Frequently Asked Questions
  Home

Frequently Asked Questions

 

Women's Stories

 

Period Planner

 

Research Opportunities

 

Links to Related Sites

 

Health Provider Information

 

About Us

 

Contact Us

 
What is a period?
How many periods do women have?
What about when a woman's period stops on its own?
What controls the natural menstrual cycle?
How does pregnancy happen?
Why do you have period bleeding when using birth control pills?
What birth control pill works best to stop the period?
What do I have to do to skip my periods on birth control pills?
Is it safe to skip your period on the pill?
I don't want to have my period during my honeymoon. Help Me!
When to call your health care provider about your period.

What is a period?

A period is one name for the monthly bleeding or menstrual cycle of reproductive aged women. The period happens because pregnancy did not happen and the lining of the uterus, which got thick with blood to prepare for pregnancy, is lost because it is not needed. Because of the bleeding the lining becomes thin and needs to be repaired by the body. More hormones will make the lining thick to prepare again to become pregnant. The whole point of having periods is to be able to get pregnant. Blood and tissue build up in the inside of the uterus to get ready for pregnancy. If pregnancy does not happen then the hormones drop and bleeding begins. A woman loses about 2-4 tablespoons (25-60 ml) of blood each month. Ten percent of women lose 80 ml or more blood with each period and anemia (low blood count) can result.

How many periods do women have?

Periods happen to women from menarche, the beginning of having periods, until menopause, which is defined as no period for 1 year. So if a woman begins her periods at age 13 she could have periods until age 50 or for 37 years. Most women have a period every month or every 28 days. Some women have their period every 26 days and other women have their period at longer intervals, up to every 34 days. What is important is that the period is regular and that it starts every month around the same time and within 5 days of the last time. Women with a regular monthly period will have 13 cycles each year of her reproductive life. A woman with regular periods could have up to 450 periods in her lifetime.

What about when a woman's period stops on it's own?

Women can stop their period naturally because of pregnancy. Women do not have periods during pregnancy. If a woman then breast feeds her baby exclusively, gives the baby no bottle or pacifier, the frequent suckling will make the woman's period stop for at least 3 to 6 months. Amenorrhea, the stopping of the period for more than 6 months, can also happen if there are problems like being underweight, overweight, sick, stressed, or even addicted to drugs; these are all examples of things that can shut off ovulation and the regular menstrual cycle. Healthy reproductive aged (defined as 15 to 44) women not using hormone medications, should have regular periods and women with amenorrhea or irregular periods should see a doctor to find out the reason for the problem. Menopause happens in half of women by age 50. Menopause is when a woman has not had a period for 1 year and tests can prove the ovaries are no longer making the female hormones and are not able to produce an egg for reproduction.

What controls the natural menstrual cycle?

Only women capable of a menstrual cycle can get pregnant naturally. The body makes chemicals and proteins called neurotransmitters and hormones which create the menstrual cycle. The neurotransmitters from the brain tell the pituitary, an organ found in the brain, to make and release protein signals that go to the ovary where an egg is developed. Estrogen is made by the ovary to help the egg develop and after the egg is released (ovulation) progesterone is made by the ovary. Both estrogen and progesterone are the female hormones that regulate the menstrual bleeding from the uterus. Estrogen makes the inside lining of the uterus get thick and full of blood vessels. Progesterone then matures the cells lining the inside of the uterus and causes the cells to fill with chemicals which will be needed. This is all to prepare for pregnancy. If a pregnancy does not happen, then the progesterone and estrogen hormone levels drop. Without enough progesterone the cells lining the inside of the uterus break open, release prostaglandin chemicals and bleeding begins. These chemicals are what cause cramping and bleeding during the period. By the time the period bleeding is done the ovaries have begun to make another egg to prepare for yet another possible pregnancy.

How does pregnancy happen?

The menstrual cycle causes the ovary to make an egg that is released by the ovary (ovulation). The fallopian tubes make a wave like action and sweep the egg into the tube where it can meet with sperm. The egg must be fertilized within 24 hours. Sperm can live up to 5 days in the uterus waiting for an egg to be released or sperm can swim up to meet an egg within 5 minutes of ejaculation. Fertilization happens when an egg cell and a sperm cell join to make an embryo. The embryo then travels to the inside of the uterus where it grows into the lining of the uterus (called implantation), and it is now called a pregnancy. Once the embryo is implanted it makes a hormone called human chorionic gonadotropin (hCG) which is what makes the pregnancy test turn positive. The hCG hormone also goes to the ovary and makes the ovary continue to make progesterone and estrogen to support the lining of the uterus and the pregnancy. Eventually the placenta (what may later be called the afterbirth) will take over from the ovary to make the hormones needed to keep the pregnancy.

Why do you have period bleeding when using birth control pills?

The birth control pill usually contains 2 hormones, a synthetic estrogen and synthetic progesterone. These outside hormones turn off the woman's ovaries so her ovaries do not make an egg and cause the mucus of the cervix to thicken to prevent sperm from entering the uterus. Because the body is not getting ready to be pregnant the lining of the uterus does not get thick and the amount of bleeding with a period on the pill is about 1/3 of the amount of blood lost (1 tablespoon or 15 ml) compared to women not using the pill. The pill does not make something build up inside the uterus. The pill actually prevents uterine lining overgrowth and the pill will help prevent uterine cancer by keeping the lining thin. Most birth control pill packages contain 21 hormone pills followed by 7 pills which contain no hormone, called the pacebo or spacer pills. This means a woman usually takes 21 days of hormone pills and then 7 days of no hormone pills. The period happens during the hormone free week and is called withdrawal bleeding. Women on birth control pills bleed because they did not take the pills with estrogen and progesterone, these hormone levels drop, and this makes the lining of the uterus weak so it bleeds. Bleeding on the birth control pill is not needed to prevent a pregnancy because the primary mechanism of preventing a pregnancy is to prevent an egg from being made or fertilized.

What birth control pill works best to stop the period?

All birth control pills with enough progestin can shut off the ovaries while the pill is taken. The estrogen in the pill helps to control spotting or irregular bleeding. But not too much estrogen because it is estrogen that builds the blood lining. Since the pill will be taken every day without a week off then it makes sense to use the lowest dose of pill available. Each pill should have the same amount of estrogen and progestin in each pill for every day of use. This means the phasic or pill packages with many different colors of pills will make your hormone levels go up and down each week and this can cause more irregular bleeding. My study of continuous birth control pill use was with the brand Alesse (20 mcg ethinyl estradiol and 100 mcg levonorgestrel) which is now available under several generic brand names like Levlite and Aviane. The progestin norethindrone may have less irregular bleeding with continuous use and the brand LoEstrin 1/20 has been available as a generic pill for many years and at this time seems to be the best "recipe" for continuous use especially if spotting on the levonorgestrel type pills. What we really need are pills in a bottle, 31 identical pills, just like a thyroid or hormone medication and to develop drug or hormone testing similar to the monitoring for individualizing seizure medications or for thyroid replacement with the goal to adjust the dosing depending on the individual woman.

What do I have to do to skip my periods on birth control pills?

Consult your healthcare provider. Taking pills to skip all your periods is not approved by the FDA so you will need a special prescription and instructions. You can take to your healthcare provider the handout from our website on continuous birth control pill use and ask for a prescription like this sample prescription.

You will need to buy more birth control pills/packages. Normally, with a period every 21 days for you need 13 pill packages for 1 year. Because continuous birth control use requires that you skip the "sugar pills", 18 pill packages will be needed for 1 year.

You should make sure you are on a low dose (20 mcg of estrogen only) monophasic birth control pill. With monophasic birth control pills all of the active (non-sugar pills) are of the same dose and are the same color. If your are already on a monophasic birth control pill, you can just switch directly with no pill free or period week. If you are not on birth control pills then start your first pill on the first day of your period. You then need to be prepared for irregular bleeding for the first 3 to 6 months as your body adjusts to the menstrual suppression.

Is it safe to skip your period on the pill?

Current low dose birth control pills are very safe for most women. It is very unlikely skipping the period or the pill free week would change the safety of the pill. Birth control pills have been used by millions of women over the past 40 years. The first birth control pills contained about 10,000 mcg of progestin and 150 mcg of estrogen. The pills being recommended for every day or continuous use have only 100 to 1000 mcg of progestin and 20 mcg of estrogen. This is a huge drop in the dose needed for the pill to work. Taking the pill every day should be no different than taking them for only 3 weeks with one week off. The effects of the pill do not totally wear off in that week anyway.

Taking the pill every day should not make the hormone levels build up any more than when you take them for only 3 weeks. However, you will be getting one more week of estrogen which could increase the overall estrogen effects and this is the reason to use only the lowest estrogen dose (20 mcg) for continuous or daily use. There are published papers about skipping periods and so far there have not been any safety problems. As a matter of fact it is possible the pill could work better to prevent pregnancy if it is taken every day instead of taking a week off each month. Remember taking a pill every day to prevent periods is not approved by the Food and Drug Administration and can only be done if you consult with your doctor.

There is a possibility that without menstrual bleeding and without the blood loss from a pregnancy women would build up iron levels which could increase their risk of cardiovascular disease. It was always thought that it was estrogen that made women less likely to die of heart attacks compared to men prior to menopause but this may not be the reason; it could be from the typical anemia found in premenopausal women from either menstruation or losing blood during the delivery of a baby. This "iron theory" is possible and women who suppress their bleeding with the continuous pill after a few years should have their ferritin (storage form of iron) measured and consider blood donation to keep it in a normal range. There are also rare diseases like hemochromatosis and polycythemia vera which would be found earlier in women not having menstrual periods or bleeding with pregnancies.

I don't want to have my period during my honeymoon. Help Me!

The most important question, is when is your honeymoon? If you are already on birth control pills it is very easy to just skip the spacer or period pills for the week when you are having your honeymoon. Then the next month you can just go back to having the monthly withdrawal bleeding or period on the birth control pill. Remember it is very important to not miss pills or take your pill late or you could get some spotting and blood on that new bathing suit. You could also change the time for your period a few months ahead of time so your scheduled period will be after, and not during, your honeymoon. By changing the schedule a six months before there will be less risk of unexpected bleeding.

When to call your health care provider about your period.

There is no one definition of a normal period, but there are certain symptoms that should prompt a call to your clinic:

  • A sudden change in the regularity of your period
  • Heavy bleeding (going through more than one tampon or pad per hour for more than a day) or clots in the menstrual flow
  • Weakness and/or dizziness during periods (possibly from too much blood loss)
  • Failure to start menstruating by age 16
  • A missed period unless that is normal for you and even then, if you miss a lot of periods you may be a risk for cancer.
  • Bleeding between periods or after sexual intercourse
  • Menstrual bleeding that lasts more than a week
  • Sudden or intense pelvic pain with bleeding (can be signs of ectopic pregnancy, which must be attended to immediately)

©Dr. Leslie Miller, 2003