Best Medication to Delay Your Period
Continue taking active combined oral contraceptive pills without the hormone-free interval by skipping the placebo pills and immediately starting a new pack of active pills. 1
Recommended Approach
Skip the placebo (inactive) pills in your current pack and start a new pack of active pills the next day to delay menstruation. 1 This approach works by maintaining continuous hormonal support of the endometrium, preventing the withdrawal bleeding that normally occurs during the hormone-free interval.
Use monophasic combined oral contraceptives containing 30-35 μg of ethinyl estradiol for the most reliable menstrual delay. 1 Monophasic formulations provide consistent hormone levels throughout the cycle, making them ideal for extended use.
Neither norethindrone nor combined oral contraceptives used for menstrual delay should be relied upon as contraception unless you have been using them continuously. 1 If you are starting pills specifically to delay your period and are not already on them, you will need backup contraception.
What to Expect with Breakthrough Bleeding
Unscheduled spotting or bleeding is common during the first 3-6 months of extended or continuous use and generally decreases with continued use. 2, 1 This is not harmful and does not indicate method failure.
If breakthrough bleeding becomes problematic, you can take a 3-4 day hormone-free interval to temporarily induce bleeding, but avoid this during the first 21 days of continuous use and limit it to no more than once per month. 1, 3 Taking a hormone-free interval more frequently may reduce contraceptive effectiveness.
Before treating breakthrough bleeding, rule out pregnancy, sexually transmitted infections, medication interactions, cigarette smoking, or new uterine pathology (polyps or fibroids). 1, 3
Backup Contraception Requirements
If starting combined hormonal contraceptives more than 5 days after menses begins, use backup contraception (such as condoms) for 7 days. 1
No backup contraception is required when combined oral contraceptives are initiated within the first 5 days of menstrual bleeding. 1
Important Counseling Points
Patients should understand before initiation that unscheduled bleeding is expected in the first 3-6 months but is not harmful and decreases over time. 1 Enhanced counseling about expected bleeding patterns improves continuation rates and satisfaction.
The hormone-free interval that occurs during traditional pill use is an artificial, medically unnecessary event. 4 Withdrawal bleeding during the placebo week does not serve any medical purpose and can be safely eliminated.
Common Pitfalls to Avoid
Do not take a hormone-free interval during the first 21 days of extended pill use, as this increases the risk of ovulation. 1 Seven consecutive days of active hormonal pills are needed to reliably suppress ovulation.
Do not use hormone-free intervals more than once per month when using extended regimens, as this may reduce contraceptive effectiveness. 1
If you miss pills or have usage errors, remember that extending the hormone-free interval is the riskiest time for contraceptive failure. 2 Take missed pills as soon as possible and use backup contraception for 7 days if two or more consecutive pills are missed.