PMS and continuous birth control- does it get better?

March 26, 2017 4:50 PM

I've been using the Nuvaring continuously for the past six months, in the hopes that it would eliminate both periods and PMS. Thusfar I'm still getting periods (and PMS) every 5-6 weeks. How much longer should I continue with the experiment? Suggestions for other things that might help?

My periods have always been unpleasant, but have become more so over the past five years-ish. They'd also become more frequent; every three weeks or so, which meant that half my life was spent with PMS or cramps. The Nuvaring reduced their frequency, which is better than nothing, but its other side effects (lack of libido, minor vaginal irritation, blood clot risk as with any hormonal birth control) make me unlikely to continue if it doesn't do more for me.

My PMS includes overwhelming depression, food cravings, significant pain in my calves, exhaustion, and worsened insomnia. I bleed for about a week and have cramps for four days of that. It starts about five days prior to my period and continues for a total of nine days or so.

My doctor prescribed citalopram, which made me not care about anything so I went off it. My gynecologist said I could give this a try, and if it doesn't work she'll prescribe a low dosage of Prozac. Ibuprofen, magnesium, fish oil, multivitamins, and exercise have had no effect.

posted by metasarah to Health & Fitness (21 answers total)

It was recommended for me to use the nuva ring continuously 3 months on then have a period which changed my life and allowed me to function more, though my issues were more endometriosis chronic pain related.

But it also reduced pms symptoms cramping and such as well.
posted by AlexiaSky at 5:02 PM on March 26, 2017

I miss read your question. I'm sorry.
posted by AlexiaSky at 5:04 PM on March 26, 2017

I used continuous birth control for about 10 years. It stopped my periods (and that worked immediately) except for break-through bleeding if I went more than about five months without a break. So I ended up doing about four months on, then one week off, which worked great. It solved PMS too, except for the week off.
posted by lollusc at 5:09 PM on March 26, 2017

So there are two types of hormonal birth control: estrogen based and progesterone based. Nuvaring is a estrogen based birth control.

Some BCs are better for longer term continuous use. Has your doctor discussed any IUD methods?
IUD can reduce flow and period.


Depending on your age, desire to have children, insurance, attachment to your organs, and risk aversion you could opt for a hysterectomy.
posted by AlexiaSky at 5:11 PM on March 26, 2017

Obviously not a doctor, but I tried this as well for hormone migraines without success and after 6 months my doctor said it was time to give it up. If it is going to help, it was supposed to by then. My daughter has all of your issues and tried various pills with continuous use without success. She resorted to an IUD which has been very helpful. No periods, pms for long stretches. Maybe a very light period every 5 months. Talk to your doctor about the pros and cons of that option. It is a bigger decision but was worth it to her.
posted by maxg94 at 5:40 PM on March 26, 2017

I did continuous birth control (pill - specifically Yasmin) for years and it was amazing. I did have to have my period about twice a year.

When I wanted to get pregnant I went off the birth control and into Zoloft, which didn't make it all better but at least allowed me to be a functional person month-round.

After the pregnancy, I had an IUD for a year and it was useless. It stopped the bleeding part of my period completely, but that was never the bad part of my periods - I still had monthly hormonal cycles and all the horribleness that came with that.

I haven't found a perfect solution yet (I got pregnant again which is pretty effective at stopping periods, but has one or two other side effects), but the pill was the best thing I've tried so far.
posted by brainmouse at 5:56 PM on March 26, 2017 [1 favorite]

Data point (potentially indicating that this isn't working for you): I use Nuvaring continuously for similar reasons. It worked immediately. I haven't had a period in years. No breakthrough bleeding either.
posted by unknowncommand at 6:07 PM on March 26, 2017

I hated Nuvaring but I use BC continuously with no issues. I'm currently using the "mini" pill because I'm breastfeeding and it is designed not to have any breaks and I have had no periods.
posted by chaiminda at 6:19 PM on March 26, 2017

It is really common to have breakthrough bleeding with continuous hormone use. I doubt you will find your results any different if you continue to use it for longer (although 18 days of the miserable symptoms you describe every 6 weeks sounds way worse than 9 days!).

In addition to Mirena IUD, you could consider Nexplanon, which is basically identical to a Mirena except it's an implant in your arm. Drawback of both methods: it's an invasive procedure and the different hormones may have an unpredictable effect on your mood/libido - but it is typically covered by insurance and neither one is very difficult to remove if you don't like it. On the plus side, no vaginal irritation, and it pretty much eliminates the blood clotting risk because they do not contain estrogen.
posted by treehorn+bunny at 6:39 PM on March 26, 2017

Regarding the mini pill, it's also progestin based and doesn't require any procedure, but you really must take it at the same time every day, which completely ruled it out in my book, although perhaps for you, it may not be such an issue.
posted by treehorn+bunny at 6:40 PM on March 26, 2017

If you haven't tried continuous hormonal birth control via pills, that's a non-invasive thing to try before going to IUD's (which may or may not solve your problem, and the insertion and removal can both hurt like a bitch).

I take microgestin, an standard (and old, well-studied) hormonal BC pill that was originally meant to be taken 3 weeks on/1 week off, as continuous BC. I take a week off every 3 months to prevent breakthrough bleeding, but importantly, even if I forget and get spotting, the breakthrough is just blood, not a "real" period. (No cramps, and no PMS but I don't usually get bad PMS symptoms anyway.) It sounds like the Nuvaring isn't really working for you, so okay, now you know, time to try something else.
posted by serelliya at 7:20 PM on March 26, 2017

Mirena IUD is great for me - no periods for over four years now. I quite liked Nuvaring but seemed to only get three months at a time before I would get breakthrough bleeding.

There is also Seasonale although I don't know if it is indicated for the symptoms you have.
posted by nat at 7:24 PM on March 26, 2017

I used Nuvaring continuously and it actually helped my PMS/mood ups and downs. Now I'm on the Mirena though and no periods is the best thing I've ever experienced basically.
posted by fairlynearlyready at 8:13 PM on March 26, 2017 [1 favorite]

I took NuvaRing continuously and it did not eliminate my periods. But- I am a great pill taker and switched to and love the progestin-only mini-pill, which I take continuously and which has completely eliminated my periods without too many side effects. My doc said that this can happen (woot!) but also that some women get perpetual breakthrough bleeding; bodies are weird! And highly variable! 6 months seems like enough to give the NuvaRing a fair shot, though, so if you are looking for an option to try maybe ask if it makes sense to try a continuous POP if you know you really can do it at the same time evey day without fail.
posted by charmedimsure at 10:21 PM on March 26, 2017

Midwife here (IANYM/TINMA/etc.): Sorry you're going through such a frustrating experience. If I'm reading your question correctly, you have been using the NuvaRing (a combined estrogen/progesterone method) continuously for six months (one ring per three weeks and then changing it immediately for another three week interval, without the one week break). As others upthread said, a prolonged continuous cycling can in fact lead to breakthrough bleeding, so it might be worth trying a break every three months. We do generally expect that your bleeding pattern will establish after 3-6 months, though, so it might be that the ring is not a great option for you.

A few other points: the Mirena is also likely to stop your periods due to the small amount of progestin delivered locally; however, because there is no systemic hormone to keep you "on balance" it may or may not address your PMS symptoms. The Nexplanon is another progestogen-only method, but it is associated with irregular bleeding: for 50% of women who use it, they have irregular and unpredictable bleeding and that is the main reason people have it taken out. 25% of women will have their normal period (for you, every three weeks) and the remaining 25% will have no period at all, but it's impossible to predict who will have what bleeding pattern. The large dose of progesterone delivered systemically also can aggravate depression and mood swings in some people. (The same is true for the depo shot).

If you were my patient, I would ask a few more questions: how old are you, what other methods have you tried and liked/disliked, what is your pregnancy history/planning, and can you tell me more about your depression? Also, I'd want to know if you'd had any other investigations into your painful and frequent periods. If you have periods every 21 days when you're not on contraception, it's worth investigating your short cycles as well. That said, if you haven't tried it already and it's not contraindicated by anything else in your medical history, a birth control pill might be a good option, either combined or progesterone-only. The dose is systemic but low enough to potentially help regulate mood things but high enough to keep your bleeding in check. The tricky thing with pills is that you sometimes have to try a few for a few months before you land on the one that works best for you. The pill may also have lowered-libido side effects, but might help with the bleeding and depression. Feel free to memail me with any other questions.
posted by stillmoving at 11:16 PM on March 26, 2017

A progestin IUD may improve your bleeding pattern but is unlikely to improve the mood and physical symptoms associated with your period. Are you using each Nuvaring for 3 or 4 weeks before immediately replacing it? I would return to your doctor and ask to give another combined hormonal contraceptives a try for continuous use.
posted by i_am_a_fiesta at 3:55 AM on March 27, 2017

I've been using pills (Mononessa) for 2+ years continuously with no breakthrough bleeding and no breaks. Before that we tried the Nuvaring continuously, but I was still having periods/breakthrough bleeding. It may be that the ring is just not right for you. You may have to try a bunch of different pills. Boo. But it can eventually work!
posted by fiercecupcake at 6:34 AM on March 27, 2017

Response by poster: Thanks for all your experiences! To respond to a few questions:

I am 41, had three pregnancies, and am definitely not having any more. I use condoms however so don’t need another form of birth control.

I wouldn’t characterize this as breakthrough bleeding, because it’s accompanied by PMS symptoms and lasts a week.

The PMS is more of an issue than the bleeding (though not bleeding would be nice!)

I’m replacing the Nuvaring after three weeks.

I used Ortho Tri-Cyclen when I was much younger and didn’t have bothersome PMS, etc. I went off it after a couple of months because they destroyed my libido.
posted by metasarah at 7:03 AM on March 27, 2017

There was a question about this several months ago, in which I talked a bit about having a hysterectomy for PMS, in case that's helpful/something you end up having to consider.
posted by diffuse at 9:29 AM on March 27, 2017

Thanks for the update and clarification. It's possible that you're having short cycles because they are anovulatory. Many women notice changes in their 40s and it's possible you're heading into menopause, albeit a bit on the early side. Do you know the menopause history of any famil members? I rarely prescribe triphasics (e.g., Tri-Cyclen) for my patients as I think the weekly change of hormone can be harder to deal with for lots of women. If you were my patient, I might try something like Microgestin 1.5/30 or generic equivalent for a more steady state of hormones for management of PMS and an estrogenic component for management of bleeding. That said: it's worth a visit to your provider to discuss if this is a new change to your periods and see if they want to order any other tests (thyroid, etc). (Again, TINMA, etc...)
posted by stillmoving at 9:45 AM on March 27, 2017

Response by poster: Update: I went off the Nuvaring and overnight, my joint pain that had been increasing over the winter went back to baseline. My doctor has no theory to explain this, but clearly artificial hormones aren't for me!
posted by metasarah at 12:51 PM on April 17, 2017 [1 favorite]