What is happening to my monthly cycles (and other drama)?!?

Dear KnowYourV,

Thank you so much for helping me. I’m 35 years old and it seems like my periods have been getting heavier and lasting longer over the past 2 years. I have only had one child and want to be able to have more in the future. I have never been emotional but I feel like I have to deal with PMS now when I never had problems with it before. So I went to my gynecologist. She decided to place me on a birth control pill that would give me only 4 cycles a year as she felt it would help the most. I am really afraid to start these, so I haven’t. It does not seem natural to me at all and I don’t even understand how this can help me, or even make me better.

Sheila

Over 100 million women worldwide currently use oral contraception ("the pill") to prevent pregnancy. The pill is also widely used to regulate menstrual periods, reduce menstrual cramps and treat hormonal imbalances and ovarian cysts. The pill is a combination of estrogen and progestin. These are the same hormones produced naturally in the ovaries and they are responsible for ovulation and the menstrual cycle.

I know it is frustrating when your body begins making changes and it’s hard to anticipate whether it will improve or continue to worsen. You are still young and years away from menopause. But with each decade your body changes in many ways and this can affect your menstrual cycles. Many women who have always experienced normal, regular cycles will suddenly begin experiencing heavy cycles with PMS and cramping just like you.

There is a misconception that birth control pills are only used for the purpose of pregnancy protection. On the contrary, the new lower dose pills can also be used for regulating menstrual cycles, decreasing menstrual blood flow and helping with PMS. With you being so young and wanting to keep your fertility the best first step for therapy would be something like the pill (as your OB/GYN doctor recommended). Of course, this type of therapy depends on all other tests and ultrasound results being normal.

It is important for you to understand how the pill works if you are going to understand why it works with your problem.

First - It prevents ovulation.

Second - It alters the cervical mucous making it less penetrable to sperm.

Third - It alters the endometrial lining inhibiting implantation of a fertilized egg even if ovulation has occurred.

By doing these things the pill causes the uterus and ovaries to be at complete rest. This can achieve improvement in menstrual cramping, the amount of blood lost during your period, improvement of iron deficiency anemia, regulation of periods, reduced breast tenderness and fibrocystic breast disease and reduced risk of ovarian and endometrial cancers and recurrent ovarian cysts. It also improves PMS and acne.

Oral contraceptives are not recommended for women who smoke tobacco, have high blood pressure, high cholesterol, diabetes or lupus. They are also not recommended for women who live a very sedentary lifestyle and are extremely overweight. This is because the pill can cause an increased risk of blood clots and strokes. Additionally, with extreme weight gain or weight over 250 pounds oral contraceptives may not work properly. It is important to call or go online with the specific company that makes your pill to see if there is a BMI (Body Mass Index) limit to prevent unwanted pregnancy from occurring.

So what should you expect from this therapy? If your periods normally come every 28 days (give or take a day) and you are put on the a birth control pill set up for monthly menses, then most likely your cycles will remain around 28 days. If you are put on the pill that allows you to have fewer periods you are merely lengthening that cycle from 28 days to 84 days. The purpose of this is to reduce the suffering that comes from having monthly cycles (such as increasing pelvic pain, heavy menstrual flow, nausea, migraines, etc.). The periods that come by doing this may be much lighter (not heavier) as the pill is very good at thinning the endometrial lining as discussed earlier. Once use of the pill is discontinued your cycles will return on a monthly basis. Most women ovulate promptly and have a period within four to six weeks. But some women, especially those who are taking the pill to regulate their menstrual cycles, may not have a period for many months afterwards.

If you don't have a period within three months take a pregnancy test to make sure you are not pregnant. Most women are much more fertile after discontinuing the pill and need to be very careful as they are at risk for twins (or greater) the first month after stopping the pill.

So whether you choose a monthly pill or extended cycle one this type of therapy is a great choice. You will begin to feel much better in a few months. However, if you have not had a complete hormone work-up or ultrasound to determine if there is a deeper cause then you need to ask your OB/GYN doctor for help with this.

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