Is it possible to delay your period? The facts vs the myths

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While we all know that periods are a healthy and normal part of being a women, there may have been times when you desperately hoped that it wouldn’t arrive when it was due. Maybe you had a holiday planned, or were slightly nervous about wearing that light coloured dress. Whatever the occasion, you might well have thought about trying to delay it. Indeed there are no strict criteria as to what entitles you to ask your doctor for help in postponing your period. It is possible, and your doctor can help with this, but successfully delaying it is not guaranteed, and not every option will be suitable for you.

The first question is why are you trying to delay your period, and for how long? Is it just a one off or are you trying to stop your periods all together? It is important to make this distinction as it will change what the best course of action is for you. If having a period is unbearable, maybe due to pain or excessive blood loss, then don’t delay things: this is abnormal and you should see your doctor and get checked out.

If you simply want to delay menstruation, or prevent it from occurring at all one month in particular, there are options. It is important not to follow any of them without consulting your doctor first.

Is taking your pill ‘back-to-back’ an option?

The combined oral contraceptive pill is commonly taken for 21 days followed by a seven day “pill free” time, during which you will experience a bleed. This bleed is not actually the same thing as a period. The hormones in the pill act to maintain the lining of the womb while you are taking it, and when the hormone levels drop during the seven day pill free break your body has a withdrawal bleed. Often women have reduced blood loss during this bleed compared to a real period, as the hormones prevent the womb lining thickening a huge amount in the first place.

It is possible to take your pill ‘back-to-back’, meaning that you start your next pack of pills as soon as the first one has finished, without having the seven day break in between. Doing this will postpone your period until you have completed the next pack of pills.

Is it safe to take your combined contraceptive pill ‘back-to-back’?

Generally, it is safe to use your pill in this way, however you should always consult the doctor who prescribed your pill to ensure that it is safe for you. Some women may consider doing this indefinitely, and while there is no evidence to say this is unsafe, there is also none to say it is safe. Generally, unless advised otherwise, you should have a bleed 2-3 times a year at least, to allow the womb lining to shed.

It is extremely important to check which type of pill you take as some forms of combined pill have different concentrations of hormones in each different pill. These are called phasic pills, and it is not possible to take these back-to-back in the same way.

If you are on the progesterone only pill, also known as the mini pill, then this is taken every day of the month, without a break. It is not possible to delay your period with this pill.

I don’t take the combined contraceptive pill – what are my options?

Norethisterone is a medication that is a synthetic progestogen, similar to the progesterone hormone that we produce naturally in our bodies. If you want to postpone your period it is possible to start taking norethisterone three days before your period is due. Your doctor will prescribe you three tablets a day that you can take for up to 20 days, delaying your period for this amount of time. You should start bleeding between two and four days after your stop taking the medication.

Progesterone sustains the lining of your womb. In a menstrual cycle, the levels of progesterone will drop, and this will cause the lining of your womb to shed and your period to occur. If progesterone, or an equivalent such as norethisterone, is taken continuously, there is no sudden drop in levels to cause shedding, thus the womb lining will be sustained and you will not have a period. Norethisterone is not a contraception, and while taking it you will still need to protect yourself using another method, such as condoms, to avoid pregnancy.

People say it’s unnatural to delay your period – is it safe or not?

Naturally, some of us will have times in our lives when we do not have regular monthly periods, such as when we are pregnant or breastfeeding. There is very little immediate difference between this and artificially stopping your period. When the combined contraceptive pill was first designed the creators wanted to mimic a woman’s ‘natural cycle’ and that is why there is a seven day break for a bleed to occur. When you take the combined pill it is not essential for you to have these bleeds. However, as stated above, unless advised by your doctor it is normally recommended that you have 2-3 bleeds a year to allow your womb lining to shed.

Ultimately, we are unsure of the longer-term effects of using hormonal medication to delay our periods as there is very little evidence available.

There can, however, be some drawbacks of trying to suspend your period. For example, women may experience breakthrough bleeding, that is bleeding at a time when they are not expecting their normal period. Often this happens due to hormonal fluctuations, therefore to minimise the chances of this happening you should take hormonal tablets, be it the contraceptive pill or norethisterone, regularly at the same time, or you may need higher doses of hormones to prevent breakthrough bleeding. If you still experience breakthrough bleeding despite this then you should consult your doctor. Breakthrough bleeding can also occur when you take your pill back-to-back for too long.

What we do know is that there are some risks and side-effects associated with the use of hormonal medication. Minor side-effects associated with hormonal contraceptives can include weight gain, bloating, breast tenderness, headaches, and acne.

Specifically, norethisterone has been associated with worsening fluid retention, which is also a side effect of progesterone, and therefore this may particularly affect you if you suffer from asthma, high blood pressure, migraines or epilepsy. Water retention is specifically worse when you use the concentrations of norethisterone needed to delay a period in this way. You cannot take either norethisterone or the combined contraceptive pill if you are at risk of developing a blood clot. It is important that your doctor goes through a thorough consultation with you to ensure these medications are suitable for you before prescribing them.

Are there any other ways of stopping my period?

Searching online brings up a huge variety of weird and wonderful ways to suspend your period, such as drinking gelatin, or even vinegar. It is important to be wary of these as there is no evidence whatsoever that they work, and it isn’t even clear how they aim to work.

However, there are a couple of alternative solutions that can help reduce the amount of blood lost or make it easier to participate in whatever event you have planned, without needing to worry about your period.

Firstly, you could consider using a flexible menstrual cup, a small plastic cup that sits inside your vagina and acts as a barrier, collecting the products of your period. It doesn’t stop your period, but is an alternative to tampons or sanitary towels. Anecdotally, some women even report being able to use the soft, disposable cups as opposed to the reusable ones as a way for ‘mess free’ sex during their period, however it is important to follow the manufacturer’s guidance.

Secondly, it is possible to reduce the amount of blood lost during a period by using medication such as ibuprofen and tranexamic acid. These drugs are not going to completely stop your period, however, and they are definitely not a contraceptive, so protection must be used at all times to avoid pregnancy.

The non-steroidal anti-inflammatory drugs (eg. ibuprofen and mefenamic acid) also have the added benefit of pain relief as they act on a substance called prostaglandin, which is partly responsible for the pain experienced during menstruation.

Tranexamic acid is an antifibrinolytic drug, which means it acts on the way your blood clots. It has been documented in studies that tranexamic acid can reduce blood loss during menstruation by up to 60%, and is more effective than the nonsteroidal anti-inflammatory drugs. So, if you are after a means of reducing your flow, it is worth consulting your doctor to see if tranexamic acid is suitable for you and your situation.

If you want to change or alter your menstrual cycle for whatever reason, it is important to consider this in plenty of time so that you can give proper consideration to all the options. Your period is also not supposed to be unmanageable, so if it is too heavy for you to deal with, or causing you a large amount of pain, it is important to go to the doctor to get checked out. Don’t try and meddle with your period without first consulting your doctor to ensure you are not doing any harm to yourself.

References

ABPI Medicines Compendium, Summary of product characteristics for Norethisterone tablets, electronic Medicines Compendium, Datapharm Communications Ltd, (2010) [website], www.medicines.org.uk, (accessed 25 September 2017).

British National Formulary, BNF 74, 74th edn., London, Pharmaceutical Press, 2017.

FSRH, Clinical Guidance: Combined Hormonal Contraception, Faculty of Sexual and Reproductive Health, 2012, https://www.fsrh.org/standards-and-guidance/current-clinical-guidance/method-specific/combined-hormonal-contraception/, (accessed 25 September 2017).

National Institute for Health and Care Excellence (NICE), Long-acting reversible contraception’, NICE Clinical Guidelines, No.30, 2014.

H. Leminen and R. Hurskainen, ‘Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety’, Int J Womens Health, Vol. 4, 2012, pp. 413-421.

Dr. Georgia Hacke MB BChir MA (Cantab)

Georgia studied her medical degree at Cambridge University. During her time there she was always interested in pursuing further studies within reproductive medicine and developmental science. Since graduating in 2015 she has worked within Cambridgeshire and Suffolk, in a variety of different hospital departments including medicine, surgery, and obstetrics and gynaecology. She is now on the pathway to start specialist training in obstetrics and gynaecology. Outside of the hospital she enjoys travelling, and ultimately she hopes to be able to take her work abroad and help promote women’s health globally.

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