Delayed Menstruation on Birth Control Pills: FAQs

Menstruation occurs on the eighth day of taking oral contraceptives?

I have polycystic ovary syndrome (PCOS) and started taking oral contraceptive pills (Alesse 21) four months ago to regulate my menstrual cycle.
However, my period only arrives on the seventh day after taking the pills.
For the past two months, after stopping the medication on December 1 and January 1, my period did not come until the eighth day (December 17).
Today is the eighth day after stopping the medication, and I am experiencing abdominal bloating, but my period still hasn’t arrived.
Is this normal? Why is my period still so late even while taking the contraceptive pills? Additionally, I had sexual intercourse with my boyfriend on the first day of my period last month (December 17), and I usually start taking the contraceptive pills on the fifth day of my period.
Is there a possibility of pregnancy? I have been taking the pills consistently without missing any doses.

Liu Xiaojie, 10~19 year old female. Ask Date: 2018/01/18

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Polycystic ovary syndrome (PCOS) has been managed with the use of oral contraceptive pills (Alesse 21) for the past four months to regulate menstruation.
However, menstruation has only occurred on the seventh day after taking the pills each time.
Recently, for the last two months (December and January), menstruation did not occur on the seventh day after stopping the medication; instead, it arrived on the eighth day (December 17).
Today marks the eighth day after stopping the medication, and there is already abdominal bloating, but menstruation has not yet started.
Is this normal?
Answer: Yes, this is normal.
Why is my period still late even though I am taking contraceptive pills?
Answer: The menstrual cycle can still be influenced by other factors (excluding pregnancy).
Additionally, on the first day of menstruation after stopping the medication (December 17), there was sexual intercourse with my boyfriend.
I usually start taking the contraceptive pills on the fifth day of my period.
Is there a possibility of pregnancy?
Answer: There is no possibility of pregnancy.

P.S.
I have been consistently taking the contraceptive pills on time without missing any doses.

Reply Date: 2018/01/18

More Info

Understanding delayed menstruation while on birth control pills can be a source of confusion, especially for individuals with conditions like Polycystic Ovary Syndrome (PCOS). Let’s break down your concerns regarding the delayed onset of menstruation, the effectiveness of birth control pills, and the implications of recent sexual activity.

Firstly, it’s important to recognize that birth control pills, such as the one you mentioned (Alesse 21), are designed to regulate your menstrual cycle. However, individual responses to these medications can vary significantly. In women with PCOS, hormonal imbalances can lead to irregular menstrual cycles, even when on hormonal contraceptives. This means that while the pills are intended to provide a predictable cycle, they may not always be effective in achieving this goal for everyone, particularly for those with underlying hormonal issues.

Regarding your specific situation, it is not uncommon for women to experience variations in their menstrual cycle while on birth control pills. The fact that your period has been arriving later than expected, such as on the eighth day after stopping the pills, can be attributed to several factors:
1. Hormonal Fluctuations: Birth control pills work by providing a steady dose of hormones to prevent ovulation and regulate the menstrual cycle. When you stop taking the pills, your body may take some time to readjust to its natural hormonal rhythm, especially if you have PCOS.

2. Delayed Withdrawal Bleeding: After stopping the pill, some women may experience a delay in withdrawal bleeding, which is the period that occurs after stopping hormonal contraceptives. This can be influenced by your body’s hormonal balance and any underlying conditions.

3. Stress and Lifestyle Factors: Stress, changes in weight, diet, and exercise can also impact your menstrual cycle. If you have experienced any significant changes in these areas, it could contribute to the delay.

Now, concerning your sexual activity on December 17, the timing of your menstrual cycle is crucial. If you have been taking your birth control pills consistently and correctly, the risk of pregnancy is significantly reduced. However, since you mentioned that you started taking the pills again on the fifth day of your period, it’s important to note that the effectiveness of the pill may not be immediate if you start taking it after a break. Generally, it’s recommended to use additional contraception (like condoms) for the first seven days after starting the pill again to ensure maximum protection.

In summary, while it is not unusual for your period to be delayed after stopping birth control pills, especially with a condition like PCOS, it’s essential to monitor your body’s responses. If you continue to experience irregularities or have concerns about potential pregnancy, it would be wise to consult with your healthcare provider. They can offer personalized advice, conduct necessary tests, and help you understand your menstrual health better. Remember, maintaining open communication with your healthcare provider is key to managing your reproductive health effectively.

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