From the Guidelines
If a woman misses her period while taking oral contraceptives, she should continue taking her pills as scheduled, as amenorrhea is a common occurrence that typically doesn't indicate pregnancy or a medical problem. The hormones in birth control pills can thin the uterine lining over time, resulting in light or absent periods 1. According to the U.S. Selected Practice Recommendations for Contraceptive Use, 2013, amenorrhea does not require any medical treatment, and reassurance should be provided to the woman 1.
If concerned about pregnancy, she should take a pregnancy test, especially if she's missed pills or experienced vomiting or diarrhea that might have affected pill absorption. If the pregnancy test is negative and she has no concerning symptoms, she can safely continue her pill regimen. However, if she experiences unusual symptoms like severe headaches, vision changes, chest pain, or severe abdominal pain, she should seek medical attention promptly. For women who find the absence of periods concerning, switching to a different pill formulation with higher estrogen content might help restore regular bleeding.
Key considerations for managing amenorrhea in oral contraceptive users include:
- Ruling out pregnancy if clinically indicated 1
- Providing reassurance that amenorrhea is a common and generally harmless side effect of oral contraceptives 1
- Counseling on alternative contraceptive methods if the woman finds amenorrhea unacceptable 1
- Monitoring for unusual symptoms that may indicate a medical problem, such as severe headaches or chest pain.
It's also important to note that persistent amenorrhea beyond 3-6 months without explanation warrants a medical evaluation to rule out other potential causes. The most recent and highest quality study on this topic is from 2015, which provides guidance on the provision of contraception and management of side effects, including amenorrhea 1.
From the FDA Drug Label
If the patient has adhered to the prescribed regimen and misses two consecutive periods, pregnancy should be ruled out before continuing oral contraceptive use.
- Missed menstrual period management: If a patient misses two consecutive periods while adhering to the prescribed oral contraceptive regimen, pregnancy should be ruled out before continuing oral contraceptive use.
- The patient should discontinue oral contraceptive use until pregnancy is ruled out. 2