No One Has to Get Their Period Anymore

Menstruating is painful, expensive, and … unnecessary?

The Atlantic

At the posthumous retrial of Joan of Arc in 1455, two decades after she was burned at the stake as a witch and a heretic, she was declared an innocent martyr. During the trial, a personal valet offered evidence of Joan of Arc’s piety and purity during her 19 years on Earth: “She never suffered from the secret illness of women.” As far as the people closest to her knew, he claimed, she never got her period.

Saintly qualifications aside, amenorrhea—the abnormal absence of periods—has historically been linked with misfortune. In 400 B.C., Hippocrates wrote that “when the menses are stopped, diseases from the uterus take place.” In 1652, the physician Nicolas Fontanus identified amenorrhea “as the most universal and most usual cause” for palsy, melancholy, burning fevers, nausea, headaches, and a distaste for meat. Some 18th-century physicians believed that suppressed menses could cause a married woman to spiral into deep hysteria, and even in 1961, the epidemiologist Frances Drew proposed that a young woman might manifest mental anguish by losing her period.

But some doctors today offer amenorrhea to patients as young as age 14 or 15: Menstruation has now become an elective bodily process. “Once your periods are established, we can turn them off,” Sophia Yen, a pediatrics professor at Stanford Medical School, told me. “We now have the technology to make periods optional.”

Few are as passionate as Yen about the possibility of a world with far less cyclical bleeding. “It’s my crusade,” said Yen, who also co-founded and runs Pandia Health, a birth-control-delivery company. “This is my moonshot.” People who have periods spend an average of 2,300 days of their lives menstruating. If more people chose to silence their period—or even just dial down the volume—that would mean a decrease in iron deficiency (which women experience at far higher rates than men), and fewer plastic tampon applicators littering landfills.

Yen envisions the period of periods soon coming to an end. But even though menstruation is often messy, painful, and expensive, it’s a meaningful fixture of adulthood for some, and one that can be hard to let go of.

Gabrielle, a 24-year-old who lives in St. Petersburg, Florida, got her first period in fourth grade. (The Atlantic allowed her and others in this story to use their first name only, to protect their privacy.)

“It felt incredibly, incredibly unfair,” she told me, to have been the first among her friends to menstruate. “There were all these little moments where it was embarrassing and bad and painful and weird”—sneaking off to the bathroom with bulky pads stuffed in her shirt, swimming while on her period, learning how to use tampons. Then, at 20, Gabrielle got a hormonal IUD (intrauterine device) for birth control and, as a side effect, stopped getting regular periods. “It feels really good to not worry” about keeping the bathroom well stocked or missing a day of work, she said. “I will keep getting an IUD until I’m ready to get pregnant.”

Today, any doctor will tell you there is no medical necessity for periods unless you’re trying to conceive. The body preps for pregnancy by thickening the uterus’s lining, like a bird building a nest for her eggs; hormonal birth control prevents pregnancy, in part, by keeping the uterine lining from ever building up. Many of the roughly 19 million Americans who rely on the pill, the shot, IUDs, implants, patches, or rings see a change in their period—often it’s lighter, but it can also disappear altogether. In clinical trials, more than 40 percent of the Liletta IUD’s users no longer menstruated by the end of the product’s six-year life. More than half of people who get the Depo-Provera shot every three months will become amenorrhoeic within a year, and almost 70 percent in the second year. And anyone using the pill, patch, or ring can safely skip scheduled withdrawal bleeding.

But getting a lighter flow as a side effect of birth control is different from choosing a contraceptive method in the hopes of turning off a period completely, and there are all sorts of reasons someone would want to do so. The cost of so-called feminine products can add up to thousands of dollars over a person’s lifetime: A recent study found that nearly two-thirds of low-income women surveyed in St. Louis couldn’t afford menstrual-hygiene products during the previous year. (This study, and others cited in this story, did not specify whether participants included trans men or nonbinary people who get periods). Amenorrhea can be a medical necessity for people with certain health conditions—such as those born without an intact uterus and vagina. It’s also a treatment option for heavy bleeding or otherwise painful periods, which afflict about one in five women, and can help relieve symptoms of polycystic ovary syndrome (PCOS), which affects 6 to 12 percent of U.S. women of reproductive age. Or a period simply may be one burden too many, especially during a pandemic: A tweet in March proclaiming that “menstrual cycles also need to be suspended until this ordeal is over” started racking up hundreds of thousands of likes.

For those whose periods are not just a monthly nuisance, but a medical complication in and of itself, amenorrhea can be a revelation. Valentina, a 20-year-old in Medellín, Colombia, was diagnosed with PCOS at 14, after her periods became practically intolerable. “The cramps were so, so strong; I couldn’t walk. I went through one tampon in one hour. I couldn’t sleep at night,” she told me. “It was traumatic.” In 2017, Valentina got a hormonal IUD and has since stopped menstruating. “After losing it, you see how much easier life is,” she said. “I’m not sure I want to have a period again.” For Nik, a 20-year-old transgender man living in Chicago, getting an IUD to suppress his period provided both mental and physical relief. “You don’t want the physical reminder every month that you weren’t born in the right body,” he told me. He went from doubling up on pads and tampons to, now, the occasional spotting.

For more than a decade, associations of obstetricians and gynecologists have assured doctors that it is safe for patients to try to reduce or eliminate menstrual bleeding—for personal or medical reasons—with hormonal contraception. There is far less certainty about how often that’s actually happening.

A 2013 survey asked 4,039 women of reproductive age in North and South America and Europe about hormonal contraception and periods; one-third said they knew it was possible to regularly reduce menstrual bleeding with birth control, and about 10 percent of respondents had done so. Other, much smaller studies have also documented the use of birth control to suppress periods. In 2016, researchers examined menstrual suppression among 400 Iranian Muslims who had made the pilgrimage to Mecca; they found that all but a few reported taking birth-control pills to quiet their period, and three-quarters of them successfully. A 2011 questionnaire of 500 U.S. veterans found that two-thirds of them had wanted to suppress their cycle during their deployment, and almost all of the subjects expressed a desire for mandatory education on how they could use birth control to avoid menstruating in combat zones.

Yen sees a future in which many more people know they can opt out, and do—in which no one menstruates unless they’re within two years of their first period or are trying to get pregnant. “In my ideal world, it would be about 28 periods over the course of a lifetime,” she said. Right now, that figure is in the hundreds. For Yen, a mother of two daughters—a 10-year-old who hasn’t gotten her period and a 13-year-old who has—that rebalancing would place her own children on a more level playing field with boys. Without periods, she says, they won’t miss two days of school or work each month, or get cramps during the SAT or swim meets, or deal with any of the other related stresses. “I want them to be competitive against those who don’t have uteruses,” Yen said. “Teenage years are so turbulent and horrific as is. I don’t want them to suffer unnecessarily—and I can alleviate this for my child.”

But a period-free future still remains a radical idea. “Menstruation can limit some people, but I reject that’s true for everybody,” says Colleen Krajewski, a family-planning specialist for the University of Pittsburgh’s Center for Contraception and Family Planning. Many people, for example, rely on periods to know they’re not pregnant. Those recovering from eating disorders might see them as a sign that they’ve begun recovering from malnourishment. And some just enjoy the feeling of being in touch with their monthly cycle.

One key reason people will continue to opt in is the persistent, deep-set discomfort about not having your period. Last October, a group of researchers in Indiana and South Carolina reported that across a mix of focus groups, individual interviews, and online surveys, “most found the idea of not menstruating strange, unhealthy, and worrisome.” In a small, 2016 experiment, Canadian researchers discovered that a majority of the participants were suspicious of ads that presented the pharmaceutical suppression of cycles as a lifestyle choice; many specifically cited health concerns. “I know my body is healthy when it bleeds every month,” one participant told researchers, “and I would be very concerned if that didn’t happen.”

Patients tend to have a lot of questions about what not menstruating means for their reproductive health, says Margaret Nachtigall, a reproductive endocrinologist at NYU’s Langone Health. Do I risk infertility? Am I losing bone density? Am I clogging up with trapped menstrual blood? Some people harbor the unsettling misconception that without a period, toxic blood will build up inside them, Chelsea Polis, of the Guttmacher Institute, has found in her research. “That’s very scary for someone to worry about that,” Polis told me.

And that confusion makes sense, because amenorrhea can be a symptom of medical conditions such as eating disorders, pituitary or thyroid disease, and hepatitis. “Not getting a period is normally something worth investigating,” Nachtigall says. She and other gynecologists told me many of their patients struggle to feel normal without a period. I certainly did. I haven’t had a regular period since 2017, when I got my hormonal IUD. After so many years of ebbs and flows, I felt inert, as if my body couldn’t tell time once unmoored from its monthly cycle. It was an uncomfortable realization: I hated having my period, and I also hated losing it.

Yen fields similar concerns from her patients. “I tell them, ‘It’s okay to bleed less,’” she said. “The reason people feel like it’s quote ‘unnatural’ is that so many of us have had one every month for so long.”