October 21, 2018
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Ask the Experts

'The Pill' for Better Periods?

by Gina Shaw  

Q: I get terrible menstrual cramps. Is it safe to use oral contraceptives to manage my period?

A: For most women, yes. Oral hormonal contraceptives have been studied extensively for many years, and are generally considered very safe. Besides preventing unplanned pregnancy, birth control pills can help to reduce the discomfort that may accompany menstruation, such as painful cramps and excessive bleeding. Some women also have irregular bleeding at other times in their menstrual cycle, and taking oral contraceptives can get that kind of bleeding under control too.

The pill has several other pluses:

  • It can lessen the painful symptoms of endometriosis—a chronic disorder in which the tissue lining the uterus also grows outside the uterus—and even reduce endometriosis lesions.
  • It cuts your risk of benign breast disease (cysts and other noncancerous growths in the breast).
  • And the biggie: Oral contraceptives substantially reduce your risk of developing certain cancers, including ovarian cancer, endometrial cancer, and colon cancer.

In some cases, women may use oral contraceptives to eliminate regular periods altogether, or to reduce the annual number of periods they have. This is done by taking the "active" (hormone-containing) pills continuously, without the usual week of inactive pills (sometimes called "sugar pills") each month that results in bleeding. Research has shown that suppressing regular periods this way is safe. There's no "buildup" of menstrual blood, because continuous contraceptive use suppresses ovulation, which keeps the uterine lining from building up. (The menstrual bleeding women get while on regular pills isn't actually uterine lining being shed—it's withdrawal bleeding from the cessation of hormones during the placebo week. The uterine lining will build back up again if you go off the pill to become pregnant.)

There are several brands of pills marketed specifically for extended use, but if you're already taking a pill you're happy with (especially if it’s a low-cost generic; the only extended-use pills are brand-name), talk with your doctor about whether you could just stay on the same pill and skip the inactive pills in each pack. (Your doctor will need to write a prescription for more than 12 packs per year in that case.)

While hormonal contraceptives are safe for most women, some women should not use them. That includes women who smoke, which can increase your risk of blood clots, heart attack, and stroke if you take the pill, especially after age 35. Women who have certain other conditions, including high blood pressure, heart valve disease, certain blood clotting disorders, or multiple risk factors for heart disease, should also avoid birth control pills. While some studies have found an association between oral contraceptive use and breast cancer, the research overall has been inconsistent. Women at high risk of breast cancer should talk with their health care providers about the relative risks and benefits of the pill.