Three days of the month, I'm not all that fun to be around either.
December 6, 2012 8:03 AM   Subscribe

I never ever ever want to have another period/breakthrough bleed. Which birth control should I be on?

That's a slight exaggeration - I would like to have kids someday. But for now, I would like to avoid the mess, mood swings, and breakouts that come with every bleed.

A couple years ago I was living in a country with over-the-counter birth control (yes, it was just as great as it sounds). I was prescribed a generic pill and I decided to just start taking it continuously, with no breakthrough bleeding. My skin cleared up and my moods improved.

Back in the USA now and it's much harder to get access to continuous birth control, since the pharmacy will not let me pick it up until after my placebo week has already started. I'm happy enough with the pill I'm on now (I tried Seasonique and hated it) but I need to figure out a way to take it continuously, or find another way not to have that bleed week. Recommendations for getting around this or other forms of birth control would be great!
posted by chaiminda to Health & Fitness (27 answers total) 10 users marked this as a favorite
Best answer: Get your ob/gyn to write you two precriptions, that way you can get the extras that you want.

You are 100% correct, if you are on oral contraception you don't NEED to have a period. I did this up until I had my hysterectomy.

Periods suck.
posted by Ruthless Bunny at 8:05 AM on December 6, 2012 [2 favorites]

i never got my period, even during the placebo days, with loestrin fe.
posted by sabh at 8:09 AM on December 6, 2012

I don't live in the USA, but I use the NuvaRing continuously, and I love it way more than I loved the pill. It's a lot more low-maintenance than the pill, too, since you don't have to remember taking it every day.

Maybe you won't encounter the problem refilling it continuously because there is no placebo pack.
posted by ohmy at 8:11 AM on December 6, 2012

Best answer: I have an IUD (Mirena) -- best decision of my life. There's no guarentee that you'll *never* have breakthrough bleeding, but it's probably even less common then taking the pill continuously, so if you didn't have breakthrough bleeding on that, you probably won't on a hormonal IUD either. I've always had heavy periods, and since I got mine ~ 6 months ago, I have a very light period the first 2 months and recently some very very light spotting. Plus I don't have to remember to take a pill/change a patch/ring or anything -- it's just there, hassle-free.
posted by DoubleLune at 8:14 AM on December 6, 2012 [2 favorites]

Best answer: I have a Mirena too and it's basically stopped my periods. Just be warned, somehow it has not stopped my PMS at all.
posted by Katine at 8:16 AM on December 6, 2012

I'm on Mirena as well, and get one or two days of breakthrough spotting a month. MUCH better than anything I've ever been on.
posted by roomthreeseventeen at 8:16 AM on December 6, 2012

Best answer: Another vote for the Mirena. I was on the pill for years and skipped plenty of periods using packs back to back. But now this thing does it for me and I don't have to do a goddamned thing. Life is good.
posted by phunniemee at 8:20 AM on December 6, 2012

God yes, Mirena. Haven't bled in a year and it's fabulous. My gyno said that people who go straight from a different form of hormonal BC to the Mirena tend to have almost no bleeding (I had none) for reasons that I didn't understand.

But I'm with Katine -- no one warned me, and she's actually the first person to correlate this with me (yay! thank you!), but I still know when I'm just about to start my period, even though I never do. It's really odd.
posted by AmandaA at 8:28 AM on December 6, 2012

Another vote for NuvaRing. I don't take it continuously, but I did do back-to-back applications a few times to avoid having a period during vacations and such. The longest I've gone with continuous coverage was three months, and I had no breakthrough bleeding and no real PMS symptoms to speak of.

Before staring on the ring, I did ask my OBGYN about an IUD, and she encouraged me to go this route if I thought I might want to start a family within five years, since that is how long Mirena is usually kept in for.
posted by singinginmychains at 8:37 AM on December 6, 2012

I am on Seasonale now but there was a time when I took a regular pill pack and skipped the placebo week, and ended up at one point needing a refill but unable to get my insurance to cover it because it was too early. The pharmacist suggested I sign up for their "prescription savings club" (all the big chains have some version) which was like $25 for the year, and then pay out of pocket for the rx, which was pretty cheap since it was a generic.
posted by radioamy at 8:39 AM on December 6, 2012 [2 favorites]

I've been on the Mirena for around three years and I have very, very lightly bled maybe three times. It's great.
posted by pintapicasso at 8:43 AM on December 6, 2012

IAAD (family doc) and have similar period-avoiding, fertility-retaining goals to you. You have a few options:

1) continuous use of a monophasic pill e.g. Alesse (not a cyclic like Tricyclen). This is what I do personally - use Minestrin continuously, no bleeding in 3 years. To get around pharmacy issues, get a prescription for a 21-day pack and ask your physician to write "use continuously" on the prescription. Obviously, your physician needs to be on board with this, but especially if you're using a low-estrogen pill, I suspect most will be.

2) long-cycle birth control pills e.g. Seasonique, Seasonale, Lybrel. You hated Seasonique, so the first two are out, though they are designed to give bleeding every 3 months. Lybrel is meant to avoid periods (although in studies, only about 60% had absolutely no bleeding/spotting).

3) Mirena - about 1 in 5 women develop amenorrhea (no bleeding).

4) Depo-Provera - up to 75% of women get amenorrhea. I see it shat upon a lot here, and it certainly does have its problems (can have erratic, heavy bleeding initially; concerns re: bone density with long term use; some women are substantially affected by weight gain), but it's a 4-times a year injection that works well for some.
posted by flying kumquat at 8:47 AM on December 6, 2012 [1 favorite]

Best answer: Several doctors have been willing to put a note on my prescription that I take my BC continuously and so need more packs. The first time it was medically indicated, but honestly all the doctors since then have been totally happy to do this for me. I've never gotten any crap from my insurance for it, either. (I take Levora, which isn't one of those special expensive BC pills, which is maybe why they don't complain.) It might be worth asking your doctor if they're willing to do that for you.

(and for the record, continuous birth control is THE BEST life choice I have ever made. good luck to you!)
posted by goodbyewaffles at 8:47 AM on December 6, 2012 [5 favorites]

Best answer: My oral BC prescription is written "take once per day, take active pills continuously, skip placebo week pills" - My pharmacy lets me pick one up every three weeks.
posted by magnetsphere at 9:14 AM on December 6, 2012 [2 favorites]

Like others, no bleeding with Mirena, though I did have everything else associated with a period. I think it's because the Mirena doesn't suppress ovulation, just thins the lining of the uterus, so there's nothing to shed.
posted by amarynth at 9:40 AM on December 6, 2012

I take Levora continuously, like goodbyewaffles above, and I don't have any problems with it most of the time. However it has been my experience that consistently, every six months since I started on it (7 years ago) I get a brick-red discharge. It's not exactly blood, but obviously has blood in it and does stain. My doctor isn't concerned with this, but at the time I first see the discharge I stop taking the pills and get a period. I have no idea if this is a common thing with Levora.
posted by CheeseLouise at 9:50 AM on December 6, 2012

As others have said, Mirena is amazing. I'm on my second one, and haven't had a period since 2007. But if for some reason that won't work for you, you might want to see if your insurance is affiliated with any prescriptions by mail programs. Before I got my Mirena, I got my oral bc through an online/mail program which sent me three months at a time, and (bonus!) was slightly cheaper than getting it at a normal pharmacy. I took it continuously, and they never balked at the timing of when the script was filled, just sent me the pills when I requested them. I think mine was called express scripts, but I'm sure there are various options, depending on your coverage.
posted by dizziest at 10:07 AM on December 6, 2012

I do NuvaRing continuously. It's been great.
posted by Sidhedevil at 10:13 AM on December 6, 2012

I think just tinkering with the prescription is probably the easiest way to go, but if you're interested in some of the 'no hassle' BC, I can definitely second the enthusiastic recommendation of the Mirena (if covered by insurance, this can be the cheapest BC of all). NuvaRing can also be used to eliminate periods without running into this problem, because you can actually leave the ring in for the whole 28 days and it is still effective, then you swap rings on the 28th day. This gets around the 'technical' issue of the prescription length because NuvaRing is prescribed as being 3 weeks in, 1 week out - you just don't have to use it that way. Just wanted to add that to clarify earlier responses. Since NuvaRing is usually expensive, using it for 4 weeks instead of 3 if you're doing it continuously also saves you money.
posted by treehorn+bunny at 10:15 AM on December 6, 2012 [1 favorite]

Just be warned that bodies are weird and sometimes they won't do what you want, or if they do, they might act differently later. I tried the no-placebo-week thing with BCP and I bled continuously after a while. I had two Mirenas which, after a year of spotting, stopped my periods completely. WIth the third, though, that hasn't happened and I'm back to light periods/spotting. YMMV.
posted by rabbitrabbit at 10:21 AM on December 6, 2012

I was on Mirena for about 4 years, and I had regular periods the whole time. They were lighter than my usual periods, but still very present. I think the no-periods thing is a less-common side effect.
posted by jeoc at 3:21 PM on December 6, 2012

Sounds like you may be in the market for something like desogestrel (brand name Cerazette). Ultra low dose progesterone only oral BC, meant to be taken continuously and prescribed in 6 month dosages. A good option for if you're uncertain about IUDs (which use the same slow release low dose hormone).
posted by givennamesurname at 4:38 PM on December 6, 2012

I've been using Mirena since 2004 & I get light, week long period every month.
I think the stats are that ~20% of Mirena users don't have periods.
I'd suggest its worth a try, but don't assume it's going to make your periods disappear.
posted by goshling at 5:04 PM on December 6, 2012

Another vote for Mirena. I do still get a period, but it's so light that I don't have to use anything - no tampons, no pads. I just notice it when wiping after peeing.

I'm not going to lie though: it hurt like a mother to get put in. It's temporary and goes away completely, but for a day you are going to be miserable. I think it's a small price to pay and I am on my third one now.
posted by corn_bread at 7:01 PM on December 6, 2012

According to my gyno when she wanted me to switch to an IUD rather than Depo (which is what I use for no periods), it's something like only 20% of women stop having periods altogether. This, alas, was not a selling point for me on switching.
posted by jenfullmoon at 8:22 PM on December 6, 2012

I love my Mirena, but I do have a very light period every four months or so. And I definitely still have PMS.
posted by woodvine at 10:51 PM on December 6, 2012

I used long-term birth control pills for a couple years, then continuously cycled my monophasic birth control pill for a few years, and I now have the Mirena IUD (in my first year). In all scenarios I would have light, random bouts of spotting. Not monthly. At those times I do have some hormonal and physical symptoms of PMS but nothing as severe nor for as long as a "normal" cycle.

On another note, maybe you need a new pharmacy or prescription that will allow you to obtain multiple packs of BC at a time.
posted by sm1tten at 5:08 PM on December 7, 2012

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