You don’t need to have a period

In light of my post on times not to tamper with the body, here’s one case where I’m very much in favor of tampering.

You don’t need to have a period.

Painful menstruation impairs daily activities for around 20% of women. That’s not including mood changes or menstrual migraines, both of which are also common. As a cause of disability, it’s not taken particularly seriously.

I was told my menstrual cramps would probably improve in my twenties. When they got worse instead, I didn’t know what to do except tough it out. My primary care provider just recommended more painkillers.

It’s a doctor’s job to warn you about the risks that come with various kinds of birth control, but we never talked about the risks I faced from unpredictable, crippling pain. Once it struck while I was babysitting two young children, and their father had to leave work to take care of them because I couldn’t stand up long enough to fix them lunch. When I worked at the jail I was in a back office having a counseling session alone with a detainee, when my skin went cold and my vision started to go dark as my body went into shock. I brought the session to a hasty conclusion, gripping the desk to keep upright, and waited until he had left to lie down on the floor until I could get up and walk. I never had to drive with bad cramps, but I can’t imagine that would be very safe.

After three and a half years of pregnancy and breastfeeding, the idea of returning to all that is not appealing at all.

Here are some ways to have fewer or no periods. This is basically the same list from actual doctors.

• Take regular birth control pills and skip the week of dummy pills at the end, starting right away on a new pack. Some sources say this is best done with monophasic pills (where the first three weeks are all the same, rather than ones where different weeks have different doses).
  There’s no medical reason for the dummy pills. When the pills were originally developed, market research indicated that women preferred to have a period as reassurance that they weren’t pregnant. Now that pregnancy tests cost less than a dollar on Amazon, there are easier ways to get that reassurance.
• Extended cycle birth control pills where you get dummy pills only every three months, or not at all. If you pay for birth control, this is cheaper than the above method because you’re not paying for dummy pills.
• IUDs. The Mirena is FDA-approved to treat heavy bleeding, it lasts 5 years, and 20% of women don’t menstruate at all after the first year. You’ll probably get more spotting for the first few months, though. Skyla and Liletta are smaller ones specifically tested for women who haven’t had a baby, though the American Congress of Obstetricians and Gynecologists consider all IUDs safe for women of all ages regardless of whether they’ve given birth. All types of IUD except the Paraguard are likely to improve menstrual cramps.
• Birth control implant. Nexplanon lasts 4 years and 20% of women don’t menstruate after the first year. Again, spotting is likely.
• Depo-Provera shots last 3 months and also cause some women to stop menstruating, again with irregular bleeding at first.
• I’ve seen some doctors say it’s ok to use the patch or NuvaRing continuously, and others say not to.

The US may be about to go back to the bad old days of no guaranteed insurance coverage for birth control, so this might be a good time to get something long-term. If you do want to get pregnant, all of these options except the shot let you return to fertility within about two weeks of stopping/removal.

There are health risks with anything you do or don’t do. Although are no known health risks of avoiding menstruation, there are no long-term studies of it. There are also no long-term studies of operating a car while in crippling pain, or of passing out in an isolated office with a random detainee, and I’d much rather use a tested contraceptive than take my chances with those.

Different methods will have different side effect profiles, so you should consider which ones you particularly care about. There are also different levels of hassle with methods that require renewing prescriptions, remembering what day to do this or that, checking that the strings are in the right place, etc.

If you’re using these for actual contraception, remember that you have a 9% chance of getting pregnant during a year of typical use with the pill, patch, or ring. Long-lasting methods work a lot better, and personally, I prefer a small risk of birth control problems over a 9% chance of either abortion or childbirth, both of which obviously come with risks as well.

If you’re not menstruating, you shouldn’t take women’s multivitamins because they have an amount of iron that’s intended for people losing blood every month. After several years, you might want to get your iron level checked.

If your period pain is really bad, get checked out for endometriosis, which is under-diagnosed. (Literally the first doctor to mention this possibility to me was the psychiatrist at work as he was helping me prop my feet on a bookshelf while I lay on my boss’s office floor after I nearly passed out in a staff meeting.)

Obviously you should talk to your health care provider about any of this. If you get a provider whose answer is basically “more painkillers,” I’d push back or get a different provider.

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