If you are unable to take estrogen or if you do not respond to combination (estrogen and progestin) pills, your clinician may prescribe either norethindrone (Camilla®), norethindrone acetate (Aygestin®) or depot medroxyprogesterone acetate (DMPA, Depo–Provera®), three kinds of progestin–only hormone medicine. Your clinician may also recommend a hormonal intrauterine device (IUD). These medicines help to thin the lining of the uterus, making periods lighter or pausing them altogether. Taking progestin (synthetic, or man–made progesterone) medication in this form is very similar to the natural progesterone that is made by your body.
Are there any reasons why I wouldn’t be able to take Progestin–only hormone therapy?
Tell your clinician if you have epilepsy (seizures), migraines, asthma, blood clots, heart, or kidney problems as these should be discussed when considering any hormone therapy. You should not take any kind of progestin if you are pregnant; have cancer, or severe liver disease. You should also tell your clinician if you have diabetes, high blood pressure, high cholesterol, or you have been diagnosed with depression in the past. Your clinician will discuss with you whether it is safe for you to take progestin-only hormone therapy.
What are the side effects?
Most teens and young women have few or no side effects while taking progestin–only medication. Possible side effects can include breakthrough bleeding or spotting, changes in weight, acne, breast enlargement, feeling bloated, headache/migraines, and nausea or vomiting. In addition, DMPA can decrease bone density (thinning of the bones), which is usually reversible after stopping DMPA.
Hormone medications can affect people differently. Some teens will have very irregular bleeding while taking progestin–only hormone therapy, especially during the first 6 months of treatment. Breakthrough bleeding is less common the longer you are on hormonal therapy.
How is norethindrone taken?
Norethindrone 0.35 mg (Camilla® and many other options) is a pill that you swallow. Each pill contains 0.35 mg of norethindrone. The pill comes in a packet of 4 weeks and you take 1 pill a day.
You should take norethindrone at the same exact time every single day as prescribed by your health care provider. A variation of 20 minutes or more may cause you to experience break through bleeding. A great way to prevent this is by setting an alarm on your cellphone to ensure that you take the medication at the same time every day.
What should I expect will happen to my menstrual bleeding if I am taking norethindrone?
If you take norethindrone at the same time each day in the dose prescribed by your clinician, your menstrual bleeding should become less, or it may stop completely. Some people on norethindrone continue to have monthly periods but the periods should be lighter and shorter.
How is norethindrone acetate taken?
Norethindrone acetate (Aygestin®) is a pill that you swallow. Each pill contains 5 mg of norethindrone acetate. Norethindrone acetate is not an approved form of contraception.
Your clinician will tell you whether to take 0.5, 1, 1.5, or 2 tablets (2.5, 5, 7.5, or 10 mg). You should take norethindrone acetate at the same time every day as prescribed by your health care provider. At Boston Children’s Hospital, we generally recommend that you do not take more than 10 mg of norethindrone acetate a day.
What should I expect will happen to my menstrual bleeding if I am taking norethindrone acetate?
If you take norethindrone acetate at the same time each day in the dose prescribed by your clinician, your menstrual bleeding should stop completely. A variation of 20 minutes or more may cause you to experience break through bleeding. A great way to prevent this is by setting an alarm on your cellphone to ensure that you take the medication at the same time every day. However, if you do not miss doses or take breaks off norethindrone acetate, you should not get periods at all.
How is drospirenone (Slynd®) taken?
Drospirenone (Slynd®) is a birth control pill that you swallow. There are 28 pills in a pack, and 24 of them are active pills containing 4mg of drospirenone. The remaining four pills at the end of the pack are considered placebo or sugar pills. Drospirenone contains an ingredient similar to approximately 25mg of spironolactone, a medication often used for acne. You will take 1 pill a day.
In some cases, your provider may have you skip the last four placebo pills and immediately begin a new pack of active pills. This is called continuous use and will prevents you from having a monthly period.
You should take drospirenone at the same exact time every single day as prescribed by your health care provider. A variation of 20 minutes or more may cause you to experience break through bleeding. A great way to prevent this is by setting an alarm on your cellphone to ensure that you take the medication at the same time every day.
What should I expect will happen to my menstrual bleeding if I take drospirenone?
If you take drospirenone and it is prescribed for continuous use (without breaks or placebo pills) your menstrual bleeding should become less and it may stop completely. Drospirenone has also been shown to improve dysmenorrhea (painful periods) in a number of teens.
How is depot medroxyprogesterone acetate given?
Depot medroxyprogesterone acetate (DMPA, Depo–Provera®) is an injection that is given in a muscle (in the buttocks, arm, or thigh) approximately every 3 months. The first shot is usually given within the first 5 days of your menstrual cycle (during your period). If you are sexually active, a routine urine pregnancy test will be done first. The next shot needs to be scheduled within 11–13 weeks.
What should I expect will happen to my menstrual bleeding if I am getting DMPA injections?
If you get DMPA injections every 11-13 weeks (or as recommended by your clinician), your menstrual bleeding may become irregular, become heavier, become lighter, or stop completely. The longer you continue to get DMPA injections, the more likely it is that you will have fewer, lighter, or shorter periods, or no periods at all. After one year of getting DMPA injections (after 4 injections), about one-half of women stop getting their periods.
What if I am having sex? Is it OK to take these medications?
Be sure to let your clinician know if you are sexually active when you are discussing which hormone medication to use to manage your heavy menstrual bleeding. Although norethindrone acetate can keep you from ovulating, this medication has not had studies to become an FDA approved form of birth control. The DMPA and norethindrone 0.35 mg/day are methods of birth control. None of these medications protect you from sexually transmitted infections (STIs). Always use condoms when you have sexual intercourse.
How is the IUD inserted?
The hormonal IUD is a device placed inside the uterus. The Mirena® IUD is an IUD that is commonly placed, and it is an FDA approved method to treat heavy menstrual bleeding. The IUD releases a small amount of hormone daily inside the uterus, and depending on the IUD placed, it can last for up to 7 years inside the uterus. The IUD insertion requires a pelvic exam, in which a device called a speculum is inserted into the vagina so that the provider can see the cervix. The IUD is placed through the cervix and positioned inside the uterus (no incisions). The IUD can be placed in the office or sometimes under sedation.
What should I expect will happen to my menstrual bleeding if I am getting the IUD?
Most patients experience some amount of spotting or bleeding immediately after IUD insertion. It is not uncommon to experience some irregular bleeding in the first three to six months of IUD use as the body adjusts to the IUD, however it often gets lighter. Approximately a fifth of patients stop having their periods with the IUD after one year.
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