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Some birth control methods can change a women's menstrual cycle. This handout explain what changes to expect with different birth control methods and when to check with your doctor for advice. The important point to understand about most menstrual change with contraception is that they are to be expected and are not harmful to the body. If you have concerns about your menstrual changes with your contraceptive, don't stop using it without talking to your doctor. Often nothing is needed, but your health care provider can assess the situation and provide treatment if necessary. Some doctors suggest using a menstrual diary or calendar to record menstrual changes so that you can have an objective record. The diary will help you remember what changes have occurred so you can tell your doctor. Oral Contraceptives or "The Pill" Oral contraceptives regulate menstrual cycles to predictable lengths. Active hormones are taken every day for 3 weeks and then inactive pill are taken during the fourth week. During the fourth week the woman will bleed. When taking the pill, a woman can anticipate when she should get her period. The oral contraceptive pill also affects the menstrual cycle in other ways. Many women consider these effects beneficial. One, the pill can help reduce painful cramps. Two, women often have less bleeding during their period, or sometimes have very little or no bleeding. Three, the pill can stop the pain some women feel when they ovulate. One side effect of the pill, which happens to about 30% of women, is breakthrough bleeding. Breakthrough bleeding is bleeding or spotting of blood between menstrual periods, which is common during the first 1 to 3 months of pill use. The bleeding may require extra pads or tampons and can be inconvenient. The good news,however, is that this effect is likely to disappear within the first 3 months of using the pill. So, generally, if you wait until you have taken a few packages of the pills, the bleeding in between periods will go away. Remember that breakthrough bleeding is not harmful, does not mean you have cancer, and will not hurt you. One cause of breakthrough bleeding is missing pills; the solution is to take your pill regularly. Some evidence suggests that women who smoke are more likely to have breakthrough bleeding than are nonsmokers. Intrauterine Devices (IUDs) Two types of IUDs are available in the United States - one containing copper and one containing progesterone. The copper-containing IUD tends to cause increased cramping and heavier bleeding during periods. The progesterone IUD, on the other hand, reduces cramping and bleeding. IUDs should not cause bleeding between periods. As the uterus develops a tolerance for the copper IUD, the cramping and bleeding may lessen. Subdermal Implants The most common side effect with implants is menstrual changes. menstrual changes occur in almost all women in the first year of use. The changes include irregular cycles, a greater number of bleeding days, spotting between periods and sometimes a heavier menstrual flow. These changes tend to subside with time. Many women experience regular cycles again within a year of starting use. Injectable Contraception or "The Shot" Injectable contraception's main side effect is menstrual changes. These changes include irregular cycles, bleeding between periods and, occasionally, heavier bleeding. When to Call Your Doctor Most menstrual bleeding changes are to be expected and not harmful. In certain situations, however, you should check with your health care provider. For example, if you are taking oral contraceptives, are sexually active, and have been getting regular periods and then you don't get a period, call you doctor. Especially if you have forgotten or missed one or more pills during that cycle, you might be pregnant. If you have been getting regular cycles and suddenly get breakthrough bleeding, you may have missed pills or have an infection. Call you doctor. Breakthrough bleeding may indicate a sexually transmitted disease (STD). If you use an IUD and you have an unusually heavy period accompanied by abdominal tenderness and/or painful intercourse or a discharge, call your doctor. This is especially important if you have had unprotected sex and may be at risk for an STD. If you use subdermal implants and have been getting regular cycles and suddenly don't get a period, call your doctor. There is a very small chance you could be pregnant. In addition, if you have irregular bleeding which is prolonged or heavy, an evaluation for infection is indicated. If you use implants or injectable contraception and experience an unusually heavy flow or painful intercourse and may be at risk for an STD, call your doctor.
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