Altering the time of menstruation

Essentials

  • It is preferable to already begin altering the time of menstruation during the menstrual cycle preceding a journey or other important event rather than during it. This way, extra medication with any potential adverse effects and/or failure to alter the time of menstruation at an important time can be avoided.

Women not using hormonal contraception

  • A progestogen can be used to alter the time of menstruation if there is no possibility of pregnancy during that cycle (IUD, condom, abstinence).
  • Norethisterone at a dosage of 5 mg twice daily (three times daily if spotting occurs) or norethisterone acetate at a dosage of 10 mg once daily
    • Treatment should be started no later than three days before the anticipated period.
    • Tablets should be taken for as long as amenorrhoea is desired but for no more than 14 days.
    • Bleeding starts 2–3 days after taking the last tablet.
  • Lynestrenol 5 mg daily (increase the dose to 2–3 tablets in the evening if spotting occurs)
    • Used also when a longer period of amenorrhoea (over 14 days) is desired.
    • Treatment should be started 4–5 days before the anticipated period.
    • Treatment should be continued for as long as amenorrhoea is required.

Women using hormonal contraception

  • Users of combined oral contraceptives with constant hormone doses i.e. monophasic products (tablet/patch/vaginal ring) can continue using the product from the next pack without a tablet-free interval or without taking placebo pills.
    • This way, menstrual bleeding can be postponed for several weeks or months, even.
      • A vaginal ring can be used for no more than 4 weeks without significantly compromising its contraceptive effect; therefore, one ring can be used to postpone menstruation by no more than 1 week. If further postponement is needed, the ring should be replaced after 3 weeks.
  • Users of combined oral contraceptives with varying hormone doses i.e. bi- or triphasic products can prolong the menstrual cycle by continuing to take tablets from the end of the next pack before having a tablet-free interval.
    • Some products, such as Qlaira®, containing dienogest (5 different dose combinations!), are not recommended for altering the time of menstruation.
  • Of users of progestogen-only oral contraceptives, those taking desogestrel tablets can ensure the timing of amenorrhoea if they so wish by doubling the dose one week before the desired period of amenorrhoea, and by continuing to take double doses over that period. Drospirenone may increase plasma potassium levels, and the safety of doubled doses has not been studied.
  • If users of hormonal IUD or contraceptive implants have bleedings, oral progestogen can be added to the regimen for as long as they wish to have amenorrhoea (see above).

Users of hormone replacement therapy

  • Users of sequential, or cyclic, hormone replacement therapy (tablets/patches)
    • The oestrogen phase (tablets in the beginning of the pack) before the oestrogen-progestogen phase can be prolonged by continuing to take oestrogen tablets from the (beginning of) another pack for as many days as menstrual bleeding needs to be postponed. After the prolonged oestrogen phase, the combined tablets from the first pack (oestrogen-progestogen tablets from the end of the pack) should be taken as usual.
      • This is the primary method if withdrawal bleeding usually already begins towards the end of the tablet strip, i.e. during the oestrogen-progestogen combination phase.
    • The oestrogen-progestogen phase can be prolonged by continuing to take combination tablets (oestrogen-progestogen tablets at the end of the pack) from another pack.
      • This is the primary method if withdrawal bleeding usually only begins at the beginning of the following strip, i.e. after the oestrogen-progestogen phase.
    • In either case, bleeding will ensue 2–3 days after withdrawing the combination product.
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