Heavy, Unpredictable Flow in a Teenager - Rethinking The Pill

Question

My mom made me go to the doctor I'm 15 and don't get my periods on time and when it comes it's so heavy!!!!! I got an order for The Pill. I'm not having sex so WHY WOULD I TAKE IT?????

Answer

Thanks for your very important question. Is The Pill (combined hormonal oral contraceptives, COC) the right treatment for teenaged unpredictable and heavy menstrual cycles?

Unpredictable cycles are common in the first several years after menarche (first period). So if your period started when you were 12 or 13, it is normal for it to be hit or miss. The biggest difficulty is not knowing when your period will start so you may stain your clothes because of not having pads or tampons or a menstrual cup when you need it!

Although your irregular periods are not a health risk, heavy flow is. Heavy menstruation often causes anemia (low blood count) which can zap your energy and health. You can learn about heavy flow and anemia here.

The first treatment for heavy flow is simple, cheap and easy-take plain old over-the-counter ibuprofen (Advil, Motrin, Nuprin, Medipren) one tablet (200 mg) with breakfast, lunch and dinner on every heavy flow day. Ibuprofen decreases the amount of flow by almost half. Make sure to tell your friends about ibuprofen because it is the best kept secret every menstruating woman needs to know.

The next question is-Does The Pill help with heavy flow in teenagers?
Although The Pill (COC) is the most common heavy flow treatment offered to younger women, there is no evidence as of 2007 that it is effective. (It has only been tested in older menstruating women). The most common reason for teen heavy flow is not making enough progesterone. Usually there is plenty of estrogen. Progesterone's "job" is to stop estrogen from over-growing the lining of the uterus. That means cyclic progesterone is a sensible treatment. See Cyclic Progesterone Therapy. 

If ibuprofen is not sufficient to decrease heavy flow to normal or tolerable, then adding natural progesterone (Prometrium, 300 mg at bedtime) on cycle days 14 to 27 is a great option. This will not only make flow lighter but also regular. You'll need a prescription so it will be helpful if you print out that hand-out (above) for her/him.

Something else you can do for yourself is to start charting your cycle http://www.cemcor.ubc.ca/files/uploads/Menstrual_Cycle_Diary.pdf. With today's technology of websites and mobile apps, charting your cycle has never been easier. By charting the changes of your cycle, as well as when you get your period and how heavy it is, you can notice patterns and changes that can be helpful for both you and your doctor.

Is The Pill a good idea for heavy, unpredictable flow in a teenager? I don't think so. We don't know that it works. And it may not be safe for your bones. Studies show that younger women on The Pill don't gain as strong a "peak" bone as they otherwise would. Plus your own reproductive system may not "grow up" normally-after all, The Pill's job is to prevent fertility by suppressing your own hormones. Finally, young women on The Pill may not learn to recognize and value the important experiences of their own cycles.

So, if you aren't sexually active with a man, thumbs up for ibuprofen and cyclic progesterone (if you need it), and thumbs down for The Pill.

Hope this is helpful for you,
All the best,
Jerilynn