Delaying a period for a special event or holiday

It is a frequent request that women understandably want to delay their period (menstruation) for a holiday, during exams or for a special event. This is usually possible but the choice of medicine will depend on various factors.

The efficacy of treatment can vary between individuals, as can the onset of the period after stopping the chosen medicine.

It is important that you allow adequate time before your period is due to help to ensure that your period won’t occur for example, norethisterone needs to be started 3 days before the effects can be seen, and the contraceptive will often require several weeks.

There are broadly 2 groups of medications which can be used to delay menstruation - progesterone alone, or progesterone combined with oestrogen.

There are some risk factors which may influence the decision. Previous venous thromboembolism (VTE), migraines and uncontrolled hypertension are contraindications to certain oestrogens and progestogens. In addition severe obesity, defined as BMI more than 30kg/m2, is a risk factor for VTE. Some oestrogens and progestogens are cautioned or contraindicated in patients at high risk of VTE or in obese individuals.

Combined contraception

The use of all of the combined contraceptives to delay menstruation is ‘off label’ - this means that the pharmaceutical company have not applied for a drug license for this indication. However, there is a lot of experience in using contraceptives in this way.

If you are taking a progestogen only contraceptive pill, then you could consider switching to a combined contraceptive if there are no contraindications. The combined contraceptive is more effective at controlling bleeding than the progesterone only pill.

Oral

If you already taking a combined oral contraceptive pill then you actually have a withdrawal bleed as opposed to a menstrual period. You can delay your withdrawal bleed by taking your packets back-to-back. Take the pill for 21 days and start a new packet of pills straight away without a 7-day break. If you have an everyday pill (usually says ED on it and there will be 28 tablets in each packet) take the active pill for 21 days and then miss out the 7 inactive pills. If you are using a biphasic or triphasic contraceptive pill, you should finish the first pack and then start the last phase of pills from the next pack immediately.

Breakthrough bleeding is more common in the first few months. You can expect your withdrawal bleed to start approximately 3 days after stopping the pill. Combined oral contraceptive pills can be taken continuously for as long as you want, but the risk of breakthrough bleeding increases with prolonged continuous use.

Ring

Extended cycling involves you inserting a new ring every 4 weeks to avoid any hormone- or ring-free interval. Spotting or breakthrough bleeding can occur. The American College of Obstetricians and Gynaecologists (ACOG) state that 89% of women who completed 6 months of extended cycling had no to minimal bleeding. 

Patch

Transdermal patches are usually applied for 3 weeks, followed by a 1 week “off” period to mimic the menstrual cycle. These can be applied continuously to delay a withdrawal bleed.

Using the contraceptive patch in an extended regimen has been shown to be equally as effective at delaying a withdrawal bleed as continuous use of the combined oral contraceptive pill.

Skin reactions can occur with patches.

Progestogens

Progesterone is an option if you have a contraindications to oestrogens.

Norethisterone

Norethisterone is the only progestogen licensed in the UK to delay periods. However, noresthisterone in the doses required to delay your period, increases the risk of blood clots and therefore women with risk factors for a clot (obese, immobile, about to undergo surgery, carriers of a thrombophilia or have a personal or strong family history of VTE) should not use it.

Norethisterone 5mg three times a day is licensed to delay periods. To be effective, norethisterone should be started at least 3 days before the expected period.

Norethisterone can be taken for up to 3 to 4 weeks if necessary. Periods usually resume within 3 days of discontinuing norethisterone.

Norethisterone is not a contraceptive and so another form of contraceptive should be used to avoid pregnancy.

Medroxyprogesterone

Depot medroxyprogesterone

Depot medroxyprogesterone acetate (DPMA) is injected every 12 weeks and it takes time to start delaying periods.

The efficacy of DPMA in delaying a period improves with time. No periods are seen in 30% of people during the first 3 months of treatment with DPMA. This increases to 55% after a year of DPMA treatment.

DPMA provides contraception for at least 12 weeks and it can take up to a year for fertility to return after stopping it.

This should not be used if you have multiple risk factors for CVD (such as smoking, diabetes, hypertension, obesity and dyslipidaemias), or have/had have vascular disease including coronary heart disease presenting with angina, heart attack, peripheral vascular disease presenting with intermittent claudication, hypertensive retinopathy , TIA, stroke, breast cancer, severe decompensated liver disease or liver tumour.

Medroxyprogesterone tablets

Medroxyprogesterone is the only available treatment that does not increase the risk of blood clots.

Medroxyprogesterone tablets at a dose of 10mg three times a day have been used off-label to delay periods. This dose has been shown to reduce heavy bleeding, although breakthrough bleeding can occur.

Periods usually resume within 3 days of discontinuing medroxyprogesterone tablets.

Oral medroxyprogesterone is not a contraceptive and so another form of contraceptive, such as condoms, should be used to avoid pregnancy.

Oral medroxyprogesterone may inhibit ovulation so fertility can be affected. The time taken for fertility to return to normal varies.