Hormonal medications can provide way to manage menstrual cycle

Just days ago, sophomore Uma Malani left school early to spend an hour in the doctor’s office, surrounded by needles and nurses, waiting to receive answers about her menstrual cycle. Since she got her first period in late seventh grade, Uma has suffered from frequent periods of intense, intolerable pain for weeks at a time. 

When on the birth control pill, Uma’s periods did not improve as she expected, and she still experienced many symptoms she sought to relieve. 

“When going to the doctor, I was looking for a better alternative to what was happening and, really, I wanted to know if there was something wrong with me,” Uma said. 

Now, she is looking for a medication option, other than the birth control pill, to manage her menstrual cycle that works for her.

Hormonal medications, including the common hormonal birth control, have the potential to provide a solution for adolescents looking to manage menstruation and menstrual-related symptoms. While these medications have been widely studied and tested, each user has a unique experience.

Shashwati Pradhan, Assistant professor of obstetrics and gynecology at the University of Chicago, often sees patients like Uma who wish to address their periods. She said many patients note painful periods with intense cramping, excessive bleeding and a duration that exceeds the typical three- to seven-day window. For patients wishing to address their cycles, for menstrual suppression or control, Dr. Pradhan and Dr. Chor both like to present a variety of options.

“There are incredibly safe and effective medications, though each one is not for everyone. People have their different kind of preferences or factors that are important to them when choosing a method, and so the most important thing is understanding what’s most important for them in terms of thinking about picking a medication to help,” said Julie Chor, a Lab parent and associate professor of obstetrics and gynecology at the University of Chicago.

Dr. Pradhan noted that while medications to manage periods are often only referred to as “birth control,” not all medications have contraceptive efficacy. 

“The term ‘birth control’ can sometimes intimidate people. Especially because a lot of my patients are younger, they come with parents and guardians who sometimes also feel like their child is too young to be on something like that,” Dr. Pradhan said. “But in terms of menstrual management, there are some hormonal medications that are not contraceptive, which makes the way we phrase it an important distinction to make.”

When seeing patients looking to manage their periods with medical steps, Dr. Pradhan categorizes the many medication options in two primary ways: combined and progesterone only. 

Combined medications consist of two primary hormones — progesterone and estrogen — and often allow the user to experience a bleeding episode approximately every 28 days that tends to be more manageable for patients, often resulting in more regular periods with lighter bleeding and cramping. According to the American College of Obstetrics and Gynecology, combined medications also have the potential to manage acne, reduce the occurrence of menstrual-related migraines without an aura and decrease the risk of ovarian, uterine and colon cancer. Combined medications include the patch, ring and widely known birth control pills, and each method has a unique potential for side effects.

With birth control pills, Dr. Chor and Dr. Pradhan both noted that adolescent patients frequently expressed concerns about side effects such as weight gain, even though medical studies show evidence of little to no correlation between hormonal birth control and weight gain. Dr. Chor believes the internet often contributes to this since teens have access to a wide range of sources.

“If you start Googling any information on contraception, there’s a lot of really high-quality information, but there’s also a lot of misconceptions too,” Dr. Chor said. “You want to validate each person’s experience, but that doesn’t mean that everyone will experience weight gain on birth control pills.”

The other main category for menstrual management consists of progestin-only medications, which contain a form of progesterone, a hormone involved in pregnancy and menstruation. These medications consist of pills, which, unlike the combined pill, may stop a patient’s period entirely or thin the uterine lining enough to largely reduce bleeding. Another form includes the birth control injection or an IUD, an intrauterine device. 

With both types of medication, Dr. Chor and Dr. Pradhan both consider the patient’s medical history when selecting a medication to address other medical conditions as well as certain menstrual disorders such as endometriosis.

Each person’s experience can differ based on individual preferences to individual side effects. For people like Uma, whose first experience with the pill was not what she expected, she now hopes trying other methods to address her periods will allow her to live her life cramp-free, as she hasn’t been able to do in years.

“One of the biggest questions that I ask my patients is how are the menstrual symptoms impacting your life? If you’re having a ton of pain, you’re missing school, you can’t make it to volleyball practice because the pain and bleeding is just too much, there are options for you.” Dr. Pradhan said. “My goal is always to help patients reclaim their time so they can get back to the things that they really want to do.”