Female-type dilemma

[juthwara]

Okay, so I started back on the pill (the mini-pill actually) exactly a week ago. And guess what decided to show up today after almost exactly a year? My period. (And after 8 freaking weeks of post-partum bleeding too. I have now made up for every period I missed while pregnant)

I really wasn't expecting this. Breastfeeding can delay your period for quite a while and even if that hadn't done it, I thought that it would have waited until I got the inactive pills in the pack. But no, my body had ovulated and it would not be denied (gee, I ovulated all on my own - how novel!).

But as people who've used the Pill know, it's best started on the first day of your cycle, the day your period starts. I had decided to just start taking the pills because, as I said before, I wasn't expecting my period to show up any time soon. But now here I am, at the beginning of my cycle but a week into the pack of pills. So here's my dilemma: do I just keep taking them from this pack and have my period again in two weeks? Or do I toss this pack and start fresh with a new one?

I would go with option two without question except that my insurance gets really shirty about paying for prescription refills more than two seconds before I need them (Really. When I spent the fall in Michigan after my mother's accident and was only home every two weeks or so, I tried to fill a prescription six days before I needed the new prescription while I was home for two days and was told no, I had to wait until four days before the old prescription ran out. Of course, this is also an insurance company that believes the year only has 360 days, to judge by their 1 month=30 days rule of prescriptions). And I'm using a mail-order pharmacy, so it's a lot harder to argue with them or just pay for the prescription out of pocket.

I would call my doctor and ask, but well, it's Sunday and I don't think I would get the best reaction if I had my doctor paged to ask a question about the Pill. So instead, I turn to the Internets for help: what would you do?

Comments

[archangelbeth]

1) My mother said that she went about 2 years without a period while nursing me full-time. Me? Try maybe five months and for once I was actually regular instead of Extended Interval. Pbpbpbpbpth.

2) I'd stick with the pill-pack and have it again in 2 weeks, if your insurance is going to be a pain. I've had 2-week intervals on my own, and unless you have horrible cramps or the like, it will probably not be worth the insurance hassle. I doubt there will be much in the way of medical issues -- you probably just want to make sure you get extra fluids for nursing + period flows.

3) I've never been on the Pill. Take my advice for what it's worth.

[archangelbeth]

PS: I love your mood icon/term there. *snicker*

[juthwara.livejournal.com]

Hee. It was the icon for "annoyed," and I was very pleased when it turned out to be red.

[fairoriana.livejournal.com]

Depending on the type of pill you're taking, insurance may not cover *that* much of it. I mean, the pill might cost $27 regularly, and your copay is only $25. I'd check that out and react accordingly. If the dollar difference doesn't make a big deal to you, then re-start with your cycle. If it does make a difference, then keep going on the pill.

[juthwara.livejournal.com]

Well, our co-pay for generics is 5%, so insurance does pay a sizeable amount. But even so, they don't cost that much.

But thinking about it, I think it's more the fact that we use a mail-order pharmacy that sends us three months' worth at a time that I should consider. When I think about trying to call them and convince them to send me only one pack at my expense, or to send one at full price but charge the other two to the insurance, and I'm sure that if that was successful I would spend the next six months trying to get them to start charging the insurance again - somehow bleeding twice in one month seems like much less of a hassle.

[kristeljohns.livejournal.com]

Long response ahead...

We haven't gotten to the reproductive system in A&P, and my Human Sexuality textbook really only gives a general overview of the function of oral contraceptives, so this is more informed guesswork than anything else.

My understanding of the timing of homonal contraceptives is that the reason you are supposed to start them on the first day of your period is because the dose of hormones in the early forms of The Pill varied depending on what stage of your cycle you were in, and the entire thing was designed to tweak your existing hormone levels to make your body think it had already ovulated when it actually hadn't. The amount of hormone in pills has decreased since the early days, but the tri-cyclic forms of pills still follow this approach, or so I am given to understand.

But the mini-pill is different, because it's just a single, low-level progesterone dose rather than a dose that varies as the month goes on. So I'm not sure it's as important to time it with your cycle. Starting from the first day of the month is mainly a safeguard procedure with these non-tricyclic forms of The Pill, because if you start on the first day of your cycle, you can know you haven't already ovulated and therefore won't go around thinking you are protected when you actually are not.

However--this period you are experiencing may be the result of the mini-pill itself. Speaking from personal experience, my cycle went WAY out of whack just about the month I started on the mini-pill at the age of 21, and it took me the better part of 8 years to get back on something resembling a 28-day cycle (I spent about 6 years spotting for 4-5 days, bleeding for 3-4 days, and then spotting for another week, even long after I had quit the mini-pill and despite having tried a number of other pill formulas--that was a real joy.) So the period you think might be due to your having ovulated may actually be because you started on those pills. I really don't know how common it is for the mini-pill to cause irregular bleeding, maybe my case was unusual and doesn't apply here. But it's something to consider.

There is a strong argument to be made in favor of the low-dose mini-pill, because loading excess amounts of hormones into your system if they aren't needed really isn't the best of ideas. But if this irregular bleeding is a side-effect of the pill, then that's not exactly an optimal situation, either.

So what is my recommendation? If it's important for you to be on the Pill NOW, then I would start a new pack and eat the cost if insurance decides to be bitchy about it (or perhaps your doctor might provide a sample pack) because I think that keeping the cycle of the pills as attuned to your natural cycle as possible really is the best option. But...if your present period is the result of the first week of being in the mini-pill rather than because you ovulated, then that isn't really fixing anything.

You may wish to test exactly what your body is doing naturally first by quitting your current pack and just waiting for your next period to begin a new one, which would not only prevent the hassel of arguing with your insurance company, it would give you an idea of whether or not the bleeding you are now having is actually a result of your cycle, or possibly a result of the pill.

Either way, talk to your doctor tomorrow (yeah, I know, duh!)

[juthwara.livejournal.com]

Well, my concern isn't so much about timing the pill to my cycle as not having to bleed twice in a month. Timing to my cycle would require _having_ a regular cycle. But maybe that's a tad cynical.

In any case, I'm pretty sure it's a natural period. Two weeks ago, I was thinking, "Huh, that's a _lot_ of mucus. I wonder if I'm ovulating?" And then I convinced myself that I wasn't, since I'm breastfeeding, after all. Such is the power of denial.

I'm on the Pill specifically because I have PCOS, so I usually need the hormones to compensate for my own screwed up hormones. OTOH, my hormones are still running so high from pregnancy and breastfeeding right now that I don't think that's going to be necessary right now. So it's tempting to take a month off, if for no other reason than that another month might make it easier to take a pill that has to be taken the same time every day. At the moment, I'm lucky to take my morning pills by 2 in the afternoon. The only problem with that is that since breastfeeding screws up your cycles, the fact that I got my period this month doesn't mean it will come again any time soon. So I could grow very old waiting for my next period to come so I can start the Pill again.

So... I dunno. It won't hurt anything to take a pill tonight and decide what to do tomorrow, so I suspect that's what I'll do.