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Using the Pill to Regulate Periods: How It Works

More than half of all birth control pill users in the U.S. take the pill for purposes other than or in addition to contraception. Doctors often prescribe hormonal contraceptives to manage menstrual cramps or regulate periods. 

Let’s look at the science behind these uses of hormonal contraception, together with the European Board and College of Obstetrics & Gynecology.

What’s inside the pill?

There are two main types of contraceptive pills: combined oral contraceptives (COCs) and so-called progestogen-only pills, or POPs (these also used to be called minipills). Both types contain synthetic analogs of female sex hormones. COCs have both synthetic estrogens and synthetic forms of progesterone (progestogens), while the POPs contain progestogens alone.

Female sex hormones influence the body at different levels. That’s why, apart from preventing unintended pregnancy, birth control pills can treat hormonal imbalance or mitigate symptoms related to the menstrual cycle.

Period regulation

Strictly speaking, if you are taking hormonal contraceptives, you don’t have periods. Instead, there are two different kinds of period-like bleeding that can happen.

Withdrawal bleeding is common among those who use COCs. It occurs when you take a scheduled break, stop taking pills at all, or take placebo pills for 7 days. This type of bleeding is easiest to control. It’s called withdrawal bleeding because it is induced by the withdrawal of the hormones during the break.

The other form of bleeding is called breakthrough bleeding. The name comes from the fact that the bleeding occurs while taking the pill. It happens when the inner lining of the uterus does not get enough hormones to remain stable and starts bleeding.

However, it’s not a sign of anything going wrong — just a sign that the inner lining has to adapt to the hormones.

Breakthrough bleeding is more typical for POP users because it is taken continuously without a break. It’s irregular by nature, which is why POPs are not the best choice if you want to be in control of your bleeding. Breakthrough bleeding may also occur if you miss a COC pill.

If you are having irregular periods, your doctor may prescribe you COCs to treat this condition. By releasing the right amounts of the right hormones at the right times into your bloodstream, these pills create a “hormonal contraceptive cycle” in your body. This is similar to a natural menstrual cycle, but it can be much more regular and predictable for some people.

From a medical point of view, it’s not necessary to have withdrawal bleeding every 28 days, as many contraceptive regimens suggest. In fact, it’s possible to take COCs every day with a short break every 3 months or even less often. People who do this have breakthrough period-like bleeding 4 times a year or less, on schedule.

Menstrual pain management

Painful menstrual cramps are another problem that combined oral contraceptives can solve. To understand how it works, you need to know what prostaglandins are.

What are prostaglandins?

What are prostaglandins?

Prostaglandins are substances that cause the uterine muscles to contract during your period in order to expel its inner lining - endometrium.

This mechanism is important for your reproductive health, but strong contractions can be painful. Prostaglandins also constrict blood vessels, which causes oxygen shortage in the tissues and, consequently, pain. Combined oral contraceptives address both these mechanisms. They provide relief by decreasing the amount of prostaglandins produced in the uterus, thus making the uterine contractions weaker.

An important note

Although all hormonal contraceptives contain synthetic sex hormones, they may act slightly differently. This is because there are many variations of these synthetic hormones, and their doses can be distributed differently among the pills in one pack (monophasic, biphasic, and triphasic). 

Different combinations will be the best option for different cases. That’s why it’s important that the treatment regimen is prescribed by a doctor, so that the chosen pill meets the patient’s specific needs and situation. For example, someone who has skin problems like acne would probably be prescribed different birth control than someone who has mood symptoms during their premenstrual phase. 

The same is true for hormonal IUDs, patches, shots, vaginal rings, and implants. Please consult a doctor to choose a contraceptive option that will be optimal for your body, especially if you want it to relieve any symptoms.

Bottom line

There are combined oral contraceptives approved for period regulation and period pain management. They can reduce your cramps and help you control your period-like bleeding. Just remember to consult your doctor about which pill is optimal for you.

Content created in association with EBCOG, the European Board & College of Obstetrics and Gynaecology

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