Managing Menstruation with Hormonal Contraceptives

Menstruation is a normal part of every young woman’s life. But as their bodies learn to regulate the hormones that control menstruation, adolescents commonly experience irregular periods, heavy bleeding and painful cramps. It can take several years after a girl's first period for her body to settle into a pattern of regular menstrual cycles.

Some adolescents miss school or sit out from sports and other activities because of painful periods. While it’s important to have a doctor check for underlying medical causes, many menstrual difficulties can be managed with hormonal medications that are commonly also used for preventing pregnancy, such as birth control pills, patches and intrauterine devices. These medications and devices regulate the menstrual cycle by introducing hormones into the body at a steady pace.

“Hormonal birth control can alleviate a lot of symptoms of PMS [premenstrual syndrome] and irregular periods," says Diane Rubin, clinical research coordinator for the PolicyLab at Children’s Hospital of Philadelphia (CHOP). "Many, many young people use birth control for non-contraceptive benefits.”

Non-contraceptive uses of hormonal birth control

Hormonal contraceptives can be helpful in controlling:

• Irregular periods
• Excessive menstrual bleeding (menorrhagia)
• Frequent and painful menstrual cramps (dysmenorrhea)
• Migraine headaches
• Acne
• Premenstrual syndrome (PMS)

Hormonal contraceptives are also helpful in treating certain gynecological disorders that cause painful periods and heavy bleeding. These include:

• Polycystic ovarian syndrome (PCOS), a hormone disorder in which the ovaries fail to regularly release eggs. This causes cysts to develop on the ovaries. Symptoms of PCOS include irregular periods, excessive growth of body hair, acne and painful periods. Hormonal birth control reduces the level of androgen, a male hormone, that causes PCOS.
• Endometriosis, a disease in which tissue similar to the lining of the uterus grows outside the uterus. This can cause severe menstrual cramps and heavy menstrual periods among other symptoms. Hormonal contraceptives stop the ovaries from over-producing estrogen, which slows the growth of endometrial tissue. Periods are lighter, more regular and shorter.

Choosing among hormonal contraceptives

A variety of hormonal contraceptive options are available by prescription. These differ in how often they’re administered and the ways they deliver hormones into the body. These include:

• Hormonal pills. A pill is taken orally each day.  
• Vaginal ring. This small flexible device is inserted into the vagina once a month.
• Hormone-releasing Intrauterine device (IUD). This tiny, T-shaped piece of plastic is inserted into the uterus. It can stay in place for three to seven years, depending on the type of IUD.
• Birth control patch. This is a sticker that delivers hormones through the skin. It’s worn on the belly, upper outer arm, buttocks or back and is changed once a week.
• Depo-Provera shot. This shot is given as an injection into the muscle every three months. It generally requires a visit to a healthcare provider, who administers the shot.

Making the decision

Some parents may feel uncomfortable talking with their teen about birth control, even when its purpose is to manage menstruation, rather than prevent pregnancy. Parents and other caregivers can find tips to start conversations about the various ways hormonal medicines can be helpful for improving the quality of life for adolescents at Parents are T.A.L.K.I.N.G., a website created under the direction of Aletha Y. Akers, MD, MPH, FACOG, Medical Director of Adolescent Gynecology Consultative Services in the Craig Dalsimer Division of Adolescent Medicine at Children's Hospital of Philadelphia (CHOP).

“It’s a really nice place to go if you’re not sure how to talk to your teenager," says CHOP PolicyLab Research Coordinator Ava Skolnik. "You can also look at the site together [with your teen].”

Skolnik recommends teenagers speak with their healthcare provider about the best hormonal medication or device that might meet their individual needs. Adolescents should consider convenience and be aware of possible side effects and risks. Some teens may have trouble remembering to take a pill every day and prefer a different method. Others may not be comfortable with shots or an implanted device.

“Every young person has their own needs,” Skolnik says. “It’s important to know what you need and to be able to express yourself to a healthcare provider.”