Heavy Menstrual Bleeding: Progestin-Only Hormone Therapy

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. These medicines stop your body from ovulating. Many teens will not have a period. 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 time every day as prescribed by your health care provider.

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 and 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.

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. If you do not miss doses or take breaks off norethindrone acetate, you should not get periods at all.

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 (that is, 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.

Coronavirus (COVID-19)

What is Coronavirus (COVID-19)?

Coronavirus (COVID-19), pronounced “kr-ow-nuh-vai-ruhs” is a new respiratory illness that has never been seen in humans before. Symptoms are often mild and similar to a cold or the flu. Most people infected with COVID-19 will develop a cough, shortness of breath, and a fever. However, people with respiratory diseases such as asthma or cystic fibrosis, those with weakened immune systems, or people over the age of 60 years old may experience severe symptoms that could be life-threatening.

How do people get this virus?

The virus is found in an infected person’s mucous, saliva and/or sputum (secretions from the lungs). COVID-19 likely spreads when an infected person sneezes or coughs close to a non-infected. The virus can also be spread by touching contaminated objects or surfaces.

How can a person tell if they have COVID-19?

The only way a person can tell for sure if they have COVID-19 is by seeing a health care provider (HCP), who will then perform a special test.  If you have been exposed to a person with the virus or you are experiencing mild respiratory symptoms and fever, call your HCP will determine if you need testing. If you experience a fever, do not take medications such as ibuprofen or NSAIDs. Take acetaminophen or Tylenol, only!

Anytime anyone is very sick or having breathing problems, they should see their health care provider or go to the closest emergency room right away.

Can COVID-19 be prevented?

There are ways to lower a person’s risk for getting infected with the COVID-19 virus (as well as many other illnesses that are spread from person to person).

  • Avoid being around people who are sick.  Don’t kiss, hug or share cups or silverware with anyone who is ill.
  • Practice social distancing (maintaining 3 to 6 ft. between you and other people)
  • Avoid shaking hands with others
  • Wash your hands often with soap and water for at least 20 seconds. Try counting to 20 by saying “one one thousands, two one thousands…” or sing “Happy Birthday” twice!
  • Use hand sanitizer when you can’t wash your hands
  • Cover your mouth and nose when you sneeze or cough
  • Avoid touching your nose, mouth, or eyes
  • Change your clothes after going out in public
  • Wash your face after going out in public
  • Clean surfaces with a disinfectant when anyone in your family is sick.
  • Get your flu shot!

 

If you have asthma, you should also:

  • Review and update your asthma plan with your health care provider.
  • Take your medicine to control your breathing

I am fifteen years old. Is it possible to get a free STI (sexually transmitted infection) test at a women’s health clinic?

Thank you for your question. According to the Center for Disease Control (CDC), every year there are about 20 million newly diagnosed people with sexually transmitted infections (STIs) living in the United States. About 10 million of those people are between the ages of 15 to 24 years old. STIs can affect anyone regardless of race, gender, age, or sexual preference. The risk is high for teens who have multiple sexual partners or their partner has multiple sexual partners, so it’s important to protect yourself and your partner. The use of hormonal contraceptives (such as birth control pills, the ring, Depo-Provera, the patch, and implants) doesn’t protect you against STIs, only pregnancy. The only way to be protected against getting an STI is to use a male or female condom every single time you have sex.

We think it’s great that you are looking into getting tested. The CDC recommend that teens and young women (under the age of 25 years) who are sexually active get  STI testing for chlamydia and gonorrhea every year. In the United States, most primary care providers (PCP) can keep STI testing and treatment confidential (meaning they won’t tell your parents, unless you ask them to). However, you need to ask your PCP if there will be a bill that goes home or a notice sent by your health insurance company to your parents. If you are due for a physical exam checkup, then you can ask for a STI test at that time. A lot of teens are surprised that their parents can help them get an appointment and talk about sexual health.  If you don’t feel comfortable talking to your PCP, you can visit a local Planned Parenthood health clinic, community health center or STI clinic for testing. The health clinic can help determine what the cost of your STI testing will be (if is not free). It’s important to remember: if you think you may have an STI, get tested.

Other helpful resources:

Whenever I stand or move around I feel like I give off a scent similar to a fart, but I am not passing gas. Any ideas what it might be? Help! I am embarrassed to ask my doctor.

confused tweenThe mysterious smell could be caused by many different things, but for starters it may have to do with your body odor. Body odor can be a difficult challenge for teens who are going through puberty (growing from a child into an adult). During puberty, teens begin to sweat more than before. One way to help manage the smell is to pay close attention to personal hygiene. Showering at least once a day with soap and water and using deodorant and or antiperspirants products is a great place to start!

Another reason for the odor can be an infection in your vagina called bacterial vaginosis, or “BV.” BV typically occurs in women (both lesbian and straight) who are sexually active but it can also occur in women who are not sexually-active. The infection is caused by an overgrowth of bacteria, producing white/yellowish discharge from your vagina. BV causes a fishy odor. It is also possible that you left a tampon in your vagina after a previous menstrual period.

Since we don’t know exactly where your mysterious smell is coming from, it may be helpful to ask a trusted friend or parent if they notice it. You may realize that you don’t actually smell at all! If a friend or family member agrees that you have a smell or you are sure that there is an unusual smell, schedule an appointment with your primary care physician. The harmless mysterious smell may actually be a warning sign for an infection, so it’s important to speak with your PCP.

I have some significant acne scars on my face and there making me be self conscious. I heard that topical retinol medicine can make them go away over time. Is it true? How do I make my acne scars go away?

Thanks for your question. Many people are concerned about acne, as well as the skin changes left behind. While retinoid creams can help with pimples, they can also help reduce scarring and dark spots that result from acne. Some types of retinoids are available over the counter at your local pharmacy. They can be irritating to your skin at first, so try applying a thin layer to any scars you have every 2-3 days. If it is not too irritating, you can go up to daily use. If it is too irritating, try using it every 4-5 days. The important thing is to be consistent. It can take weeks to months to notice the benefit, so stick with it. If you don’t feel like it’s helping, talk to your healthcare provider, they may prescribe a stronger medicine and/or refer you to a dermatologist (i.e. a skin specialist).

Other helpful tips:

  • Wash your face 1-2 times daily with a gentle face wash.
  • Moisturize your face after washing with a facial moisturizer. Yes, you should still use a moisturizer even if you have acne.​

The coronavirus is spreading. I don’t want to get it. What should I do?

Thanks for your question. Right now a lot of people share your concerns. The coronavirus is a virus. Symptoms can include: fever, cough, shortness of breath, and body aches. If you are having these symptoms, we recommend you call your healthcare provider to discuss the best next treatment steps.

While there is no vaccine for it currently, there are some things you can do to help lower your own and others’ risk of getting the coronavirus:

  • Wash your hands frequently with soap and water. It is important to wash your hands for at least 20 seconds.
  • Avoiding touching your face (including your eyes, nose, and mouth).
  • Cough into your elbow (NOT your hands).
  • Stay home if you are sick.
  • Avoid close contact with people who are sick.

For the most up to date information on the coronavirus we recommend checking the Center for Disease Control and Prevention website (cdc.gov) and checking with your local health department.

In January, I had surgery to remove a dermoid cyst off of my ovary. Immediately following surgery, I began my period after not having it for years. My doctor said my periods delay was due to the cyst, but now I think my cycle is messed up because I didn’t get my period for February. Is there something wrong?

Thank you for your question. A dermoid cyst (also called a mature teratoma) is a common type of benign growth on the ovary. It’s different from other ovarian cysts such as a Follicular or Corpus Luteum because a dermoid cyst doesn’t affect your hormones. These cysts are usually not harmful but can result in pain if there is torsion of the ovary (twisting of the ovary). Having a dermoid shouldn’t affect your periods. Sometimes when a girl is stressed about surgery, hormone levels may fall and the result is a period. If you haven’t had your period for years, you should see your primary care provider (PCP) and figure out what is causing the problem.

I recently had unprotected sex while taking antibiotics (medicine used to treat infection) and antifungals (medicine used to treat fungal infections). Could I be pregnant?

Great question, thank you. For many years, there was a misconception surrounding the interaction between antibiotics and oral contraceptives (the pill).  While there are a very few antibiotics such as rifampin that can make the pill less effective (while on the antibiotic), research has shown that most antibiotics don’t change the risk of getting pregnant. However, some anticonvulsant (seizure) medications such as phenytoin and barbiturates do interact with the pill, lowering the effectiveness. It’s always a good idea to have a conversation with your primary care provider (PCP) and let them know that you take the pill.

It’s also very important that you use two forms of protection every time you have sex. Most contraceptive methods can protect you against pregnancy, but not all of them will protect you against sexually transmitted infections (STIs). It’s also a good idea to use two forms just in case one of them fails, or the condom breaks. Having a conversation with your PCP may help you select the two forms of protection that are right for you. If you believe you may be pregnant, schedule an appointment immediately with your PCP to discuss your concerns.