What can be done about breakthrough bleeding?
Breakthrough bleeding usually decreases with time, but there are some things you can do in the meantime:
- Stay on schedule. Missing a pill makes breakthrough bleeding more likely.
- Keep taking the pills as directed. Breakthrough bleeding isn't a sign that the pill isn't working. If you stop taking it, you risk unplanned pregnancy.
- Track breakthrough bleeding in a calendar or diary. Typically, careful tracking offers reassurance that breakthrough bleeding is decreasing.
- Ask your doctor about taking a short pill-free break. If you've taken active pills for at least 21 days, your doctor may suggest stopping for three days to allow bleeding that resembles a period and then taking the pills again for at least 21 days.
- If you smoke, ask your doctor to help you quit. Women who smoke are more likely to experience breakthrough bleeding than are women who don't smoke.
If these suggestions don't help or the breakthrough bleeding becomes heavy or lasts more than seven days in a row, contact your doctor.
Are any birth control pills specifically designed to lengthen the time between periods?
Yes. These are referred to as continuous or extended-cycle birth control pills. Among those currently available in the U.S. are:
- Seasonale, Jolessa and Quasense. With this regimen, you take active pills continuously for 84 days — or 12 weeks — followed by one week of inactive pills. Your period occurs during week 13, about once every three months.
- Seasonique and Camrese. With this regimen, you take active pills for 84 days — or 12 weeks — followed by one week of pills containing a very low dose of estrogen. Your period occurs during week 13, about once every three months. Taking low-dose estrogen pills instead of inactive pills helps reduce bleeding, bloating and other side effects sometimes associated with a hormone-free interval.
- Quartette. With this 91-day regimen, you take active pills for 84 days — or 12 weeks. Each pill contains a constant dose of progestin but the dose of estrogen gradually increases — starting with 20 micrograms (mcg), moving up to 25 mcg and moving up again to 30 mcg — at three distinct times during the regimen. Then you take one week of pills containing a very low dose of estrogen. Your period occurs during week 13, about once every three months. The gradual increase in estrogen in Quartette may decrease episodes of breakthrough bleeding experienced during early cycles of extended-cycle pills compared with other extended-cycle pills.
- Amethyst. This pill contains low doses of both progesterone and estrogen and is designed to be taken continuously for one year. There are no breaks for hormone-free intervals, which means no periods.
Can you delay your period with traditional birth control pills?
It's possible to delay or prevent your period with continuous use of any birth control pill. This means skipping the placebo pills and starting right away on a new pack. This works best with monophasic pills, which have the same amount of hormones in every pill.
Your doctor might recommend a schedule such as the following:
- Take active pills 6 weeks in a row. You'll need to use two pill packets. Take the active pills from the first packet, discard the remaining inactive pills, and then take the active pills from the second packet. Don't take a break between packets.
- Take the inactive pills from the second packet. When you've taken the active pills from the second packet, you'll have taken six weeks of active pills. Take the inactive pills from the second packet during week seven. This is when you'll have your period. To reduce withdrawal symptoms and unscheduled bleeding, your doctor may suggest taking inactive pills for only three or four days rather than the full seven days.
If you don't have unpredictable bleeding or other significant side effects, your doctor might suggest you take the active pills continuously for nine weeks in the next cycle and 12 weeks in the cycle after that.
Is it better to delay your period with 28-day birth control pills or with continuous or extended-cycle pills?
The choice of birth control pill is up to you and your doctor. Keep in mind that you can reduce withdrawal symptoms and unscheduled bleeding by taking inactive pills for only three or four days rather than the full seven days or by replacing inactive pills with low-dose estrogen pills.
Feb. 10, 2015
See more In-depth
- Kaunitz AM. Hormonal contraception for suppression of menstruation. http://www.uptodate.com/home. Accessed Jan. 6, 2015.
- Hatcher RA, et al. Contraceptive Technology. 20th ed. New York, N.Y.: Ardent Media; 2011:249.
- Edelman A, et al. Management of unscheduled bleeding in women using contraception. http://www.uptodate.com/home. Accessed Jan. 14, 2015.
- AskMayoExpert. Which products designed for monthly cycles may be used in an extended-cycle regimen? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- AskMayoExpert. Is it safe to use continuous oral contraceptives for greater than one year (i.e., no placebo pills the entire year)? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Jolessa (prescribing information). Sellersville, Pa.: Teva Pharmaceuticals; 2011. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f1076019-6f2c-4c90-9f3c-ab0c7cdd9315. Accessed Jan. 19, 2015.
- Camrese (prescribing information). Sellersville, Pa.: Teva Pharmaceuticals; 2013. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0e198d28-4986-4b93-833f-17c7ed4ce13e. Accessed Jan. 19, 2015.
- Quartette (prescribing information). North Wales, Pa.: Teva Pharmaceuticals; 2014. http://www.herquartette.com/PDFs/quartette_pi.pdf. Accessed Jan. 19, 2015.
- Darwish M, et al. A comparison of the pharmacokinetic profile of an ascending-dose, extended-regimen combined oral contraceptive to those of other extended regimens. Reproductive Sciences. 2014;21:1401.
- Nelson AL. Communicating with patients about extended-cycle and continuous use of oral contraceptives. Journal of Women's Health. 2007;16:463.
- Frederick CE, et al. Extended-use oral contraceptives and medically induced amenorrhea: Attitudes, knowledge and prescribing habits of physicians. Contraception. 2011;84:384.
- Freeman SB. Continuous oral contraception: Strategies for managing breakthrough bleeding. Advance for Nurse Practitioners. 2008;16:36.
- Amethyst (prescribing information). Corona, Calif.: Watson Pharma, Inc.; 2010. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=45825. Accessed Jan. 26, 2015.