How do I use progesterone to miss a menstrual cycle?

Using Progesterone to Skip a Menstrual Period

To intentionally skip a menstrual cycle, progesterone alone is NOT the recommended approach—you should use continuous combined oral contraceptives (containing both estrogen and progestin) taken daily without a hormone-free interval. 1

Why Progesterone Alone Is Not Recommended

• Progesterone-only methods cause unpredictable bleeding patterns rather than suppressing menstruation, with increased frequency of breakthrough bleeding, spotting, and prolonged bleeding in up to 25% of users 2
• The FDA specifically states that injectable medroxyprogesterone acetate is NOT recommended for controlling menstrual bleeding due to its prolonged action and difficulty predicting withdrawal bleeding timing 3
• Progesterone-only pills are designed primarily for contraception during lactation, not cycle manipulation 4

The Correct Method: Continuous Combined Oral Contraceptives

Start with a low-dose combined oral contraceptive containing 20-30 μg ethinyl estradiol with levonorgestrel or norethisterone, taken continuously without the traditional hormone-free interval. 1

How to Use This Method:

• Take one active pill daily at the same time every day without stopping for the hormone-free (placebo) week 1
• When you finish one pack, immediately start the next pack the following day 5
• This suppresses menstruation and reduces bleeding episodes 1

Managing Breakthrough Bleeding (Common in First 3-6 Months):

• Reassure yourself that irregular bleeding typically improves with continued use 5, 1
• If breakthrough bleeding occurs and you want treatment, consider NSAIDs (ibuprofen or mefenamic acid) for 5-7 days 1
• Only after the first 21 days of continuous use, you may take a planned 3-4 day hormone-free interval if needed, but NOT more than once per month 1

Critical Missed Pill Protocol

If you miss pills while using this method, follow these specific steps:

• Late pill (<24 hours): Take immediately, continue regular schedule, no backup needed 5, 1
• One missed pill (24-48 hours): Take the most recent missed pill immediately, discard others, use backup contraception (condoms) for 7 consecutive days 5, 1
• Two or more missed pills (≥48 hours): Take the most recent missed pill immediately, discard others, use backup contraception for 7 consecutive days 5, 1
• If pills are missed in the last week of the pack (days 15-21): Omit the hormone-free interval by starting a new pack immediately the next day 5

Important Safety Considerations

• Higher-dose pills (30 μg ethinyl estradiol) provide better ovulation suppression when pills are missed, but stroke risk increases by 19% for every 10 μg increase in ethinyl estradiol 1
• Monitor blood pressure during routine follow-up 1
• Do NOT use hormone-free intervals during the first 21 days of extended/continuous use 1
• Do NOT use hormone-free intervals more than once per month as this compromises contraceptive effectiveness 1

Common Pitfall to Avoid

The most common mistake is attempting to use progesterone-only methods (like progestin-only pills or injectable progesterone) to skip periods—these methods actually cause MORE irregular bleeding rather than suppressing menstruation 2, 6. The levonorgestrel-releasing intrauterine device (LNG-IUS) can reduce menstrual bleeding by up to 90% 7, but this is a different clinical scenario requiring device insertion and is not the same as intentionally timing cycle suppression.