Contraceptives’ Impact On Periods

Introduction

Contraception, the act of preventing pregnancy, involves a wide range of methods that gives individuals and couples the ability to manage their reproductive futures. Beyond its fundamental role in pregnancy prevention, contraception carries broader implications. Some methods, like condoms, offer protection against both pregnancy and sexually transmitted diseases (STDs). Moreover, it can positively impact overall reproductive health for instance it can alleviate menstrual discomfort and regulate irregular periods. Additionally, some methods have been linked to a lower risk of specific cancers.

Within the realm of contraception, various hormonal methods present diverse effects on menstrual patterns whilst non-hormonal alternatives provide contraception without altering the menstrual cycle. By exploring these different contraception options, individuals can make informed choices that align with their needs and priorities, ensuring a well-managed and empowered reproductive journey. 

What is contraception?

Contraception is the act of preventing pregnancy through the use of devices, sexual practices, medications or surgical procedures. Its primary purpose is to empower individuals and couples to control their reproductive choices and prevent unwanted pregnancies. This, in turn, gives the ability to be an active participant in family planning without fear. 

In addition to the benefit of pregnancy prevention, certain forms of contraception, such as female and male condoms, can provide added protection by reducing the risk of sexually transmitted diseases (STDs). This is known as barrier contraception which physically blocks the sperm from reaching the egg. Alternatively, there are other forms of contraceptives, such as hormonal methods, that do not involve the use of a physical barrier during sexual intercourse. 

Although contraception is commonly used for pregnancy, it can serve other important purposes related to reproductive health. It can help with menstrual symptoms such as heavy and painful bleeding or irregular periods. Some forms of contraceptives can help reduce the risk of ovarian and endometrial cancer as well as manage certain health conditions such as polycystic ovary syndrome(PCOS).^1,2 Using barrier methods, like condoms, can help lower the risk of cervical cancer by protecting against human papillomavirus (HPV), the leading cause of this cancer.^3,4 

Hormonal contraception

The use of hormonal contraceptives can lead to changes in menstrual bleeding patterns. When newly starting on hormonal contraception, some individuals might encounter irregular bleeding or spotting. Others could observe changes in the duration or intensity of bleeding, and in certain cases, bleeding might even cease altogether.

The combined pill (combination pill)

The combined pill, also referred to as the “combination pill”, contains synthetic versions of oestrogen and progesterone. It works by suppressing ovulation, preventing the release of an egg from the ovary. Additionally, it thickens the cervical mucus which makes it difficult for sperm to reach the eggs, and alters the lining of the uterus, making it less receptive to a fertilised egg. 

The combination pill typically comes in a pack with 21 active pills containing hormones (oestrogen and progesterone) and, sometimes, 7 inactive pills (placebo). After 21 days of taking the active pills containing the hormones that provide contraception protection, you stop taking them and either take the 7 inactive pills or have a 7-day pill-free break. A lot of changes are exhibited when starting on the combined pill. During the first few months, it is common to see spotting between periods. About 20% experience this during their first cycle and about 10% of users still have these symptoms in the third cycle.⁵ One study showed that about 1 in 10 users stopped using this method because of irregular bleeding.⁶

The mini pill (progesterone-only pill)

The mini pill, also known as the progesterone-only pill, primarily works by thickening the cervical mucus, which makes it difficult for sperm to reach the egg as well as thinning the uterus lining. It also suppresses ovulation. Unlike combination pills, it does not contain any oestrogen. 

The mini pill is effective when taken consistently at the same time every day. There are two different types of progesterone-only pills:

1. 3-hour progesterone-only pill (traditional): must be taken within 3 hours of the same time each day
2. 12-hour progesterone-only pill (desogestrel progesterone-only pill): must be taken within 12 hours of the same time each day

As with the combination pill, in the first cycle, about 20% experience spotting whilst 10% will still experience these symptoms in their third cycle.⁵ Around one year of use, approximately 20% of individuals using desogestrel progesterone-only pill might experience a total cessation of bleeding. This is a less common occurrence with other types of progesterone-only pills.⁷

The contraceptive patch

The contraceptive patch is a small adhesive sticky patch worn directly on the skin. The patch releases a daily dose of hormones, oestrogen and progesterone, through the skin into the bloodstream to prevent pregnancy. Because it contains the same hormones as the combined pill, it operates similarly by thickening the cervical mucus, altering the uterine lining, and preventing ovulation. 

The patch needs to be changed once a week for three weeks, followed by a patch-free week during which a withdrawal bleed is experienced. After the patch-free week, apply a new patch and start the 4-week cycle again. During the first cycle of using the patch, about 20% of users experience breakthrough bleeding and spotting and approximately 10% will still experience this in the third cycle.⁸ It has been seen that 1 in 10 users stop using the patch due to bleeding and spotting.⁹ 

The vaginal ring

The vaginal ring is a flexible, plastic, small ring that is inserted into the vagina to provide hormonal contraception. The ring releases a continuous dose of oestrogen and progesterone, similar to the combined pill and patch. Similarly, it works to prevent pregnancy by thickening the cervical mucus, changing the uterine lining and suppressing ovulation. It is typically worn for three weeks and then removed for a one-week break, during which withdrawal bleed is experienced. 

After the break, a new ring is inserted and a new cycle begins. This offers a discrete and convenient method of contraception for those who would prefer not to use pills or other forms of contraception. During the first cycle of using the ring, fewer than 1 in 10 experience breakthrough bleeding or spotting and after about a year of use, users experience approximately 3 spotting days per month.^10,11 Experiencing notably less spotting than other methods within the first year of use, fewer than 1 in 10 users stop using the vaginal ring.¹²

The contraceptive implant 

The contraceptive implant is a small flexible rod that is inserted into the upper arm. It steadily releases progesterone to stop ovulation, thicken the cervical mucus and alter the uterine lining. By thickening the cervical mucus, it makes it difficult for the sperm to reach the cervix. This implant provides long-lasting contraception - up to 3 years.

Typically you can have the implant inserted at any time of your menstrual cycle, as long as you are not already pregnant. If it is fitted within the first 5 days of the menstrual cycle, you’ll be protected immediately from becoming pregnant. However, if fitted any other day during your menstrual cycle, then additional contraception (e.g. condoms) is required for 7 days.

Studies have shown that in the first three months of use, between 15-20% of users experience bleeding that may last for more than 14 days and around 5% experience frequent bleeding.¹³ On the other hand, 11% may experience no bleeding in the first three months; on average, users will experience spotting or bleeding for 7 days per month in the first three months.¹⁴

The contraceptive injection

The contraceptive infection, also known as the “birth control shot” is an injection of the hormone progesterone. The hormone works to prevent pregnancy by suppressing ovulation, thickening the cervical mucus and changing the uterine lining. Depending on the injection you take, it can last for 8 or 13 weeks. It is a convenient method as it doesn’t require daily or weekly attention. 

However, it does require you to remember to take your repeat injection before it expires or becomes ineffective thus resulting in no protection against pregnancy. During the first six months, about 10% of users will experience bleeding or spotting that lasts more than 21 days.¹⁵  Whereas, 12% may have no bleeding in the first three months and on average the number of bleeding and spotting per month during this period is 7 days.¹⁴ 

After a year of use, nearly half of users stop bleeding and on average experience 3 days of bleeding and spotting per month.¹⁴

The intrauterine system (IUS)

An IUS (intrauterine system) is a small T-shaped device that is inserted into the womb (uterus) by a healthcare professional. It is a form of long-acting contraception that releases progesterone to stop pregnancy. Depending on the brand, this can last between 3 to 5 years thus providing effective birth control over a long period of time. This option can be seen as a low-maintenance option for those who don’t want to worry about daily, weekly or monthly contraceptive methods. 

When using a low-dose IUS (containing less than 20 mg levonorgestrel), in the first three months, between 37 to 56% of users may experience bleeding or spotting that's longer than 14 days in a row.¹⁶  It has been suggested that this method of contraception is most effective in heavy menstrual bleeding, with many studies reporting that over a course of a year of use, bleeding decreases more than 90%.¹⁷

Non-hormonal contraception

The intrauterine device (IUD)

As with the IUS, an IUD (intrauterine device) is a small T-shaped plastic device but with copper wire around the stem. This method can protect against pregnancy for between 5 to 10 years depending on the type. Similarly, it is inserted into the womb by a healthcare professional. Unlike an IUS, the IUD does not release any hormones into the body therefore, there are no hormonal changes to the body. Instead, it works by utilising the natural properties of copper by creating an environment which is toxic to the sperm, thereby preventing fertilisation of the egg (spermicide). 

Hence, those using the IUD will continue to experience ovulation and maintain their menstrual cycle, unlike the withdrawal bleeding commonly observed with many hormonal contraception methods. During the first few months, it is common for users to experience heavier and/or longer periods, as well as spotting and bleeding.¹⁸ On average, menstrual bleeding may increase by 20-50% after the insertion of an IUD however this symptom may reduce for some after 3 to 6 months.¹⁹

Which contraception methods do not affect your period?

There are some contraception methods that will most likely not affect your period. This includes:

• Male condoms
• Female condoms
• Cervical caps
• Spermicides 
• Natural family planning: this is also known as the fertility awareness method which involves tracking your fertile days based on your menstrual cycle
• Diaphragm

If one of these methods is chosen, it must be used every time correctly when having sex to prevent pregnancy. 

Summary

Many different methods of contraception are associated with changes in menstrual bleeding patterns. The changes vary from person to person. When initiated, some people may experience irregular bleeding or spotting. Whereas, some may notice changes in the length, heaviness of bleeding or total cessation of bleeding. When choosing a contraceptive method, individual risk factors and medical history should be considered, so it is essential to discuss all options with a healthcare professional.