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question

Should I be concerned if I miss a period while on the pill?

Patricia Geraghty, NP
Patricia Geraghty, NP
Women's Health
answer
It is safe to skip your periods when using hormonal contraception such as pills or the vaginal ring. Some women "skip" their periods because when they get to the placebo pills at the end of the package, they simply don't bleed. Other women skip their period purposefully by passing over the placebo pills and continuously taking hormone-containing pills.
Combined hormonal contraception methods contain the two female hormones, estrogen and a progestin. Estrogen stimulates the growth of the uterus lining, that which will become the menstrual period. Progesterone slows the growth while causing the lining to mature. In some women, particularly after they have used pills or the ring for an extended time, the balance of the grow/no-grow signals favors a thin lining. When they reach the placebo pills, there is simply no lining to slough off and they "skip" their period. This is perfectly safe.
Menstrual bleeding is triggered by a drop in the level of the female hormones progesterone and estrogen. These are the same hormones that are contained in  birth control pills or the vaginal ring. Women who use these methods can delay menstrual bleeding by continuing to take hormone containing pills instead of the hormone-free or placebo pills found at the end of each package. A vaginal ring user can insert a new ring immediately after removing her current ring at the planned time. Both of these actions, called extended cycles,  keep a steady level of hormones, preventing the trigger for bleeding.

Extended cycles are available in 91-pill packages. Use of other pills or the vaginal ring to do this is not approved by the FDA, but has been widely studied in medical trials as safe and effective. Most studies had women take three or four packages of hormone containing pills, or use three or four vaginal rings consecutively, followed by four to seven days of placebo pills or ring-free days. Use of pills that change dosing each week, tri-cyclic pills, and the birth control patch are not recommended for this.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.