How to Never Have Your Period Again
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When it comes to monthly cycles, I’m one of those women who was born lucky: four-day panty-liner periods and the occasional little backache that felt like an excuse to pamper myself with a warm bath or cup of tea—or a few more chocolate chips. That’s it.
I thought it was that way for everyone until two things got me to start asking questions: 1) my husband and I and our two daughters made a trip to Africa, where I got a glimpse of the things desperate moms do to manage their fertility; and 2) my daughters hit their mid-teens. I decided I wanted to understand more about women’s bodies and especially about long-acting reversible contraceptives (LARCs) that I’d heard could change the pregnancy risk from 1 in 12 each year on the Pill to less than 1 in 700 on the most effective method available.
I started reading and initiating conversations about contraception. One unexpected thing that came back at me was stories about periods: A young teacher had to excuse herself from the classroom so she could throw up because her periods made her nauseous; a neighbor had such heavy bleeding that it made her dangerously anemic; a friend had cramps that were as intense as early labor. Another woman went to buy groceries for her kids and had to change her tampon and pad twice just to get out of the store!
Well, OK, it turns out that American women miss over 100 million hours of work annually from menstrual symptoms, so probably a lot of you knew, but I didn’t. What I also didn’t know was this: For 50 years researchers have been examining the health costs of our bodies gearing up every month to make a baby—and even questioning whether the number of cycles we have (almost 400 on average) is normal in historical terms. As research has accumulated and contraceptive technologies have improved, more and more medical practitioners are giving women with problem periods the option to reduce or eliminate menstrual bleeding.
In fact, they are giving women with normal periods the same option, because not getting your period every month can sound pretty great even to some of us who don’t suffer debilitating cramps and anemia and such. It also may be healthier. From a quality of life standpoint, two thirds of women would rather ditch their periods, while one third actually prefer the rhythm of the monthly cycle. From a health standpoint, the pros and cons appear balanced enough that many medical practitioners believe women should be fully informed about what is known at this point and allowed to make their own decisions.
Here are a few facts about women and periods from my earlier piece, “A Brief History of Your Period and Why You Don’t Have to Have It:
- Modern Western women have four times as many periods over a lifetime as our hunter-gatherer ancestors and triple the number for women just 100 years ago. In other words, what seems "natural" now is very different from what our bodies have historically supported or have evolved to support.
- Menstrual symptoms are the number-one reason young women miss school or work. In the developing world menstruation is a factor in adolescent girls leaving school.
- Italian researchers found that menstrual symptoms and related absenteeism account for approximately 15% of the wage and promotion gap between men and women.
- There are no known long-term health costs of menstrual regulation or suppression in healthy women.
Deborah Oyer, a family planning doctor in Seattle who also trains medical students, residents and other practitioners, asks all of her contraception patients, “How often do you want to have your period? Monthly? Every three months? Or not at all?” Until she asks, many women don’t know they have a choice. It turns out, they have several.
When used continuously, pills, the ring, the shot, the patch and the hormonal IUD can all substantially reduce or even eliminate menstrual bleeding and cramps. Oyer often recommends a hormonal IUD, since longer-acting methods offer better pregnancy prevention. (On the Pill about 1 in 12 women gets pregnant each year; with a hormonal IUD that number drops to 1 in 700.) But no one method is best for everyone. Ultimately you have to decide what fits your lifestyle and your body.
For example, somebody who wants the long-term freedom of an IUD has to have the time for a little self-pampering during the initial adjustment period. Short-acting methods like birth-control pills can suppress your period and related symptoms from the very first cycle. By contrast, a hormonal IUD may cause several months of spotting while the uterine wall gradually thins. The typical payoff is a 90 percent reduction in menstrual flow for up to seven years, and many women have no bleeding by the end of the first year. But you have to get through what some users call “the black panties phase.” One college-aged dancer chose to wait for a pause in her performance schedule, using rings to manage her cramps and bleeding during the school year and then getting an IUD during her summer break.
If you count on your period as a monthly pregnancy test, you may worry that with no bleeding you could end up pregnant and not know it. Oyer says there are other ways of knowing whether you are pregnant: “Most women, within a few weeks of becoming pregnant, haveseveral symptoms that alert them that they are pregnant. These symptoms can include nausea and vomiting, breast tenderness, aversion to smells, bloating, dizziness, and needing to pee more frequently.” She warns against trusting your period as a definitive test. “It’s a little-known fact that many women continue to get periods in early pregnancy. It is always important to pay attention to your body when wondering about pregnancy. A period should be reassuring only in the absence of other symptoms.”
Making any big health decision raises an array of hopes and fears, and Oyer patiently led me through some common misconceptions. No, menstrual suppression doesn’t cause a build-up that can lead to cancer. In fact, it can help symptoms of endometriosis and may reduce the risk of some cancers. Except for the shot, there’s no evidence that menstrual suppression causes bone loss. (The shot appears to cause temporary calcium loss that is rebuilt after it is discontinued.) All research suggests that women who want to get pregnant resume regular cycles and normal fertility rates within a few months after discontinuing continuous contraception. However, suppressing your period won’t “save your eggs” and prolong your fertility or postpone menopause if that’s what you were hoping.
Thanks to the array of options available, even women with chronic health problems like migraines, diabetes, a history of blood clots or polycystic ovary symptom often find a method that is safe and effective. Oyer encourages all women to ask themselves what they want and then get the information that will let them make an informed decision:
“The studies we have about continuous contraception are limited, but they strongly suggest that reducing or even eliminating your period can be a healthy option. Long-acting methods, LARCs, may be relatively new to most American women, but hormonal IUDs have been used in Europe for over 20 years, and they have been researched since the 1960s and 1970s. That said, you need to decide what is right for you—to gather information, weigh the risks and benefits, talk to your provider, and listen to your body.”