| Menstrual Bleeding Changes with Different Contraceptive Methods
Some birth control methods can change a
woman's menstrual cycle. This handout explains what changes to expect with different birth
control methods and when to check with your clinician for advice. The important point to
understand about most menstrual changes with contraception is that they are to be expected
and are not harmful to the body.
If you have concerns about your menstrual
changes with your contraceptive, don't stop using it without talking to your clinician.
Often nothing is needed, but your health care provider can assess the situation and
provide treatment if necessary. Some clinicians suggest using a menstrual diary or
calendar to record menstrual changes so that you can have an objective record. The diary
will help you remember what changes have occurred so you can tell your clinician.
Oral Contraceptives or
"The Pill"
Oral contraceptives regulate menstrual cycles
to predictable lengths. Active hormones are taken every day for 3 weeks and then inactive
pills are taken during the fourth week. During the fourth week the woman will bleed. When
taking the pill, a women can anticipate when she should get her period.
The oral contraceptive pill also affects the
menstrual cycle in other ways. Many women consider these effects beneficial. One, the pill
can help reduce painful cramps. Two, women often have less bleeding during their period,
or sometimes have very little or no bleeding. Three, the pill can stop the pain some women
feel when they ovulate.
One side effect of the pill, which happens to
about 30% of women, is breakthrough bleeding. Breakthrough bleeding is bleeding or
spotting of blood between menstrual periods, which is common during the first 1 to 3
months of pill use. The bleeding may require extra pads or tampons and can be
inconvenient. The good news, however, is that this effect is likely to disappear within
the first 3 months of using the pill. So, generally, if you wait until you have taken a
few packages of pills, the bleeding in between periods will go away. Remember that
breakthrough bleeding is nor harmful, does not mean you have cancer, and will not hurt
you.
One cause of breakthrough bleeding is missing
pills; the solution is to take your pill regularly. Some evidence suggests that women who
smoke are more likely to have breakthrough bleeding than are nonsmokers.
Intrauterine Devices
(IUDs)
Two types of IUDs are available in the United
States - one containing copper and one containing progesterone. The copper-containing IUD
tents to cause increased cramping and heavier bleeding during periods. The progesterone
IUD, on the other hand, reduces cramping and bleeding. IUDs should not cause bleeding
between periods. As the uterus develops a tolerance for the copper IUD, the cramping and
bleeding may lessen.
Subdermal Implants
The most common side effect with implants is
menstrual changes. Menstrual changes occur in almost all women in the first year of use.
The changes include irregular cycles, a greater number of bleeding days, spotting between
periods and sometimes a heavier menstrual flow. These changes tend to subside with time.
Many women experience regular cycles again within a year of starting use.
Injectable
Contraception or "The Shot"
Injectable contraception's main side effect is
menstrual changes. These changes include irregular cycles, bleeding between periods, and
occasionally, heavier bleeding.
Another change, however, may be no bleeding at
all. Especially with longer duration of use, women are more likely not to bleed. By the
end of 1 year, about half of women using injectable contraception will stop having their
periods. Not getting your period is fairly common and does not mean you are pregnant. As
long as you are not pregnant before getting your first injection and have returned on time
for the next injection, it is unlikely that you are pregnant. Injecteable contraception is
99% effective when used as directed. After discontinuing this method of contraception, it
make take several months for your menstrual periods to return.
When to Call Your
Clinician
Most menstrual bleeding changes are to be
expected and not harmful. In certain situations, however, you should check with your
health care provider. For example, if you are taking oral contraceptives, are sexually
active, and have been getting regular periods and then you don't get a period, call your
clinician. Especially if you have forgotten or missed one or more pills during that cycle,
you might be pregnant. If you have been getting regular cycles and suddenly get
breakthrough bleeding, you may have missed pills or have an infection. Call your
clinician. Breakthrough bleeding may indicate a sexually transmitted disease (STD).
If you use an IUD and you have an unusually
heavy period accompanied by abdominal tenderness and/or painful intercourse or a
discharge, call your clinician. This is especially important if you have had unprotected
sex and may be at risk for an STD.
If you use subdermal implants and have been
getting regular cycles and suddenly don't get a period, call your clinician. There is a
very small chance you could be pregnant. In addition, if you have irregular bleeding which
is prolonged or heavy, an evaluation for infection is indicated. If you use implants or
injectable contraception and experience an unusually heavy flow or painful intercourse and
may be at risk for and STD, call your clinician.
Remember…
Use latex condoms to protect yourself against
STDs. Sexually transmitted infections can happen to anyone who is sexually active.
Especially if you may have been exposed to an STD and you have unusual or sudden menstrual
changes, painful intercourse or discharge, check with you clinician. Don't stop taking or
using your birth control method on your own. Always call your clinician to talk things
over. Most likely, your menstrual changes are normal and to be expected. If not, your
clinician can have you come in and examine you for any signs of infection or pregnancy. |
