Sometimes the timing of a menstrual period can be a big headache – for example, if you need to attend a wedding where you are planning to dance the night away; or you are planning a holiday overseas; or you need to go to a temple or attend a religious function. Young women often want to change the date of their periods, and this is one of the most common reasons why they go to a family doctor or a gynaecologist, and ask for medication to reschedule their periods.
Unfortunately, many of them don't do a very good job and this often ends up creating a mess. If the medications aren't taken properly, the women will end up getting their period on exactly the day they don't want it. The trouble is that doctors are busy people, and while they are quite happy to write the prescription which contains hormones, sometimes these don't work as planned — either because women don't understand how to take them or because the medicines induce vomiting, so they don't act properly.
This is why it's important that women have some basic information about what they can do to adjust their cycles without being overly dependent on a doctor. Here are some basics you need to remember.
The reason you get regular periods is because your ovaries produce hormones called oestrogen and progestrone on a cyclic basis when you ovulate. In the first half of the cycle, their levels rise, and they act on the lining of your uterus, and cause it to build up. In the second half of the cycle, when the levels of these hormones drop, the lining no longer gets the hormonal support it needs. It then sheds, and this is when your period starts. This means that if you want to adjust the date of your period, you need to manipulate these hormones, and this may also need the doctor to switch off the production of your body's own hormones in that month.
Lots of women are very scared that trying to manipulate their hormones can cause side effects and risks. The good news is that this can be done safely, if it is done intelligently, under medical supervision. While there are lots of home remedies which women have tried to adjust their cycle, these are often unreliable and don't always work as expected.
Rule #1: Plan in advance
The secret to planning properly is to do this well in advance. It's much harder to do this successfully if you're trying to do it at the last minute, because once your own body's hormones have started acting, it's much harder to override them. This is why rule number one is: plan in advance. This makes it much easier for both you and the doctor as well, and the treatment will be much more effective.
Rule #2: Postpone
It's much easier to postpone the period than to prepone it. This is because we can never be sure how an individual's body will respond to these medicines, because every woman is different, and which is why it's better to have a margin of safety. Postponing is much easier because you're very unlikely to get a period while you're taking the tablets.
It helps if you are well-organised, and you should keep a diary which tracks your cycles. Lots of apps allow you to do this, and this is valuable information to share with your doctor.
You should understand what the doctor is giving you and why — it's not complicated — and because it is your body, you do need to understand what medicines you're taking. This doesn't mean that you start self-medicating — it's just that you should know what your doctor is are doing, and why.
The commonest medicines used to adjust your cycle are birth control pills or oral contraceptives, which contain the same reproductive hormones which your body produces — oestrogen and progesterone. Thus, if you want to postpone your period, you would continue taking these until you are ready to get your period. These medicines act on the uterine lining, and cause it to build up, so that you will not start bleeding while you are taking them. Once you stop the tablets, you will get a period three to seven days after the last tablet which you take. This is called a withdrawal bleed. After you have completed the course, the hormones will be excreted from your body, and your regular cycle will resume.
Similarly, if you want to prepone the period, you stop the tablets about three to seven days before the date you want to get your periods. However, you need to start taking them in the first week of your previous period, and take them for at least 10 days so that they can act effectively. The trouble is that if you wait too long, your body's natural hormones will have kicked in, and you may then not get a withdrawal bleed after stopping the hormones; your own hormones will continue to act on your uterine lining, and stop it from shedding.
Part of the problem with these medicines is that they do have side effects. The most troubling ones can be nausea and vomiting, especially for the first few doses. The good news is that we now do have clever options — such as hormonal tablets to be taken vaginally — to bypass this problem.
It's important to learn how your body responds to these medicines, and if you have taken them in the past, you should share this information with your doctor, so that she can use this as a baseline. This is especially true if you happen to have irregular cycles — for example, because of Polycystic Ovarian Disease (PCOD).
Finally, what happens if there is an emergency situation and you need to induce a period at short notice? This does become a little more complicated, but your doctor can prescribe more powerful medicines for you. Thus, she can help you regulate your cycle and not mess up what could be an important occasion in your life. If you are well-informed, you will be able to discuss your options more intelligently with your doctor, and help her help you.
Dr Aniruddha Malpani is a leading IVF specialist