Skipping Your Period With a Triphasic Pill, Part II

You can use a triphasic pill brand to skip a period. Before we review the regimens used to skip a period with a triphasic pill brand, let me clarify a few terms.

Triphasic, Skip a Period

Combination birth control pill - each active pill has a combination of estrogen (ethinyl estradiol) and progestin (synthetic progesterone). Each placebo ("sugar") pill is inactive; it does not have hormones.

Pill brands came in 21-, 28-, and 91-day packs. The 21-day pack has only active pills. The 28- and 91-day packs have an extra 7 inactive, or placebo pills.

The placebo pills are reminder pills. They're put in the pack to get you into the habit of taking a pill every day. They serve no other purpose.

Monophasic brand - all active pills have the same amount of estrogen and progestin. All active pills are the same color. In 28-day packs, the 7 placebo pills are a different color. That's two different colored groups of pills per 28-day pack.

Triphasic brand - the active pills have either the same, or two different amounts of estrogen, and two or three different progestin amounts. All active pills with the same amount of estrogen and progestin are the same color--usually three groups of colors per 28-day pack. The 7 placebo pills are a different color. That's four different colored groups of pills per 28-day pack.

For more on monophasic vs. triphasic, see Skipping Your Period With a Triphasic Pill, Part I.

Skipping a period - when you use a combination birth control pill--monophasic or triphasic--you don't have a menstrual period for the entire time you take the pill.

The monthly bleeding you experience while on the Pill is withdrawal bleeding, a chemically induced event. This artifice was introduced for political, religious, etc. reasons by the Pill inventors; it serves no known medical function.

The menstrual period and withdrawal bleeding are not one and the same thing.

Bottom line: When you use the Pill and you modify the regular 21/7 (21 days of active pills/7 days of placebo pills during which you experience withdrawal bleeding) to an extended regimen, like the 84/7 one, you are only changing the frequency of withdrawal bleeding; from monthly, to once every three months. The regimen change has no effect on your menstrual period since, while on the Pill, you don't have a menstrual period.

Triphasic, Extended Regimen

If you want to skip your period, using a monophasic Pill brand is best.

Why? Because all monophasic active pills have the same amount of hormones. This means steady hormone levels and less likelihood of nuisance side effects like breakthrough bleeding/spotting (BTB).

BTB is not dangerous to your health (for most women) but it's a significant inconvenience (not to mention a major reason women discontinue Pill use).

Because triphasic pill brands have varying hormone levels which fluctuate--usually, from week to week--you're more likely to experience BTB if you use a triphasic brand to skip your period.

So, what are you to do?

If you're not already on the Pill, start using a monophasic brand to skip your period.

If you're already using a triphasic brand and it suits you, no need to switch to a monophasic. Go ahead and use your existing triphasic brand. If it works, great! If not, you can always change to a monophasic brand later.

Now, if you're already on the Pill, a triphasic one, you're most likely on the regular regimen: 21 days of active pills, followed by 7 days of placebo pills during which time you experience an episode of bleeding.

In order to eliminate that monthly bleeding episode, or shift its frequency (to, say, once every three months) you have to modify the regular 21/7 regimen you've been using. You need to use an extended regimen, and you have several options to chose from.

Before we go on to the actual regimens, note the following:

- no matter which regimen you chose, you're still protected against pregnancy (provided you don't miss any pills, of course)

- the regimen recommendations to follow are based on clinical experience (there are no formal studies on triphasic extended regimens)

- since Ortho Tri-Cyclen* is a commonly used triphasic brand, I'll use it to illustrate the various extended regimens

*There are 28 pills in the pack. Four groups of 7 pills, each group a different color:

White pills (seven)- each pill has 0.035 mg estrogen (ethinyl estradiol) and 0.180 mg progestin (norgestimate)

Light blue pills (seven)- each pill has 0.035 mg estrogen and 0.215 mg progestin

Blue pills (seven)- each pill has 0.035 mg estrogen and 0.250 mg progestin

Green pills (seven)- each pill is a placebo pill (no hormones)

Notice how the amount of estrogen is the same throughout the month, while the progestin amount keeps increasing.

And now, without further ado, the triphasic regimens.

Triphasic Regimens

To skip one period or delay it by one week:

A) Take the 21 active pills (first three weeks of pills). When you get to the 7 placebo pills (last week of pills) throw them out and instead take the third week of active pills from a new pack.

(Ortho Tri-Cyclen) Take 7 white pills + 7 light blue pills + 7 blue pills. That's 3 weeks and 21 pills. When you get to the 7 green pills, discard them, and take 7 blue pills from a new pack instead. Once you're done, either wait one week and then start a new pack (delays bleeding by one week), or start a new pack right away (skip bleeding).

7 white pills + 7 light blue pills + 7 blue pills + 7 blue pills (from a new pack)
Wait one week, then start a new pack/Start a new pack right away.

B) Take the 21 active pills and the 7 placebo pills (four weeks). Wait for one week**. Start a new pack and take the 21 active pills, followed by the 7 placebo pills. [This regimen shifts the bleeding episode by one week during the second month.]

**VERY IMPORTANT: You are not protected against pregnancy during the week you delay taking the next pack. You must use an alternate birth control method (condom, diaphragm, sponge, etc.).

7 white pills + 7 light blue pills + 7 blue pills + 7 green pills
Wait one week (no pills). [No Pregnancy Protection!]
Start a new pack.

To delay bleeding for months:

1. Take the 21 active pills (first three weeks of pills). When you get to the 7 placebo pills (last week of pills) throw them out and instead start a new pack.***

7 white pills + 7 light blue pills + 7 blue pills
Start a new pack (take active pills only).

***This is the regimen most likely to trigger BTB.

2. Take the 21 active pills (first three weeks of pills). When you get to the 7 placebo pills (last week of pills) throw them out. Start a new pack backwards, after first discarding the 7 placebo pills from this new pack.

[Pack #1] 7 white pills + 7 light blue pills + 7 blue pills + [Pack #2] 7 blue pills + 7 light blue pills + 7 white pills {+ [Pack #3] 7 white pills + 7 light blue pills + 7 blue pills}

3. Start with three new packs (or two). Take the first 7 active pills from each of the three packs (three weeks total). Then take the next 7 active pills from each of the three packs (three weeks). Finally, take the last set of 7 active pills from the three packs (three weeks). Stop for one week, then restart.

[Pack #1] 7 white pills + [Pack #2] 7 white pills + [Pack #3] 7 white pills + [Pack #1] 7 light blue pills + [Pack #2] 7 light blue pills + [Pack #3] 7 light blue pills + [Pack #1] 7 blue pills + [Pack #2] 7 blue pills + [Pack #3] 7 blue pills
Stop for one week, then restart.

So, there you have it. These are some of the regimen options you have if you want to use a triphasic Pill brand to skip your period.

As you can see, using a triphasic for an extended regimen can be a bit confusing. Also, you're more likely to experience BTB. So, even if you're already using a triphasic on a regular 21/7 regimen, consulting with your physician about switching to an extended regimen is most helpful.