual suppression also helps women cope with or get rid of uncomfortable side effects or conditions that are connected to their bleeding. For years, women have suppressed their periods for things like honeymoons or vacations, and new surveys show that many women are interested in bleeding less than once a month, or not at all.1,2,3

Do I have to bleed every month?

There is no evidence that shows women need monthly withdrawal bleeding, and no health problems are linked to skipping or eliminating bleeding. Studies have found that using the pill continuously for two or more cycles before having withdrawal bleeding is as safe and effective at preventing pregnancy as a traditional regimen.4

Am I a good candidate for menstrual suppression?

Any woman who wants to bleed less frequently, or not at all, can try menstrual suppression, and it may be especially appealing to women who are already on hormonal contraception. Women who may be good candidates for menstrual suppression include: women who have serious symptoms around the time of monthly withdrawal bleeding, like premenstrual syndrome (PMS); young women and adolescents; women who are perimenopausal; women in the military; athletes; or developmentally delayed women. Women who like getting monthly withdrawal bleeding for whatever reason, including to feel sure they are not pregnant may not be interested in menstrual suppression.

What are the benefits of menstrual suppression?

Women may enjoy many benefits from skipping monthly bleeding. Some of these benefits include5:

  • Less pain with monthly bleeding
  • Less heavy bleeding
  • Fewer PMS symptoms
  • Fewer perimenopausal symptoms (hot flashes, night sweats, and irregular monthly periods, etc)
  • Reduced menstrual migraines, endometriosis, and acne
  • An increased feeling of well-being

In the United States, 2.5 million women aged 18–50 years have menstrual disorders. Of these women, 31 percent report spending an average of 9.6 days in bed each year.6 By reducing the symptoms that often happen around the time of their monthly bleeding, menstrual suppression may help women feel better and have more flexibility in their lifestyle.

What are the side effects or disadvantages of suppressing bleeding?

The most common side effect of menstrual suppression is that many women have breakthrough bleeding or spotting in the first few months.7 This is less common once your body has gotten used to the new routine. Blood from spotting may be dark brown from being in the uterus longer. You should contact a clinician if you experience ACHES—Abdominal pain, Chest pain, Heavy bleeding, Eyesight or vision changes, or Severe leg pain.

How can I suppress monthly bleeding?

Oral Contraceptives

The easiest way is to change the way you take your birth control pills. Birth control pills contain the hormones estrogen and progestin, which regulate your cycle, and are taken every day at the same time to prevent pregnancy. A traditional schedule is 21 days of active pills (which contain hormones), followed by 7 days of placebo pills (which are hormone-free). During the placebo week, women go through withdrawal bleeding, which will look and feel much like a period. To suppress bleeding, a woman simply skips her 7 days of placebo pills and starts the new pill pack right away. By doing so, she skips the withdrawal bleeding entirely.

Women can suppress their withdrawal bleeding for two or more months (called extended use) or even up to a year or more (called continuous use).

Some birth control pills are specifically designed to be used for extended use. For example, Seasonale® is designed so that a woman takes 84 days (3 months) of pills containing hormones, followed by one week of placebo pills to bring on withdrawal bleeding. Using this pill, a woman would only bleed four times a year.

With a continuous use schedule, a woman might choose to bleed only once a year, or not at all. LybrelTM is a birth control pill made specifically for continuous use and packaged with an entire year of active pills.

Other Hormonal Methods

In a similar way to the pill, other birth control methods can be used to suppress monthly bleeding. The birth control injection (Depo-Provera®), one type of intrauterine device (Mirena®), and a birth control implant (ImplanonTM) also eliminate monthly bleeding, although breakthrough bleeding and spotting are still likely.8 There have been a few studies that looked at extended use with the vaginal ring (NuvaRing®) and the contraceptive patch (Ortho Evra®). While the studies found similar results as when using the pill, the FDA has not yet approved the ring and the patch for extended use.9,10

  1. Association of Reproductive Health Professionals Greenberg Quinlan Rosner Survey, July 8-13, 2005.
  2. Glasier AF, Smith KB, van der Spuy ZM, Ho PC, Cheng L, Dada K, et al. Amenorrhea associated with contraception—an international study on acceptability. Contraception 2003;67:1-8.
  3. Andrist LC, Arias RD, Nucatola D, Kaunitz AM, Musselman BL, Reiter S, et al. Women’s and providers’ attitudes toward menstrual suppression. Contraception 2004;70:359-363.
  4. Anderson FD, Hait H, the Seasonale-301 Study Group. A multicenter, randomized study of an extended cycle oral contraceptive. Contraception 2003;68:89-96.
  5. Sulak PJ, Kuehl TJ, Ortiz M, Shull BL. Acceptance of altering the standard 21-day/7-day oral contraceptive regimen to delay menses and reduce hormone withdrawal symptoms. Am J Obstet Gynecol 2002;186:1142-1149.
  6. Kjerulff KH, Erickson BA, Langenberg PW. Chronic gynecological conditions reported by US women: findings from the National Health Interview Survey, 1984 to 1992. Am J Public Health 1996;86:195-199.
  7. Anderson FD, Hait H, the Seasonale-301 Study Group. A multicenter, randomized study of an extended cycle oral contraceptive. Contraception 2003;68:89-96.
  8. Kaunitz AM. Menstruation: choosing whether…and when. Contraception 2002;62:277-284.
  9. Miller L, Verhoeven CH, Hout J. Extended regimens of the contraceptive vaginal ring: a randomized trial. Obstet Gynecol 2005;106:473-482.
  10. Stewart FH, Kaunitz AM, Laguardia KD, Karvois DL, Fisher AC, Friedman AJ. Extended use of transdermal norelgestromin/ethinyl estradiol: a randomized trial. Obstet Gynecol 2005;105:1389-1396.