Kids Health Info

Oral Contraceptives - Skipping periods when taking the Pill


  • A guide to taking the oral contraceptive pill continuously.

    What is the Pill?

    The Pill, also known as the oral contraceptive pill (OCP), combined oral contraceptive pill (COC) or birth control pill, is a daily medication that contains hormones to change the female menstrual pattern and to prevent pregnancy. Most pill packets have 21 hormone pills, known as ‘active pills’, and seven ‘sugar’, or placebo, pills. Some newer types of the Pill have 24 hormone pills and four sugar pills.  A menstrual period usually starts a couple of days after taking the sugar pills and is prompted to start by a fall in hormone levels.  Sugar pills have no active ingredients; they are simply part of the packet to help you stay in the habit of taking one pill every day.

    ‘Cyclical use’ and ‘continuous use’ of the Pill

    The Pill is usually taken so that a menstrual period or withdrawal bleed will happen every month, copying the pattern of a normal menstrual cycle.  This is called cyclical pill use.  

    Continuous use of the Pill is when the placebo or sugar pills in the packet are skipped.  This means that the period or withdrawal bleed is also skipped.  This is done in an effort to reduce the number of periods per year or to try to stop your periods completely.

    Reducing the number of periods may be recommended for young women with heavy or painful periods, or for those who have symptoms such as seizures, dizziness, asthma, headaches or mood disturbances that worsen with their menstrual cycle.  It may also be an option for young women with an intellectual or physical disability who find it difficult to manage their periods.

    How do I start taking the Pill continuously?

    If continuous pill use has been recommended and you are not currently taking the Pill, it is usually best to take all the pills in the first packet, including the sugar pills, and expect a period or withdrawal bleed.  Following this bleed, only take the hormone pills and ignore the sugar pills.  Move on to the next packet after 21 (or 24) days.  

    If you are already taking the Pill in a cyclical fashion, you can change to continuous usage by skipping the sugar pills when you get to them and moving straight to the next packet.

    Is taking the Pill continuously effective for contraception?

    Yes. However, it is important to remember that if the Pill is being used for contraception as well, there should be no more than one four-day pill-free period or pill break in a month. The time off the Pill (or the time taking the inactive, sugar pills) should never be longer than seven days, otherwise the risk of pregnancy may be increased. 

    If you can successfully skip a period, then you know that your ovaries are ‘switched off’, and that you have good contraception in place.

    Is the Pill only for contraception?

    No. Many women find that there are added benefits to taking the Pill. Not only can the Pill make your periods lighter, lowering your risk of anaemia (i.e. low levels of iron), but it also gives some protection against developing ovarian cancer, endometrial cancer, bowel cancer, and osteoporosis.

    The Pill can also reduce the severity of acne, the risk of ovarian cysts, problems with fibroids, and endometriosis.

    I’m taking the Pill continuously and I’ve noticed some bleeding…

    Sometimes breakthrough bleeding can occur even though you are taking the Pill continuously.  If the bleeding is light or just ‘spotting’ lasting for a day, keep taking the active pills daily as you have been. 
     
    If the light bleeding continues for more than three or four days, or is more like a moderate or heavy period and lasts for more than a day, a four day break from the Pill is recommended.  

    This involves taking no pill or taking sugar (inactive) pills for four days, during which time you should experience a proper period or withdrawal bleed. Start taking the active pills again after four days.

    Your doctor may prescribe you tranexamic acid (Cyclokapron) if the bleeding is very heavy and if it has been helpful in the past, or you can use pain relief (e.g. Ponstan, Naprogesic, Nurofen, etc.) for period pain during this time.  

    Usually the episodes of breakthrough bleeding become less and less frequent, until eventually you may only have one or two periods per year, or none at all.

    Is it safe or ‘natural’ to skip my periods?

    Yes. Skipping periods is quite safe. Pregnant women do not have a period for nine months and breastfeeding women may not have a period for up to two years, depending on how often they breastfeed their baby. 

    During pregnancy and breastfeeding it is as if the ovaries are switched off – just as they are when you are on the Pill. In the past, and in places where women still have very large families and breastfeed all their babies for extended lengths of time, women have less than 50 periods in a lifetime. It can be argued that nature had never meant women to have periods every month, year in year out, and that it is quite ‘natural’ to skip them.

    Will the hormones in the Pill affect my body in the future?

    No. Your baseline fertility and future fertility will not be affected by taking the Pill continuously or cyclically. After you stop taking the Pill, you are no longer protected from becoming pregnant.

    Oops, I forgot my pill today! What should I do?

    If a pill is forgotten but it is still within 12 hours of the usual dose time, it is considered a ‘late pill’. Take it as soon as you remember, and continue to take the Pill daily at the usual time, even if this means taking two pills on the same day. You will be protected from pregnancy.

    If you are forgetful in taking the Pill daily, or have had more than one four-day pill break in a month, you should talk to your doctor about some other contraceptive or period management options that may suit you better.

    Key points to remember

    • Using the pill to skip periods is safe and won’t cause long term problems.
    • Aim to take an active pill daily with no breaks for withdrawal bleeds.
    • If heavy or prolonged bleeding occurs, have a four day break from the active pills then restart them.
    • Contact your local doctor, gynaecologist or the hospital if you have questions or concerns.

    More information

    If there are any questions or concerns regarding use of the Pill, contact the Gynaecology Fellow via the switchboard on (03) 9345 5522.

    Kids Health Info factsheet: Brain Injury - Period management



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Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.