Last week, the New York Times published a piece titled “How to Stop Your Period” endorsing long-term menstrual suppression.
Author Katie Rogers writes, “There are women like me, who do it to avoid painful periods, and others who simply want the better quality of life that comes from not having a monthly period. Dr. Shari Lawson, an assistant professor of obstetrics and gynecology at Johns Hopkins University School of Medicine, said that ‘looking at this continuously as a lifestyle is often the next step up’ from occasional period suppression.”
One method of period suppression involves taking extra packs of the Pill. Rogers explains, “To skip a period, a woman can just skip the placebo week and start a new pack without a break.” Other options include using a NuvaRing, an intrauterine device, or an injectable hormonal contraception to lower period frequency.
The Journal of the American Medical Association, however, recently published a comprehensive investigation on the association between hormonal birth control and depression, citing that “using hormonal contraceptives ‘was associated with subsequent use of antidepressants and a first diagnosis of depression.’ The authors also note that ‘all types of hormonal contraceptives’ were associated with these risks.”
Apart from a significantly increased risk of depression due to consumption of the Pill, there are numerous other reasons why getting rid of our periods is not as awesome as it sounds.
We asked feminine health experts Dr. Marguerite Duane, family physician and executive director of Fertility Appreciation Collaborative to Teach the Science, and Dr. A. Nicky Hjort, M.D., OB-GYN at Peninsula Primary Care in California, to weigh in on period suppression and the possible cons associated with this trend.
The Risks of Stopping Our Periods
Dr. Hjort notes, “This is an interesting thing because we’re taking medication, and we’re using it, in some instances, to suppress a cycle that is bothersome, dangerous, or problematic, and we’re taking that same therapy and now going to the next level, which we should always do with caution.”
Rogers’ opening argument is, “For many women, periods are just a monthly nuisance.” But Dr. Hjort cautions, “I think viewing the period as a nuisance and a distractor from life is a slippery slope. What becomes the next nuisance?”
Dr. Hjort shares, “I’m an extremely cautionary physician, meaning that I never give patients medications unless there’s an indication for it. So I use cycle control and continuous cycle control specifically for several very important reasons. I use it for folks that have painful periods, which is often called dysmenorrhea, menorrhagia (heavy periods), or metromenorrhagia (heavy and irregular periods). Those are medical problems with a true medical indication that merits the risks of oral contraceptives, and although they are minor, they are not negligible.”
Rogers states, “There are no known risks for using birth control continuously beyond the side effect profile that already exists for the drug.” Dr. Duane points out that while this is true, “they fail to highlight that there are numerous side effects associated with hormonal contraception that can affect every organ system and also includes very serious side effects such as blood clots to the lungs (called pulmonary embolisms) and to the brain causing strokes, both of which can result in death.”
Dr. Duane adds that hormonal contraception is associated with an increased risk of breast, cervical, and liver cancer. In fact, the World Health Organization classifies combined hormonal contraception as a group 1 carcinogen—same as tobacco—because of these increased risks. “While suppressing one’s cycle continuously may provide relief from temporary symptoms associated with the menses, it may not treat underlying causes of these symptoms and can certainly put a woman at risk of increased harm,” Dr. Duane notes.
Creating a Problem Where None Exists
Dr. Hjort shares, “I’ve had a few patients that once had normal periods, decided that she wanted them to go away, and I placed her on extended cycles. Now she has headaches that have worsened, hypertension that has worsened, or, worst of all, she’s gone from having a period once a month to having irregular bleeding on and off for several months’ duration that can be extremely difficult to manage in the most severe of cases.”
“So sometimes, not only have you taken away a problem that you didn’t really have and treated it with a medicine you didn’t actually really need, but now you’ve created a problem you previously didn’t have,” Dr. Hjort adds.
Besides managing irregular bleeding, Dr. Hjort mentions that interrupting the cycle or prolonged spacing of periods can “prolong the interval between when the contraceptive is no longer required and pregnancy becomes desired.”
Combined with the increased risks of depression, heart attack, stroke, and blood clot, “Why would you take anything that you don’t need to?” Dr. Hjort asks.
The Benefits of Normal Reproductive Cycles
Dr. Duane asserts, “There are real benefits associated with the normal cyclical hormonal changes women experience when their reproductive cycle functions normally, including increased brain growth and mental health.”
One study published this month in Scientific Reports, for instance, found that matter in the hippocampus—the region of the brain associated with memories, mood, and emotions—grows in volume during the most fertile days of a woman’s cycle.
And a 2014 study in the Journal of Neuroscience reports that a rise in estrogen levels deters women from impulsive behaviors. According to Medical Daily, “The surges of these hormones can influence a woman’s mood, self-esteem, and how she connects to others.” Dr. Ben Michaelis, a clinical psychologist in NYC, tells Medical Daily, “Estrogen levels are closely linked with women’s emotional well-being, as estrogen affects parts of the brain that control emotions.”
In Medicine, Less Is More
More research needs to be done on the effects of continuous cycle suppression and its effects on women’s health. But both Dr. Duane and Dr. Hjort caution against any unnecessary medical intervention.
Dr. Hjort shares, “I’m coming from a place where I believe, in medicine, less is more, and medication should be reserved for true medical indications, and therapy should be based on real medical problems and our therapies directed as such.”
Roger writes, “The key to successful period suppression begins with telling your doctor that you’re interested in safely stopping menstruation.” What if there’s no such thing as a safe guarantee?
Dr. Duane points out that hormonal contraception is not a vitamin that should be taken daily, as it has serious side effects that affect every aspect of a woman’s body. She says, “A woman’s cycle is a sign of her normal, functional reproductive health system. To suppress it continuously in an effort to address symptoms and not getting at the root cause of the symptoms does a disservice to women in the health care they deserve.”
Dr. Hjort says, “It depends on how I view my period in the context of my femininity. . . . If we can view it in the perspective of normalcy instead of an intrusion, then that really honors our bodies more. Just from the psychosocial perspective of defining a normal physiological function as a nuisance and bother, watch it. Where do we draw the line? That, in my opinion, is the biggest con.”
Photo Credit: Brian James Photography