Women Don't Need to Have Periods
Using birth control to eliminate menstruation isn’t unsafe, even if some worry it’s “unnatural.”
No matter why a woman is seeing a doctor—be it for a headache or for a broken toe—she can reliably expect to be asked the date of her last period within the first minute of her consultation. Because of the confused looks I get when I reply with “May 2012,” I started prefacing my answer with an explanation that I have a Mirena IUD, an intra-uterine device used for birth control that lessens periods for some women and eliminates them completely for others.
I fall into the latter category. Though most nurses and doctors move along after this response, a nurse recently looked at me in undisguised disapproval and asked, “But what about when you want children?” I told her that I would take it out when I want children. “But doesn’t it feel unnatural to not have a period?” she asked. I told her it feels great to not have a period. She shook her head and said, “Just seems strange to have a foreign object in your body like that.” I replied, “Yeah, like a baby.” She stopped asking questions at that point.
Though this particular nurse was especially harsh, she is hardly alone in her suspicion of birth-control methods that prevent women from monthly bleeding. Friends ask if I am constantly worried that I’m pregnant. Men I am not even exclusively dating wonder if I worry about infertility. The word “unnatural” comes up often. A brief look at the language used to talk about menstruation reflects how closely it’s tied to the concept of female identity. “You’re becoming a woman!” people exclaim to adolescents experiencing their periods for the first time. “Feminine products” is the euphemism of choice for pads and tampons at the drugstore though there are plenty of aisles worth of feminine-coded products available—razors, makeup, and shampoos marketed toward women with the design of helping them look “feminine.” (This focus on the “femininity” of periods also completely ignores the existence of trans men who menstruate.) All of these products have the purpose of eliminating or disguising those functions of the body that have been deemed “unfeminine” like growing body hair and sweating, just as menstrual products are designed to make the period as undetectable as possible. Periods can be painful and messy, and while they are considered a marker of female identity, there are also social pressures to keep them invisible on account of their “ick” factor. So there are some who find eliminating periods altogether to be their best option.
“There is no medical reason why a woman has to menstruate every month,” said Alyssa Dweck, an assistant clinical professor of OB/GYN at Mt. Sinai School of Medicine in New York. “And there is nothing wrong with tweaking the system if bleeding is difficult for women.”
Cherry Collier, an executive coach based in Marietta, Georgia, was such a woman. Her doctor suggested a hysterectomy when, after she reported heavy bleeding, he discovered three fibroids in her uterus. Because she was still of child-bearing age, she sought alternative opinions and learned that she could stock up on birth-control pills, skip the placebo week and be on a continuous hormone dose that would eliminate her periods and alleviate her suffering. “It was so liberating and so exciting. The result is the period is lighter, less painful, and it is so different because I chose how to handle it,” she told me. Carolyn Thompson, an OB/GYN and fellow at the American College of Obstetricians and Gynecologists, told me via email that this method is both safe and was especially common before the introduction of “extended cycle” birth-control pills like Seasonalle, Seasonique, and Quartette. These brands are specifically packaged to enable skipping periods but are hormonally the same as other birth-control pills. “There are some women whom we would prefer to avoid periods: those who have migraines, severe bleeding/cramping, endometriosis,” Thompson said. “There are also many women who just don't want to have a period every month and who take the pill continuously. This carries no harm, either short- or long-term.”
Before at-home pregnancy tests, it made more sense that women wanted their periods as reassurance against pregnancy. “When people were designing the pill, they asked women what they wanted, and women said they wanted to have a period to confirm they’re not pregnant,” says James Segars, director of the division of reproductive science and women’s health research at Johns Hopkins University’s department of gynecology and obstetrics, “The period you have on birth-control pills is totally pharmacologic.”
The pill was only the beginning of women taking control, not only of their fertility, but of their periods. Though “that time of the month” is shorthand for the period, many people have irregular and unpredictable periods that the introduction of the pill helped to regulate. People with particularly heavy bleeding or conditions like endometriosis can expect them to become more manageable with the pill. Periods, as natural as they are, can profoundly disrupt someone’s daily life when they are accompanied by pain or excessive bleeding that necessitates devoting time and energy to their care.
Kristin Vincenzo, a public-relations professional in New York, started taking the Depo-Provera injection starting in 1999 after a trial run with the birth-control pill Micronor. Prior to taking birth control, her periods had been irregular. Seeing as this was a decade or so before the recent reemergence of long-acting reversible contraceptives like IUDs, the effects were met with a lot of skepticism. “I feel like there’s a lot of things that make me feel like a woman and my period isn’t one of them,” she said. Though Kristin was resolute that not having a period was a positive experience, she told me that at that time, IUDs were still considered very risky, which is why she went with the injection. “I just remember hearing horror stories about the IUD from the 1970s when I was younger so I never even considered it.”
A landmark study in The New England Journal of Medicine in 2013 found that hormone-releasing intra-uterine devices improved health outcomes for women with abnormally heavy bleeding more than traditional treatments like taking hormonal birth-control pills. Danielle Boose is a 31-year-old mother of two who turned to the Mirena IUD after massive bleeding caused her to miss school and her severe cramps caused her life to stop “emotionally and physically,” she said. But she too was met with skepticism. “My girlfriends still say, ‘I would never put something foreign in my body. There are other things you can do,’” she says of her peers who are doubtful of the safety of IUDS. “But there’s risk in the pill, there’s risks in the shot, so for me, it was a good decision.”
As more women turn to long-acting reversible contraceptives that substantially decrease bleeding or sometimes eliminate bleeding entirely, many wonder about potentially negative or “unnatural” consequences. The Mirena is one of the most popular IUDs— it releases hormones and prevents pregnancy for five years. Thompson told me that she inserts hormonal IUDs like the Mirena for women almost every day in her practice. “Women think it is unnatural to not have a period or think that something could be ‘building up’ inside the uterus if they don't have a period,” Thompson told me in an email. In reality, uterine build-up is more likely to occur when a woman is not on hormonal contraceptives. “The risk of not having a period when on no hormones is the unchecked buildup of the uterine lining that has the potential to become precancerous or cancerous,” she said.
Much of the conversation around period elimination is focused on women who have debilitating periods. But there are those, too, who are simply inconvenienced by their periods, and would rather not have them. Susan Shain is a 29-year old travel writer who got an IUD because her hectic travel schedule saw her changing time zones frequently, making it difficult to take a pill at the same time every day. She had used the NuvaRing at one point but it needs to be stored in cold temperatures, and that she was worried that refrigeration could be unreliable where she was going. “I love to travel, I love to spend time outdoors. I love not having to worry about a period,” Susan said. Another woman named Jennifer Hancock is a writer in Manatee County, Florida, who told me she turned to the Mirena exclusively for the purpose of getting rid of her period. “When it is a regular part of your life, you don’t realize how much time and money is being taken away from you,” she said.
I count myself as one of those who was inconvenienced and frankly resentful of the fact that I had to spend three to seven days per month bleeding when it was not a medical necessity that I do so. A Midol slogan famously said, “Because your period's more than a pain.” This is true not only for women like me who just don’t want the burden of buying tampons and avoiding wearing white. There are shift workers who cannot escape to the restroom, women in male-dominated jobs where they feel they have to hide their feminine-hygiene products to prevent further alienation, sex workers for whom bleeding is more than a hassle, and women with young children or otherwise unreliable sleep schedules who don’t need the stress of making sure they take a birth-control pill at the same time every day.
“Having a monthly period is reassuring but it is certainly not necessary,” says Segars, “And with these long-term, reversible contraceptives, the failure rate is really, really low so women can benefit a lot from them.” That, of course, is the major selling point of all of these treatments in the first place: They are contraceptives that prevent pregnancy. And because they often come in the form of injections or devices, they are less prone to human error than hormone pills and therefore more effective at preventing pregnancy. Getting rid of women’s periods is just a bonus—a bonus that saves them time, money, pain, and stress, with no known medical downsides. And if they ever want their periods back, all they need to do is have the IUD or implant removed.
The demands that periods be endured as a function of womanhood while at the same time being hidden from sight understandably prompts many to defend periods as worthy of celebration. “We need to reclaim this experience and find power in the blood that unites us,” is the battle cry of Sarah Ogden Trotta on Everyday Feminism in an article titled, “5 Reasons Why Menstruation Is Awesome (Despite What We’re Told).” At Cycle Harmony, Chief Harmony Officer Jing Jin recommends several ways to honor the menstrual cycle. “Honor the heightened awareness and creativity when you menstruate. Paint, draw, write, dance and celebrate... Create a space to tune in and connect with the radiant goddess within you,” is included among tips like keeping a period journal and connecting with your feminine power. And because I want to champion women’s choices rather than limit them, I won’t suggest that those who feel like radiant goddesses when they’re united in blood should eliminate their periods.
But I’d like to remind people of another word commonly associated with women’s monthly bleeding: The Curse. I’ll take unnatural over hexed any day of the month.