Delaying Menstruation: Evidence-Based Methods
Primary Method: Extended/Continuous Combined Hormonal Contraceptives
- The American College of Obstetricians and Gynecologists recommends using combined hormonal contraceptives in an extended or continuous regimen to delay menstruation, by skipping the hormone-free interval and immediately starting the next cycle of active hormones, for women who want to delay their period 1, 2
- Women already using combined oral contraceptives can skip the 7-day hormone-free interval and start a new pack of active pills to delay menstruation for as long as desired, without needing additional contraceptive protection 1
- If combined hormonal contraceptives are started more than 5 days after menstrual bleeding began, backup contraception should be used for 7 days 3
Available Formulations
- Combined hormonal contraceptives are available in various formulations, including oral contraceptive pills, transdermal patch, and vaginal ring, which release different amounts of estrogen and progestin daily 2, 3
Expected Bleeding Patterns and Management
- Unscheduled spotting or bleeding is common during the first 3-6 months of extended or continuous use, but generally decreases with continued use, and is not harmful or a sign of method failure 1, 2
- If breakthrough bleeding persists beyond 3-6 months, the patient should be evaluated for underlying problems such as pregnancy, medication interactions, or uterine pathology, and consider a 3-4 day hormone-free interval if no problem is found 1
Clinical Efficacy and Safety
- Combined hormonal contraceptives delay menstruation by creating a thinner endometrial lining, inhibiting ovulation, and reducing prostaglandin production, which decreases uterine motility and cramping 2
- Absolute contraindications to combined hormonal contraceptives include severe uncontrolled hypertension, ongoing hepatic dysfunction, and complicated valvular heart disease 2
- The baseline risk of venous thromboembolism increases 3-4 fold with combined hormonal contraceptives, but remains lower than pregnancy-associated risk 2
Special Populations Who May Particularly Benefit
- Women with menorrhagia, premenstrual symptoms, or other conditions that affect menstrual bleeding may particularly benefit from extended or continuous regimens of combined hormonal contraceptives 1, 2