I am going through menopause and my periods vary 1-6 days later each month (making it the 25th of the month). I have 2 very big events at that time in June and July AND DO NOT WANT my period during those weeks.
When would I start the pill in order to have my periods come mid-month, rather than the end of the month?
I would think you could take combined pills continuously from sometime early in June until late in July.
Have you been told to avoid birth control pills containing an estrogen? Are you on combined pills at the present time? What else do you want me to know?
Her reply on 4-26: “I am on no birth control pills at all as of now. The dates that I do not want my period are: the week of June 20th through the 27th and July 20th through the 27th. I would like to have my period mid-month to avoid any bloating around those dates.
I have YAZ, not Yasmin, but have not started it. I started my period today. Should I begin the YAZ today, which will be Sunday; skip the white pills and go on to the next pack, or begin the YAZ mid-cycle (around May 10th) and take them as scheduled with the white pills? I worry about breakthrough bleeding.”
“Thank you so much!”
Take your YAZ continuously until June 14th, and then stop for about 4 days. Then take another 21 YAZ pills from June 19th through July 9th. Then stop for about 4 days. Restart a new pack of pills on about July 13th or 14th. This should cover you for both time spans when you do not want to be bleeding.
You may find some of the following info of interest and perhaps of help, too:
11. Combined Oral Contraceptives by Anita L. Nelson, MD
Extended cycle use. Studies have clearly documented that the majority of the pill’s “side effects” (such as headache, cramping, breast tenderness, bloating and/or swelling) occur during the week women are taking their placebo pills, not when they are not taking hormone pills.[i][i] Because recent surveys have shown that many women would prefer to bleed less frequently than once a month,[ii][ii] it is time to re-evaluate the need for monthly withdrawal bleeding.[iii][iii] Fifty percent of Italian women without menstruation-related symptoms said they wanted to lessen the frequency of menstrual periods; half of them wanted amenorrhea.[iv][iv]
The purpose of menstruation in spontaneously cycling women is to end the prior unsuccessful cycle (no pregnancy) and to prepare for the next cycle (which may result in pregnancy). COC users are trying to avoid pregnancy. They have no biological need to endure artificial pill-induced withdrawal bleeding on a monthly basis. Unless the patient wants to use bleeding as a reassurance that she is not pregnant, monthly cycling is not necessary; it is not healthy and may be avoided by extended COC use.[v][v]
In clinical studies, women with prolonged flow had fewer menstrual-related problems with extended cycle use,[vi][vi] and the majority of those women continued to use the extended cycle.[vii][vii] A recent Cochrane review reported that five out of six studies found that women’s bleeding patterns were equivalent or improved with continuous-dosing regimens.[viii][viii] A regimen of extended pill use with extra packs of pills is cost-effective for women with menorrhagia.[ix][ix] Trials with extended cycles with levonorgestrel, norethindrone, and drospirenone have all demonstrated safety and efficacy.[x][x],[xi][xi],[xii][xii] [dk1] [dk1]Other women for whom extended use would be particularly attractive are those with dysmenorrhea or menstrual migraines, and those on active military duty or who have other types of demanding jobs.
Options for extended use include the following:
• Brief manipulation of a cycle for convenience such as for a honeymoon, trip, athletic event, camping experience, business meetings, exams or presentations.
• “Bi-cycling”, which is the back-to-back use of 2 packs of active pills by taking the first pack of 21 active pills, throwing away the 7 placebo pills in that first pack and immediately starting the second pack of 21 active pills followed by the 7 placebo pills at the end of the second package.
• “Tri-cycling”, meaning taking the 21 active pills from 3 packages followed by the 7 placebo pills from the third package.
• Taking FDA-approved products for extended cycle use. Two products are now available to reduce the number of withdrawal bleeds to 4 times per year. Another product that provides 12 months (13 cycles) of active pills is awaiting FDA approval.
• No-cycling, meaning taking active pills indefinitely (for many months or years) with no placebo pills as long as the woman has no troublesome spotting. Any strong progestin monophasic pills may be used in this off-label manner, but extra prescriptions are needed.
Menstrually-Related Health Benefits
1. Decreased dysmenorrhea. COCs significantly decrease menstrual cramps and pain. Although the original studies that demonstrated this benefit were based on high-dose formulations, low-dose formulations have also been shown to help when given in the conventional cyclic fashion.[xiii][xiii] COC use reduces the incidence of all degrees of dysmenorrhea by 60%.[xiv][xiv] The worse a woman’s problems are, the more effective the pill is. Severe dysmenorrhea is reduced by almost 90%.[xv][xv] In a randomized clinical trial, low-dose COC users reported fewer absences from school and work and used less pain relief medicine than placebo users. Even more significant relief from dysmenorrhea can be achieved by continuous or extended cycle COC use, which eliminates withdrawal periods for months.
2. Decreased menstrual blood loss. COCs decrease the number of days of bleeding and the amount of blood women lose each cycle. In women with menorrhagia, high-dose COC use reduced blood loss by 53%.[xvi][xvi] In studies with low-dose COCs (30 mcg EE), menstrual blood loss and duration of flow were also decreased.[xvii][xvii] Overall, a 38% to 49% reduction in menstrual blood loss was seen in another study with a 30 mcg EE preparation.[xviii][xviii],[xix][xix] In addition, nearly 50% of women experienced a reduction in duration of menstrual bleeding with COC use.[xx][xx] Women who use any of the extended cycle options reduce their numbers of withdrawal bleeds each year and further decrease their total menstrual blood loss. These features are particularly important for women with idiopathic menorrhagia, adenomyosis, and coagulation defects. Hormonal methods, including COCs, are also first-line therapies for treatment of menorrhagia due to fibroids.
3. Regulations of menses. For women using COCs cyclically, the birth control pill produces very predictable withdrawal bleeding. This predictability allows women to plan their lives around their menses, rather than having to make last minute adjustments in their schedules when their menstrual flow starts.
4. Reduction in premenstrual syndrome (PMS) symptoms. COCs can reduce menstruation-associated PMS symptoms such as mastalgia, cramping, and pain. Drospirenone-containing pills have also been shown to improve symptoms of water retention, bloating, negative affect, and increased appetite associated with menstruation.[xxi][xxi],[xxii][xxii] Extended-cycle low-dose levonorgestrel formulations may also be more effective in reducing symptoms of PMS than is reported with selective serotonin reuptake inhibitors (SSRIs).[xxiii][xxiii]
5. Reduction of premenstrual dysphoric disorder (PMDD). In a randomized double-blind placebo-controlled study, one low-dose drospirenone-containing birth control pill with 24 active pills and 4 placebo pills has been shown to significantly reduce the severity and frequency symptoms of PMDD. Both physical symptoms (P<0.001 scores) and behavioral symptoms (P=0.015) were reduced significantly more by the active treatment groups than by placebos.[xxiv][xxiv]
6. Decreased anovulatory bleeding. Low-dose COC use was associated with a more than 80% improvement in dysfunctional uterine bleeding in a randomized, double-blind, placebo-controlled study.[xxv][xxv] Anovulatory bleeding is a significant challenge for women with polycystic ovarian syndrome (PCOS), for women in the perimenopause, and for growing numbers of women with anovulatory cycles due to obesity.
[i][i]. Sulak PJ, Scow RD, Preece C, Riggs MW, Kuehl TJ. Hormone withdrawal symptoms in oral contraceptive users. Obstet Gynecol 2000;95(2):261-266.
[ii][ii]. Extended Regimen Contraception Clinical Proceedings. ARHP Clinical Proceedings. 2003 May 2. Available at: http://www.arhp.org/healthcareproviders/cme/onlinecme/extendedregimencp/index.cfm?ID=328.
[iii][iii]. Coutinho E, Segal S. Is menstruation obsolete?
[iv][iv]. Ferrero S, Abbamonte LH, Giordano M, Alessandri F, Anserini P, Remorgida V, Ragni N. What is the desired menstrual frequency of women without menstruation-related symptoms? Contraception 2006;73(5):537-541.
[v][v]. Miller L, Notter KM. Menstrual reduction with extended use of combination oral contraceptive pills: randomized controlled trial. Obstet Gynecol 2001;98(5 Pt 1):771-778.
[vi][vi]. Edelman A, Gallo MF, Nichols MD, Jensen JT, Schulz KF, Grimes DA. Continuous versus cyclic use of combined oral contraceptives for contraception: systematic Cochrane review of randomized controlled trials. Hum Reprod 2006;21(3):573-578.
[vii][vii]. 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(6):1142-1149.
[ix][ix]. Schwartz JL, Creinin MD, Pymar HC. The trimonthly combination oral contraceptive regimen: is it cost effective? Contraception 1999;60(5):263-267.
[xi][xi]. Foidart JM, Sulak PJ, Schellschmidt I, Zimmermann D; Yasmin Extended Regimen Study Group. The use of an oral contraceptive containing ethinylestradiol and drospirenone in an extended regimen over 126 days. Contraception 2006;73(1):34-40.
[xiii][xiii]. Milsom I, Sundell G, Andersch B. The influence of different combined oral contraceptives on the prevalence and severity of dysmenorrhea. Contraception 1990;42(5):497-506.
[xiv][xiv]. Mishell DR Jr. Noncontraceptive health benefits of oral steroidal contraceptives. Am J Obstet Gynecol 1982;142(6 Pt 2):809-816.
[xv][xv]. Robinson JC, Plichta S, Weisman CS, Nathanson CA, Ensminger M. Dysmenorrhea and use of oral contraceptives in adolescent women attending a family planning clinic. Am J Obstet Gynecol 1992;166(2):578-583.
[xvi][xvi]. Nilsson L, Rybo G. Treatment of menorrhagia. Am J Obstet Gynecol 1971;110(5):713-720.
[xvii][xvii]. Larsson G, Milsom I, Lindstedt G, Rybo G. The influence of a low-dose combined oral contraceptive on menstrual blood loss and iron status. Contraception 1992;46(4):327-334.
[xviii][xviii]. Fraser IS, McCarron G. Randomized trial of 2 hormonal and 2 prostaglandin-inhibiting agents in women with a complaint of menorrhagia. Aust N Z J Obstet Gynaecol 1991;31(1):66-70.
[xix][xix]. Iyer V, Farquhar C, Jepson R. Oral contraceptive pills for heavy menstrual bleeding. Cochrane Database Syst Rev 2000;(2):CD000154.
[xx][xx]. Runnebaum B, Grunwald K, Rabe T. The efficacy and tolerability of norgestimate/ ethinyl estradiol (250 micrograms of norgestimate/35 micrograms of ethinyl estradiol): results of an open, multicenter study of 59,701 women. Am J Obstet Gynecol 1992;166(6 Pt 2):1963-1968.
[xxi][xxi]. Parsey KS, Pong A. An open-label, multicenter study to evaluate Yasmin, a low-dose combination oral contraceptive containing drospirenone, a new progestogen. Contraception 2000;61(2):105-111.
[xxii][xxii]. Borenstein J, Yu HT, Wade S, Chiou CF, Rapkin A. Effect of an oral contraceptive containing ethinyl estradiol and drospirenone on premenstrual symptomatology and health-related quality of life. J Reprod Med 2003;48(2):79-85.
[xxiii][xxiii]. Freeman EW, Borisute H, Deal L, Smith L, Grubb GS, Constantine GD. A Continuous-Use Regimen of Levonorgestrel/Ethinyl Estradiol Significantly Alleviates Cycle-Related Symptoms: Results of a Phase 3 Study. Fertil Steril 2005;84 Suppl 1):S25.
[xxiv][xxiv]. Yonkers KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol 2005;106(3):492-501.
[xxv][xxv]. Davis A, Godwin A, Lippman J, Olson W, Kafrissen M. Triphasic norgestimateethinyl estradiol for treating dysfunctional uterine bleeding. Obstet Gynecol 2000;96(6):913-920.
Key Words: menopause, periods, bleeding, birth control pills, combined pills, continuously, manipulate, estrogen, YAZ, mid-month, breakthrough bleeding, cycle
Posted 5-4-2010, Updated 5-7-2010, Updated 5-9-2010