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Is it safe to skip my period using birth control pills?

Is it safe to skip my period using birth control pills?

Nicole Knight, AHCJ | January 24, 2020 | Avoiding Pregnancy

Your period can arrive at the absolute worst time — like the morning you’re leaving for a long-awaited Hawaiian vacation. So it’s no surprise that around 60% of women in a national survey said they wished they could avoid having a period and another one-third said they’d prefer to never have one (1).

For some, the thought of fewer or no periods is appealing for reasons related to work, school, a lack of access to menstrual products, or the fact that the monthly cost of tampons and pads adds up (I see you #tampontax) (2). Many women find menstruation painful or debilitating, and others may have medical reasons to want to avoid menstruating (3, 4).

Still, it’s natural to wonder whether menstrual suppression — the official name for stopping your period — might have a lasting effect on your fertility and body. When asked about menstrual suppression, 69% of women said they’d do it if they could be sure it wasn’t harmful to their health (1).

We’re here to share the latest facts on menstrual suppression, such as whether it’s safe or not, and whether stopping your period has any effect on your health or fertility.

 

How does menstrual suppression work?

Doctors define menstrual suppression as using either hormonal medication or hormonal devices to decrease the frequency and volume of menstruation or to suppress menses entirely (4). The most common way to suppress menstruation is by taking hormonal birth control pills continuously (5). So in a cycle where you’d take 21 days of hormonal contraception and 7 days of placebo pills, you’d skip the placebo week, and instead begin the next pack of pills immediately. 

There are also oral contraceptive pills on the market today, such as Seasonale® and Seasonique®, that are designed to be taken continuously. These pills contain estrogen and progestin and come in 91-day cycles, so you have a period only every 3 months (4).

Hormonal options include a vaginal ring, injectable progestin-only Depo-Provera® shot, and the Mirena® IUD (4) — but these options may not stop menstruation immediately. For example, research on Mirena by its manufacturer found that 20% of Mirena users stopped having a period within a year and 50% stopped having a period by the end of 2 years (4). 

This is by no means an exhaustive list of options to stop menstrual bleeding. Either way, if you’re interested in menstrual suppression, be sure to talk to your doctor before making any changes to hormonal birth control.

 

Are there side effects of menstrual suppression?

For the most part, science has found no additional risks associated with using hormonal birth control continuously — beyond the health risks already linked to hormonal pills or devices (4). A widely used doctor’s manual notes that extended and continuous regimens of birth control pills and the vaginal ring are safe and have few side effects (4). However, continual use of the patch isn’t advised because of a potential heightened risk of deep-vein blood clots — although research on this isn’t conclusive (4).

Using hormonal birth control continuously may cause a new side effect — spotting (4). For example, about 1 out of every 3 women on Seasonale had 20 or more days of spotting during their first cycle, but the spotting tended to go away with time (6).

 

Is menstrual suppression unhealthy?

Nearly 100% of female OB/GYNs in a national survey by the American College of Obstetricians and Gynecologists (ACOG) said menstrual suppression was safe for their patients, and more than half said they’d done it themselves (7). 

You may think: Doesn’t my body need to bleed monthly? But regular menstruation isn’t physiologically necessary (4). Prehistoric women ovulated only around 50 times in a lifetime, but these days we may ovulate a whopping 450 times — we get our first periods earlier, go through menopause later, and have fewer pregnancies and breastfeed less than our ancestors (8). 

If you’re already taking some type of combined hormonal birth control, your ovulation is already suppressed, and taking progestin (one of the hormones in combined birth control) thins your uterine lining. The bleeding that occurs when you switch to the placebo pills in your pack isn’t due to endometrial build‐up, but to hormone withdrawal (9, 10). 

(Side note: The pseudo-period you have while taking placebo pills is actually a marketing gimmick that was designed back in the 1950s to make birth control pills more acceptable to the general public... and the Pope (4, 11). Yep, really.) 

 

Are there health benefits of menstrual suppression?

For some, taking hormonal contraception continuously may relieve pelvic pain, headaches, breast tenderness, and bloating that may occur with menstruation (12). If you have endometriosis, research suggests continuous use of hormonal birth control or a levonorgestrel-releasing IUD may relieve severe menstrual cramps and chronic pelvic pain (12). Fewer periods may also benefit women who are negatively affected by monthly blood loss, such as those with anemia or bleeding disorders (13).

 

What are the risks of menstrual suppression?

The risks of suppressing your period appear to be the same risks and side effects that come with using any type of hormonal birth control (4). Even so, bear in mind there have been no long-term studies examining the safety of stopping your period by continually using hormonal birth control (13).

Beyond that, there’s the issue of birth control failure. With typical use, hormonal birth control pills prevent 91% of pregnancies in a year, but if you suppress menstruation, it’s more difficult to know if your birth control failed and you’re pregnant (14). 

If you decide to try menstrual suppression, expect your doctor to advise you to keep an eye out for other signs of pregnancy besides a skipped menstrual period, such as breast tenderness, fatigue, and nausea, and take a pregnancy test if you’re unsure.

 

Does menstrual suppression affect my fertility?

Research suggests taking hormonal birth control continuously doesn’t affect your ability to start menstruating again or become pregnant (15, 16). 

When a research team tracked 198 women who’d been taking a continuous regimen of birth control pills for a year and then stopped, they found that 98.9% of study participants began menstruating or became pregnant within 90 days of stopping the pills, and the median length of time to begin menstruating or become pregnant was actually sooner — 32 days (15). Separate research showed that most women’s periods return within 36 days of going off birth control and 81% became pregnant within a year (16).

Hopefully we’ve covered your most pressing questions on menstrual suppression — but be sure to talk with your healthcare provider to ensure you fully understand the potential risks and benefits of saying goodbye to monthly menstruation, and to make sure it’s a healthy, safe option for you.

 

References:

  1. https://www.sciencedirect.com/science/article/pii/S0010782404001726 
  2. https://www.washingtonpost.com/news/wonk/wp/2016/01/08/the-tampon-tax-explained/
  3. https://www.acog.org/Patients/FAQs/Heavy-Menstrual-Bleeding
  4. https://www.uptodate.com/contents/hormonal-contraception-for-suppression-of-menstruation
  5. https://www.arhp.org/images/uploadDocs/menstruationfactsheet.pdf
  6. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021544s009s010lbl.pdf
  7. https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1552-6356.2004.tb00150.x 
  8.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516549/ 
  9.  https://www.sciencedirect.com/science/article/pii/S0140673699111590
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837850/ 
  11. https://www.newsweek.com/birth-control-pill-7-day-break-introduced-please-pope-deemed-unnecessary-1299728
  12. http://unmfamilyplanning.pbworks.com/w/file/fetch/82693909/ACOG%20Bulletin%20%23110.pdf
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837850/
  14. https://www.womenshealth.gov/a-z-topics/birth-control-methods 
  15. https://www.fertstert.org/article/S0015-0282(07)01117-X/fulltext
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621397/