Ask the Experts About LGBT Health
Q: Birth Control Question
Hi,
I would like to know if its possible to skip a period while being on birth control pills. I'm going on vacation when I'm supposed to get my period - at the end of this month/beginning of the next one - so I want to avoid my period just for this one time. What can I do?
A: Response from Dr. Raney
Yes it is fine to skip the 4th week of your pill pack, and move on to the next pill pack in order to suppress menstrual bleeding during your vacation. This is a strategy frequently used by women who, for reasons of convenience (for travel, sports, or special occasions), prefer to skip their menstrual period. Some women who have menstrual migraines, painful or heavy periods are advised by their medical provider to take the birth control pill continuously for 2 or 3 months or longer before having a pill free or placebo pill week in order to minimize these symptoms.
The monthly bleeding that occurs when a woman uses a typical 28 day pill pack has no biological function. Birth control pills interfere with the rhythm of your body's natural production of estrogen and progesterone, and thus inhibit ovulation. They also cause changes in the quality of the cervical mucus, making it harder for sperm to pass through the endocervical canal into the uterus. While taking birth control pills, the lining of the uterus thickens some, but not to the same extent that it would during a natural cycle. The hormone free week of a 28 day pill pack was designed to allow the uterine lining to be shed at monthly intervals, mimicking a natural period; but, it actually has no health benefit.
Taking pills continuously for 2 or 3 months, or perhaps longer is fine. The main problem we find is that it there can be sometimes be breakthrough bleeding, which happens when the uterine lining sloughs off a bit. So, do be prepared for possible breakthrough spotting or bleeding. Monophasic pills (pill packs that have the same amount of hormones in every pill) are less likely to cause breakthrough bleeding than triphasic pills (pill packs that have three different levels of hormones).
Studies indicate that it is safe to take a low dose combined ethinyl estradiol / progestin pill continuously for up to a year, as long as you do not have a history of blood clot, stroke, hypertension, liver disease, breast cancer, or smoking (especially in older women). In fact such a pill is now on the market. Since you are on the pill already, I assume your doctor screened you for these risk factors before starting it. It has also been shown that there is no additional delay in the return to fertility if you only allow bleeding on a quarterly or yearly basis rather than monthly.
So go ahead and skip your period and enjoy your vacation.
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Forum Experts
 Harvey J. Makadon, MD is Clinical Professor of Medicine at Harvard Medical School and Director of Education and Training at The Fenway Institute at Fenway Health in Boston. He is a member of the Division of General Medicine at Beth Israel Deaconess Medical Center and is the lead editor of The Fenway Guide to LGBT Health, published by the American College of Physicians in 2007. He has long been involved in developing both educational and clinical programs to serve gay, lesbian, bisexual and transgender populations.  Patricia Raney, MD, is a staff physician at Fenway Health in Boston, Massachusetts. She is a graduate of the University of Massachusetts Medical School and is Board Certified in Family Medicine. Her clinical interests include women's health and wellness, primary care, preventive care and the health concerns of lesbians, bisexual women and transgender people. On a more personal note, she is an avid stone carver. |
