My very active 12.5-year-old daughter hates getting her period, which she began having two years ago. When can young women begin to use hormonal birth control methods that reduce the number of periods they have each year? Are there reasons young women should wait until they are older?
— Jessica Jimenez, Texas
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Short Take
There are many reasons, regardless of age, that someone may dislike having a menstrual cycle. However, an unpredictable menstrual cycle, which is commonplace in the first few years after one’s first period, can make them especially challenging for adolescents. Hormonal contraception can help many teens and pre-teens manage these issues.
Tell Me More
Many teenagers — not just those who are active in organized sports — find their periods bothersome. For some, getting a regular period can be a reassuring sign that your body is functioning in a healthy way and that you are not pregnant, however, in one study, approximately 70 percent of adolescents between the ages of 15 and 19 indicated that they would prefer to have their periods less frequently than once a month.
The hassles of managing a monthly period are many: Pads cannot be used for swimming and they can chafe or be uncomfortable. Tampons and menstrual cups are an option, but not everyone is comfortable using internal menstrual products. Leakage of blood onto underwear and clothing can happen regardless of the menstrual product.
Making menstruation more stressful is the fact that menstrual periods are often irregular for the first few years. Worrying if your period is going to start whether you are at a sporting event, in class, or just hanging out with friends can be stressful. Period cramps (dysmenorrhea), premenstrual syndrome (PMS) and diarrhea can also make menstruation unpleasant or challenging regardless of age.
Tips to Help Menstrual Management
Taking nonsteroidal anti-inflammatory drugs, such as ibuprofen, before the start of each period can reduce the amount of blood by 30 to 40 percent and may also help with cramps and diarrhea.
Period underwear, absorbent underwear designed specifically for menstrual blood, is a useful way to be prepared for an irregular cycle or to provide back-up for tampons or menstrual cups. Some may find the price limiting and period underwear may not be convenient if it needs to be changed outside of the home.
The combination oral contraceptive pill — the birth control pill with estrogen commonly referred to as “the pill” — is a common way to manage menstruation-related concerns. Periods will be predictable, generally are lighter, and cramps and diarrhea often improve.
The pill can also be taken continuously, meaning a person can skipp the placebo week of pills in that package so periods are less frequent — for example every 8 or 12 weeks. When the pill is taken this way every month, by one year, 72 percent of women will have no periods. Unpredictable spotting is a common side effect, especially in the first few months.
The birth control pill without estrogen (the progestin-only pill) is an option for teens who cannot take estrogen for medical reasons, although typically it is less effective at menstrual period manipulation.
One consideration with all oral contraceptives is the ability to take a pill every day as missed pills may lead to irregular bleeding. In addition, if a teen is taking the pill to manipulate her period and decides to be sexually active, there may be false reassurance about contraception for inconsistent pill takers.
Depot medroxyprogesterone acetate (DMPA), a contraceptive injection, has a high rate of stopping periods by the fourth injection. It is associated with a reduction in bone density, but in general there is recovery when it is stopped.
The hormonal intrauterine device (IUD) can result in lighter periods or stop periods altogether, but this may take several months of irregular bleeding. Insertion of IUDs for adolescents ages 13 to 17 is successful 95 percent of the time.
The contraceptive implant is typically not recommended for menstrual manipulation as almost one-quarter of users have frequent or prolonged bleeding. Only 20 percent of women who use the implant will have no period.
Risks of Taking the Pill
The biggest medical risk that comes with taking the pill is an increased risk of blood clots — but that risk is low. If we follow 10,000 women for one year then one will have a clot; on the pill, that risk rises to 3 to 4.
There can be an impact on height when a person is exposed to estrogen too early. By two years after the first period, most teens have stopped growing, however, the younger a girl starts her period, the longer she may continue to grow. Most of the data suggests the birth control pill with estrogen has no impact on stature, but for adolescents who start their period early, a discussion about height with a pediatrician or pediatric and adolescent gynecologist may be in order.
Many people of all ages prefer not to have a period for a variety of reasons, even Ob/Gyns. The risks associated with the medications used to regulate or stop periods are generally very low, but only an individual can decide if the benefit to risk ratio is worth it. You daughter’s doctor should discuss the impact her period is having on her life and review all the options to help her weigh the pros and cons.
Dr. Jen Gunter, Twitter’s resident gynecologist, is teaming up with our editors to answer your questions about all things women’s health. From what’s normal for your anatomy, to healthy sex, to clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called, The Cycle, promises to handle your questions with respect, forthrightness and honesty.