Birth control pills and menstruation - a few questions

[auRa]

As I sit here tenderly massaging my aching abdomen and dreading tonight’s movie session with my friend because I just know I’m going to start bawling in some really stupid part for no reason, I get to thinking.

If I recall correctly (from high school biology, it’s been a while), the way birth control pills work is through a combination of estrogen and progesterone; the estrogen prevents the egg cells from maturing, and the progesterone prevents ovulation and thickens cervical mucus to prevent conception. In effect, they keep the hormone levels in the body at a steady level. A woman on the pill will not produce an egg cell once a month. However, most birth control pills work on a 3 + 1 basis, with three weeks of taking the pill and then one week’s break during which bleeding occurs. But if there’s no egg cell, what’s coming out? Does the uterine lining still prepare for a possible implantation even if there’s no mature egg cell? Wouldn’t that be something controlled by the hormones (the progesterone, I’m thinking)?

Stemming from that, I have another question. I believe that in the States, there are several birth control pills on the market which are taken 3 months in a row so menstruation only occurs four times a year. (One such brand is coming to the Finnish market sometime this year.) Now, I know that technically, you can also take “regular” birth control pills for a few packs straight in order to postpone your period. But why does menstruation have to occur at all? Is there some sort of limit as to how long you can keep on taking pills and not menstruate? Is there a health risk? Is menstruation still necessary even if a woman is not producing mature egg cells whatsoever?

[Lissa]

@auRa

Is there some sort of limit as to how long you can keep on taking pills and not menstruate? Is there a health risk?

Some birth control products stop menstruation all together, such as Depro-Prevera. I’ve been on it for close to seven years and haven’t menstruated since. I intend to stay on it until menopause, and have had no problems whatsoever. (Honestly, it’s one of the best things that ever happened to me.)

Some doctors are actually leaning to the theory that it’s more healthy NOT to menstruate as much. Women in the past often didn’t have as many periods as modern women because of their frequent pregnancies. IIRC, every time an egg is released, it tears a tiny hole in the surface of the ovary. Most of the time, this would never cause a problem, but some doctors theorize that some womens’ diseases can be aggravated by it.

[Geobabe]

The designers of the pill came up with the 3 weeks on, 1 week off schedule thinking that it was more natural, but as Lissa says, it’s been found that it may actually be detrimental to have so many periods.

Here is an article that discusses delaying periods.

Can you skip your period permanently? Is there anything wrong with that?

We don’t have enough information and experience to say it’s healthy to skip your period permanently, but there are no known adverse consequences of never having a period while on combination OCs. More research needs to be conducted to determine whether the extra hormones you take each year will have any ill effects over the long term.

[CC]

I believe that in order to anwer your question, we’re going to have to actually see what happens once this behavior becomes fairly common in society, and track it empirically for a number of years. I think that a number of endocrinologists are willing to make some predictions, but there are very few folks who are really good at predicting the future. Five, ten, fifteen and twenty and fifty years down the line, we may have some better understanding of what happens to a woman who suppresses this natural event for five, ten, fifteen or twenty years. And it may be that the effects are very subtle and the results are only evident when looking at large numbers of women over a large amount of time. Or maybe not. But, clearly, only time and large numbers of women will give us the answers that have the validity and reliability that we require to answer your question. Good luck to all of us, men and women alike. xo, C.

[Mathochist]

@auRa

If I recall correctly (from high school biology, it’s been a while), the way birth control pills work is through a combination of estrogen and progesterone; the estrogen prevents the egg cells from maturing, and the progesterone prevents ovulation and thickens cervical mucus to prevent conception. In effect, they keep the hormone levels in the body at a steady level. A woman on the pill will not produce an egg cell once a month. However, most birth control pills work on a 3 + 1 basis, with three weeks of taking the pill and then one week’s break during which bleeding occurs. But if there’s no egg cell, what’s coming out? Does the uterine lining still prepare for a possible implantation even if there’s no mature egg cell? Wouldn’t that be something controlled by the hormones (the progesterone, I’m thinking)?

First of all, it’s more succinct and descriptive to say that the classic birth-control pill works by tricking the body into thinking it’s already pregnant. If I recall, when you drop the hormone levels (fourth week) the built-up lining flushes out as if there had been (sorry to say) a miscarriage. “Wait! She’s not pregnant anymore! Clear out!”

Stemming from that, I have another question. I believe that in the States, there are several birth control pills on the market which are taken 3 months in a row so menstruation only occurs four times a year. (One such brand is coming to the Finnish market sometime this year.) Now, I know that technically, you can also take “regular” birth control pills for a few packs straight in order to postpone your period. But why does menstruation have to occur at all? Is there some sort of limit as to how long you can keep on taking pills and not menstruate? Is there a health risk? Is menstruation still necessary even if a woman is not producing mature egg cells whatsoever?

Why does the pill have you menstruate at all? Oddly enough, the answer is the Catholic Church.

See, one of the developing doctors was a devout Catholic, and he saw the problems that having too many kids could impose on a family. His reading of the position on contraception was that “natural family planning” and trying to only have sex in the “safe period” was kosher (so to speak), and so he intentionally developed the mechanism to simply extend the safe period to the entire month. He had hoped that the church would give its stamp of approval and thus alleviate the pressures unchecked family growth could cause its members.

[Gfactor]

Just wrote a staff report that includes the issue of menstrual suppression. Here are a few resources:

http://www.periodthemovie.com/ (documentary about the menstrual suppression debate)

http://capitalizingonthecurse.com/index.html (has a chapter on the topic with a critical review of literature)

http://www.amazon.com/gp/product/0195130219/104-2494692-5727938?v=glance&n=283155 (The leading book on the subject)

http://www.noperiod.com/ (a website on the topic)

http://www.amazon.com/gp/product/1400045037/qid=1149097074/sr=2-1/ref=pd_bbs_b_2_1/104-2494692-5727938?s=books&v=glance&n=283155 (the leading book arguing against menstrual suppression)

http://www.post-gazette.com/healthscience/20030624hcycle2.asp (a pretty good article).

[Gfactor]

@Mathochist

First of all, it’s more succinct and descriptive to say that the classic birth-control pill works by tricking the body into thinking it’s already pregnant. If I recall, when you drop the hormone levels (fourth week) the built-up lining flushes out as if there had been (sorry to say) a miscarriage. “Wait! She’s not pregnant anymore! Clear out!”

It’s called withdrawal bleeding.

This withdrawal bleed is different from a usual period.

A woman has a period when she is not on hormonal birth control. The lining of the uterus thickens in preparation for a possible pregnancy. When (after ovulation) a pregnancy has not occurred the uterus sheds that thick menstrual lining.

With continuous hormonal use the lining of the uterus does not thicken and thus there is nothing or very little for the uterus to empty.

http://www.fwhc.org/birth-control/continual-hormones.htm

Gynecologists have known it for years, but the word is just now getting out to everyone else: There is no need for women who aren’t planning a family to menstruate every month. Indeed, many researchers believe that fewer periods may be healthier.

---

Suppressing menstrual periods is easy with the use of hormonal contraception. Standard birth control pills, as well as the patch and the ring, build in a seven-day break from hormones every month, during which there is withdrawal bleeding as the uterine lining breaks up. The bleeding is usually lighter than normally occurs because the hormones keep the uterine lining only about a third as thick as with a natural cycle. When the pills are used continuously, the uterine lining is kept in place indefinitely, although slight breakthrough bleeding is possible.

Several studies of extended contraception have found that many women like it because it reduces or eliminates menstrual discomforts. Surveys of female gynecologists find that most use it themselves, and virtually all of them consider it a safe practice for their patients.

Health Products | Health News - Consumer Reports

[CC]

I’m not a gynecologist, but I play one at home. And I do appreciate the arguments that many women make for permanently, or semi-permanently supressing menstruation. However, I’d be very reluctant to mess with a system that has served the species pretty well for a few million years. Given what we know about the role of hormones in heart disease and cancer, to name a couple of major issues, why disturb a system that has taken many generations to evolve to this level? If anything, I think it would be wise to wait to see what 30 years or so of epidemiological data show before embarking on such a path. I mean, it’s probably not such a benign aspect of the body as upper lip hair that you could modify it without much significant effect on your health. I understand the attractive convenience factors - hell, as a male, I can also benefit from some of them - but I wouldn’t want my wife or daughters to mess with Ma Nature to that extent. Not without a great deal more understanding of the long term effects of the long term suppression of this major system. Unh uh.

[even_sven]

@CC

I’m not a gynecologist, but I play one at home. And I do appreciate the arguments that many women make for permanently, or semi-permanently supressing menstruation. However, I’d be very reluctant to mess with a system that has served the species pretty well for a few million years. Given what we know about the role of hormones in heart disease and cancer, to name a couple of major issues, why disturb a system that has taken many generations to evolve to this level? If anything, I think it would be wise to wait to see what 30 years or so of epidemiological data show before embarking on such a path. I mean, it’s probably not such a benign aspect of the body as upper lip hair that you could modify it without much significant effect on your health. I understand the attractive convenience factors - hell, as a male, I can also benefit from some of them - but I wouldn’t want my wife or daughters to mess with Ma Nature to that extent. Not without a great deal more understanding of the long term effects of the long term suppression of this major system. Unh uh.

Well, we are already messing with mother nature in a pretty bit way by taking birth control pills to begin with. And it’s not like the 3-week on 1-week off thing is based on decades of careful research. It was an essentially arbitrary decision made in an attempt to pacify the Catholic Church.

In earlier years, women had far fewer periods- they began later in life, ended earlier, and were often supressed by pregnancy and malnutrition. Even today many women have naturally erratic periods that may only come a couple times a year.

As always, talk to your doctor before attempting this. My doctor gave me the OK to do it with my regular birth control pills, stating there is “nothing special” about the ones designed for continuous use. For the times that you do have your period, consider investing in a DivaCup (do a search for tons of info) and your life will become 100 times better.

[kimera]

As other women have noted, women’s current reproductive cycles are very unnatural. Women in a natural-fertility populations have 1/4 of the periods that modern women have. Women today reach menarche earlier, are pregnant less, and lactate less. I can’t find any cites for hunter-gathering societies, but I bet it was the same or even less. There is strong evidence linking the high rate of menstruation to breast cancer which is nearly unheard of in hunter-gatherer societies. The more cycles a woman has, the higher her risk of breast cancer.

[CC]

@kimera

As other women have noted, women’s current reproductive cycles are very unnatural.

Hard to know exactly what you mean by this, but unless you’re talking about women who use birth control pills to regulate their cycles, a woman whose cycle occurs naturally can hardly be said to have an “unnatural” cycle.

@kimera

Women in a natural-fertility populations have 1/4 of the periods that modern women have. Women today reach menarche earlier, are pregnant less, and lactate less.

Yes, girls today reach menarche earlier. There are several hypotheses why, but there’s nothing “unnatural” about that, unless you consider changes in society to be unnatural. I would propose that discoveries relative to nutrition, discoveries that are the result of our well-developed cerebral cortex, are simply evolutionary adaptations, and we are “lucky” to be aware of them. If it results in better health, well, then, fine. And maybe earlier menarche is a result of better nutrition. And if that’s the case, I’d argue that it’s a natural outgrowth of our increased ability to think.

[Moirai]

The pill I take (Ovcon) has almost eliminated my periods- I have maybe two days of light spotting- what I used to get the last day or so of my old periods.

I love it.

I found this dose when I stopped breast feeding. My OB/GYN says it isn’t unusual for women to stop menstruating completely on this pill. Woo hoo!

@kimera

The more cycles a woman has, the higher her risk of breast cancer.

No shit?

[even_sven]

@CC

Yes, girls today reach menarche earlier. There are several hypotheses why, but there’s nothing “unnatural” about that, unless you consider changes in society to be unnatural.

Several of these hypotheses focus on fairly unnatural causes, such as hormones in milk and artificial lighting. The truth is we don’t know the reason, but as someone that started menstrating at age ten, I hope we figure it out one day.

[Lissa]

@even sven

Several of these hypotheses focus on fairly unnatural causes, such as hormones in milk and artificial lighting. The truth is we don’t know the reason, but as someone that started menstrating at age ten, I hope we figure it out one day.

As a historian, my personal theory is that it’s a result of change in nutrition. Young women of the past did not get as much fat in their diet as girls do today, and a higher-fat diet has been linked to early onset of menstruation.

[kimera]

The chances of developing breast cancer decrease with later menarche, earlier first birth, high parity, and earlier menopause. This is because the susceptibility of the breast to carcinogens is directly related to its epithelial cell proliferation rate and inversely related to its degree of tissue differentiation. After menarche, but before the first birth, epithelial cells in the intralobular terminal ducts are especially susceptible to carcinogens. Pregnancy and lactation induce differentiation of these cells into well-developed secretory lobules that have a slower proliferation rate and are more resistant to carcinogens. Increased exposure to estrogen from an increased number of menstrual cycles also elevates the risk of breast cancer as estrogen accelerates breast epithelial cell proliferation (Eaton et al 1994). By increasing the cell proliferation rate in breast epithelium, there is an increased risk of random genetic errors causing malignancy (Strassman 1999).

http://webpub.allegheny.edu/employee/r/rmumme/FS101/ResearchPapers/RachelBayer.html

[Gfactor]

A sci fi story all about menstrual suppression:

Willis, Connie, Even the Queen, (1993), reviewed at http://explorers.whyte.com/sf/etq.htm

[Gfactor]

@CC

unless you’re talking about women who use birth control pills to regulate their cycles,

What about women who use birth control pills for birth control?

Usage estimates vary, apparently:

Some 44 percent of nonsurgically contracepting women took The Pill in 1995, while 51 percent of those 15 to 24 years old used it as a contraceptive. Almost 80 percent of women now between 45 and 55 years old have taken The Pill at some point.

http://www.milkeninstitute.org/publications/review/2001_6/12-21.pdf

About 370,000 Japanese women use the pill, according to estimates, only 1.3 percent of the 28 million Japanese females between 15 and 49 years old, compared with 15.6 percent in the United States, according to the United Nations.

http://www.cbsnews.com/stories/2004/08/20/health/main637523.shtml

In all but one state, birth control pill use was highest among those aged 18–24 years. Prevalence of pill use among this group ranged from 72% (Kansas) to 39% (New Jersey). In New Jersey, persons aged 18–24 years reported condoms (44%) as the most common method. Among those aged 25–34 years, the pill was also the most common method reported

http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5406a1.htm

[irishgirl]

There are pros and cons to everything.

For exaple, if one took the COCP everyday, you would be getting 25% more synthetic hormones than someone taking it at the current 3 weeks on/1 week off regime. Research on blood clots (DVT/PE) and breast cancer is related to the current regime, and we don’t know what indefinitely preventing menstruation would do to the statistics relating to that.

For example, would 25% more hormones lead to a 25% increase in the risk of breast cancer and DVT? Or a 5% increase? Or a 50% decrese?

What about those seeking a quick return of fertility after long term continuous pill use- will that become a potential problem?

We just don’t know- we do know that long term (more than 10 years) on the pill does carry an increased risk of breast cancer, and that any use of oestrogen containing pill does carry an increased risk of blood clots ( the risk of blood clots is lower than that in pregnancy, but significantly higher than in non-pregnant non-pill users).

Some women find that the pill doesn’t significantly decrease their menstrual cramping, some find that it does, some women have heavier periods on some preparations, some women have longer periods than they would naturally. There is no one rule, although generalisations can be made, it can all fall down badly in specifics.

Unfortunately, when it comes to women and hormones there is a reason why there are so many different types of pills- no one single preparation will suit every single woman. The type of pill that gives you no side effects could make your friend into the hormonal mood swing bitch queen from hell. One pill could leave your skin flawless, but make your sister break out like a teenager.

You might be able to run 60 packs together and have a 2 day light bleed with no cramping, your friend might run 2 packets together and find herself dealing with a month of spotting and the period from hell at the end of her second packet.

I know from personal experience that 2 packs is my limit- every single time I run 3 packs together I spend the last 2 weeks crying uncontrollably, and then have a 9 day period with excruciating (well, worse than my normally excruciating) cramps.

So, if it works for you and you like the idea (and the fact that there is no long term data doesn’t scare you) go ahead, run as many packets as you like together…if the idea doesn’t appeal to you, or you find that it doesn’t suit you, don’t do it.

At any rate the pill is not ideal for the over 35s, smokers and anyone with a BMI over 30- even if running packets together indefinitely does become widely practised, it will never be an option suitable for every woman.

Like so much in gynaecology, it’s all about appropriate choices in the context of the individual.

As for me, I’m hoping that Mirena will sort my problems out…I just have to wait until I can sort out an appointment with a gynaecologist.

[even_sven]

@Lissa

As a historian, my personal theory is that it’s a result of change in nutrition. Young women of the past did not get as much fat in their diet as girls do today, and a higher-fat diet has been linked to early onset of menstruation.

I found it doubtful that my mom and my grandma didn’t get as much fat in their diet as me. These changes have been in the last 20-30 years- if it was fat, you’d think it’d become evident, say, with the 1950s or so. Furthermore, it would have a corrolation to body weight (it doesn’t) and would have been evident before in some populations throughout history.

[Gfactor]

@even sven

Furthermore, it would have a corrolation to body weight (it doesn’t)

These folks disagree:

Underweight females generally experience menarche at later ages than normal weight females. In contrast overweight females often experience menarche earlier than the average weight female. Athletic females and ballet dancers frequently experience late menarche, and these delays may be due to the disruption in fat accumulation which results from excessive exercise. Physically, inactive adolescents, on the other hand, tend to experience menarche at an earlier age than normally active females. In conclusion, the body’s fat content along with a variety of environmental and psychosocial factors are responsible for the development and maintenance of female reproductive functions.

Body weight and the initiation of puberty - PubMed

http://www.press.uchicago.edu/cgi-bin/hfs.cgi/00/14591.ctl