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The beach vacation you have been looking forward to for months. The 22 hour plane ride to Tokyo. Your honeymoon. What do these things have in common? They never fail to fall during your period. “Surely, if we can put a man on the moon, then we can get rid of periods?” You wonder in frustration, as you pack extra sanitary gear in your bag. The answer is “yes”. If you are extra nice to your neighborhood gynecologist, she can likely help you with your period predicament.
The menstrual cycle is a result of a delicate hormonal dance. Estrogen coaxes the ovary to make an egg and prompts the lining of the uterus to thicken. After the egg is released, progesterone halts the growth of the lining, and the uterus waits for the arrival of an embryo. When no embryo arrives, progesterone production stops; it’s this lack of progesterone that triggers the vacation-ruining period. Altering these dance steps with some additional hormones can usually result in a delay in the cycle until a more opportune time.
If you are already on the birth control pill, your doctor will likely tell you that the easiest way to avoid your period is to simply skip the placebo pills and start your next pack early. When you are taking the birth control pill, the natural “hormonal fluctuations” of the menstrual cycle are replaced by the hormones in the birth control pill; so technically, it’s possible and medically safe (for most women) to never have a period while you are on the pill. When the pill was originally being marketed, many women found the idea of not having a period each month unnerving, so the placebo week – resulting in a period – was added to make it feel more “natural.” The great majority of women can safely skip the occasional cycle by taking the next pack of pills with minimal side effects, however some women get a lot of irregular bleeding and spotting if they consistently skip their period. Women with endometriosis, severe cramps, and menstrual migraines can particularly benefit from taking pills continuously and not having a period. If you want to try skipping more than one cycle, talk to your doctor to see if this might be a good option for you.
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If you are not on any type of hormonal contraception, then you could consider going on birth control pills for a month or two before the big event to delay your cycle; or your doctor may recommend that you take a form of the hormone progesterone to delay your cycle. It’s the drop in the level of progesterone that triggers a period to happen, so you can start taking progesterone early in your cycle and continue to take it until after your vacation is complete. These methods are no guarantee, but they do work the majority of the time.
If you looking to get rid of your periods for the longer term, there are other options:
- Depo-Provera. For my active teenage patients who find that their periods interfere with their sports, the Depo-Provera shot can be a sensible option. It is composed of a high dose of progesterone which prevents ovulation and prevents the growth of the lining of the uterus (during a cycle, it’s this tissue that, once shed, becomes the menstrual flow). Depo-Provera is a birth control shot that is given every 3 months. After a few months of irregular spotting as their body adjusts, the majority of girls will not have a period at all. When you stop using Depo-Provera it can take up to a year before your cycles to regulate and for you to conceive. Long term ( > 5 yr) use can be associated with reversible osteoporosis, so after 5 years it is recommended to try an alternate treatment.
- The Mirena IUD. While all progesterone IUD’s typically cause periods to lighten somewhat, the Mirena IUD is the only one FDA approved for heavy menstrual bleeding and is generally the best IUD for getting rid of periods. When Mirena IUD's are first inserted, they can cause irregular bleeding for a few months, but then 60% of women do not experience menstrual cycles at all, while another 30% experience light periods.
- Endometrial ablation. For women who experience heavy menstrual bleeding and are done with childbearing, an endometrial ablation can be an excellent option. An endometrial ablation is a minor surgical procedure where the inner lining of the uterus is removed so that it cannot regrow each month. After the procedure, 60-70% of women never experience another period, another 30% have much lighter flow. While the procedure does have rare complications, most women are extremely pleased with their ablations. In fact it's the only thing I do, other than delivering babies, where women write me thank you notes and bake me cookies afterwards.
I know that cycles are natural, but sometimes you may not want to experience this “all natural phenomena” while on the beach in Hawaii. If you find yourself in an occasional bind and want to delay your cycle, talk to your gynecologist and she may be able to help. Or, if you need a longer term solution, then an IUD, ablation, or extended regimen pill may be a good option.
by Heather Rupe, DOBoard-certified OB/GYN
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