Amenorrhea with Lo Loestrin: Normal and Expected
Yes, it is completely normal to take Lo Loestrin (ethinyl estradiol and norethindrone) and not have a menstrual cycle. Amenorrhea (absence of menstrual bleeding) is a common and expected side effect of this low-dose combined hormonal contraceptive.
Understanding Amenorrhea with Lo Loestrin
- Breakthrough bleeding, spotting, and amenorrhea are frequent experiences for patients using oral contraceptives 1
- Low-dose estrogen formulations like Lo Loestrin are particularly associated with hypomenorrhea (light periods) or amenorrhea with long-term use 2
- The FDA drug label specifically notes that amenorrhea may occur with combined hormonal contraceptives and should be expected 1
- Amenorrhea is not harmful and does not indicate a problem with the medication's effectiveness 3
Clinical Significance of Amenorrhea
- Amenorrhea with hormonal contraceptives is the result of endometrial suppression, which is part of how these medications prevent pregnancy 4
- Extended or continuous use of hormonal contraceptives can eliminate the hormone-free interval entirely, maintaining suppression continuously 4
- The absence of bleeding does not mean the contraceptive is ineffective - in fact, it indicates successful hormonal suppression 1
When to Be Concerned
- If amenorrhea occurs after previously regular cycles on Lo Loestrin, pregnancy should be considered and ruled out, especially if accompanied by symptoms like morning sickness or unusual breast tenderness 1
- If a patient has not adhered to the prescribed schedule and misses a period, the possibility of pregnancy should be considered 1
- If the patient has adhered to the prescribed regimen and misses two consecutive periods (when periods were previously occurring), pregnancy should be ruled out 1
Benefits of Amenorrhea
- Many women actually prefer the absence of menstrual bleeding 5
- Extended-cycle and continuous-cycle oral contraceptives are specifically designed to decrease frequency of menses or eliminate them completely 5
- Amenorrhea can alleviate symptoms of coexisting medical conditions that are exacerbated by menstruation 5
- Studies show that continuous combined hormonal contraceptive regimens can produce amenorrhea in 61-73% of cycles 6
Managing Patient Expectations
- Counseling about expected bleeding patterns and reassurance that bleeding irregularities (including amenorrhea) are generally not harmful has been shown to reduce method discontinuation 3
- The incidence of amenorrhea tends to increase with longer duration of treatment 6
- Approximately 40-50% of patients using continuous combined regimens experience amenorrhea for at least seven consecutive cycles 6
In summary, amenorrhea while taking Lo Loestrin is normal, expected, and not a cause for concern unless there are signs of pregnancy or if the patient has not been taking the medication as prescribed. The absence of menstrual bleeding is simply a side effect of the hormonal suppression that makes this medication an effective contraceptive.