Alternatives to the pill for regulating flow
Question
My husband and I have been practicing NFP for the past 9 years. When my period returned after the birth of our fourth child two years ago, I started experiencing some very heavy bleeding during my periods. The heavy bleeding is usually accompanied with large blood clots. My physician suggested that I take the birth control pill to regulate the flow. I am 36 years old and my periods have always come regularly. Is there some way to take the pill and still avoid the possibility of a “micro-abortion?” What would you suggest that I do?
Answer
Last Updated: June 9, 2013
There are several possibilities as to why your periods may be heavier after your fourth child. One reason is chronic endometritis, an inflammation of the uterus sometimes occurring after birth. Although two years has passed, occasionally this condition can persist. It can be diagnosed with a biopsy of the uterus, or sometimes “empirically” treated with a course of antibiotics such as doxycycline for ten days or so. In some women improvement is dramatic. Another possibility is a fibroid, polyp, or other anatomical condition of the uterus. An ultrasound or biopsy might reveal a condition such as this.
However, the most likely cause, especially if you are over 35 and your doctor wanted to try birth control pills, is a minor hormonal problem in which progesterone is deficient. This can be treated by using progesterone in the luteal phase, the last half of the cycle. The best therapy, if you are using NFP, is to use progesterone vaginal capsules in a fairly high dose (600 mg.), three days after the peak to twelve days after the peak, or from cycle day 18-27. These capsules are available by prescription from Kubat pharmacy in Omaha (1-800-782-9988) and are not expensive. They are much less messy than progesterone vaginal suppositories. Alternatively, Crinone, a vaginal gel of natural progesterone can be used during the same time period, but may interfere with your mucus readings. If the vaginal preparations work, you could try decreasing the dose to 400 mg. and eventually switching to oral micronized progesterone. You could also try oral micronized progesterone right away, but the vaginal preparations will have a stronger and more reliable effect on the uterine lining.
I do not know of any way to take oral contraceptives and avoid the abortifacient effect, other than abstinence. Some have suggested abstaining on “fertile mucus days”, but this has never been studied. The pill’s effect on the mucus will distort your perception of the potentially fertile days of breakthrough ovulation and you will not know when they are occurring. Cooperative progesterone therapy in the forms mentioned above is an excellent alternative to birth control pills for this problem.
Dr. Mary Davenport
However, the most likely cause, especially if you are over 35 and your doctor wanted to try birth control pills, is a minor hormonal problem in which progesterone is deficient. This can be treated by using progesterone in the luteal phase, the last half of the cycle. The best therapy, if you are using NFP, is to use progesterone vaginal capsules in a fairly high dose (600 mg.), three days after the peak to twelve days after the peak, or from cycle day 18-27. These capsules are available by prescription from Kubat pharmacy in Omaha (1-800-782-9988) and are not expensive. They are much less messy than progesterone vaginal suppositories. Alternatively, Crinone, a vaginal gel of natural progesterone can be used during the same time period, but may interfere with your mucus readings. If the vaginal preparations work, you could try decreasing the dose to 400 mg. and eventually switching to oral micronized progesterone. You could also try oral micronized progesterone right away, but the vaginal preparations will have a stronger and more reliable effect on the uterine lining.
I do not know of any way to take oral contraceptives and avoid the abortifacient effect, other than abstinence. Some have suggested abstaining on “fertile mucus days”, but this has never been studied. The pill’s effect on the mucus will distort your perception of the potentially fertile days of breakthrough ovulation and you will not know when they are occurring. Cooperative progesterone therapy in the forms mentioned above is an excellent alternative to birth control pills for this problem.
Dr. Mary Davenport
Answered By:
Mary Davenport, MD, MS
Mary Davenport, MD, FACOG, an obstetrician/gynecologist from the Oakland Region of California, offers telehealth services over MyCatholicDoctor.com She graduated from Tufts University School of Medicine and completed her residency at UC San Diego. Dr. Davenport is a Fellow of the American College of Obstetrics and Gynecology, and serves on the Advisory Board of the California Association of Natural Family Planning.
