Has Your Doctor Told You About Skipping Your Period for Good?
When Kirsten Schultz learned about continuous birth control her junior year of college, it was as if “a world opened up to me,” she said. She had gone to Planned Parenthood to ask whether it was safe to try to skip a period inconveniently due to arrive during a romantic getaway. Not only was it safe to skip a period, they informed her, but she could suppress her period altogether if she wanted to.
“It was really a very freeing concept,” Schultz said.
Two or three years after starting her period, Schultz, who has dealt with pain related to chronic illness since childhood, identified that fluctuating hormone levels during her menstrual cycle increased her baseline pain levels. Prior to that Planned Parenthood appointment, she had found various ways to lessen the pain, but none that truly treated it.
By using birth control to suppress her period, she said, “I don’t have to worry about tampons, and I also don’t have to deal with extra pain that’s even more debilitating than normal.”
The concept of continuous birth control, also referred to as continuous cycling or period suppression, isn't new, but it is under-discussed. If your periods come with hellish cramps, heavy bleeding, or intense mood swings; they aggravate other health conditions, as was the case for Schultz; they don’t align with your gender identity; or you simply wish you didn’t have to deal with them—well, you don’t.
What's the point of placebo pills?
There’s no medical reason that the standard pack of hormonal birth control pills contains twenty-one active doses and seven placebos. The decision to package birth control pills with a week of placebos has a purely social basis, said Alison Edelman, a doctor who specializes in contraceptive care. Early backers wanted to frame them as a natural way to control your fertility and hoped that the cyclical format of the pills, mimicking the menstrual cycle, would underscore that idea.
Because it mimics a natural cycle, many birth control users refer to the bleeding that accompanies the week of placebos as a period. But it’s not.
Over the course of a typical menstrual cycle, the lining of the uterus—called the endometrium—builds up in preparation for a possible pregnancy. When the brain signals to the uterus that there is no pregnancy underway, that lining begins to break down and flush out from your body.
In addition to suppressing ovulation, said Rachel Shepherd, an OB/GYN who practices at River Place OB/GYN in West Austin, Texas, birth control pills prevent the lining of the uterus from thickening.
The pills do this, Edelman said, by overriding the signals that travel between your brain, ovaries and uterus. All the traffic on this “total highway of hormones” gets controlled by the hormones in the pills. No egg is released from your ovaries, and the endometrium stays thin.
What numerous, though not all, birth control users experience during their placebo week is called withdrawal bleeding. According to Edelman, it’s likely related to the blood vessels in the endometrium.
Shepherd noted that some also experience symptoms of estrogen withdrawal when taking the placebo pills, which include headaches, moodiness, cramping and heavy bleeding. In those cases, she and her colleagues routinely recommend continuous birth control.
Choosing the pattern you want
Edelman recalls learning in medical school in the 1990s to recommend continuous birth control only to patients dealing with medical issues such as menstrual migraines or polycystic ovarian syndrome.
When Schultz entered graduate school in 2010, she found that the line of thinking Edelman encountered in her training persisted. The on-campus health service had little knowledge of continuous birth control and would not fill her prescription. While she did use birth control to treat medical conditions, none of them were directly linked to her reproductive system. So, she relied on Planned Parenthood, which meant taking three buses and paying out of pocket for her medication.
Seeing the lack of awareness around different birth control options, as well as sexual health more generally, had a powerful effect on Schultz.
“It ended up being formative for my career,” she said. She's now a sex educator, and works to improve people’s understanding of birth control.
“I wish there were more conversations about different options, contraindications, benefits and consequences,” Shultz said.
Edelman said she believes more medical practitioners are moving in that direction. She’s seen a shift in thinking around continuous birth control that now emphasizes helping people optimize what they want and choose the period patterns that feel best for them.
If you’re already taking birth control and are interested in adjusting the timing of your periods or suppressing them altogether, Edelman said there’s no safety concerns to prevent your trying it out. One important thing to keep in mind if you are using the pill to prevent pregnancy is that you should not be off of it for more than seven days at a time.
What about the downsides?
The short answer is there aren’t many. The most common unwanted side effect of continuous birth control is breakthrough bleeding. Switching to a different formulation or simply sticking with the system for longer often eliminates this inconvenience.
For a subset of birth control takers, however, the bleeding does persist. Edelman recommends these folks return to a cyclical method.
There’s even some evidence, albeit association- and population-based, that suppressing your period may be healthier than menstruating over the entire course of your lifetime. Because life expectancies used to be much shorter, Edelman explained, and women spent most of their fertile years pregnant or breastfeeding, they had far fewer periods over the course of their lifetimes.
For those who embrace their periods, she said there’s no need for concern, but if you’d prefer to forgo yours, you should feel fully empowered to do so.
Just because it’s safe to suppress your period doesn’t mean it’s right for everyone. Some find periods (technically, withdrawal bleeding) to be reassuring confirmation that they’re not pregnant. Others simply appreciate feeling that they’re upholding their body’s natural rhythm. And for some, cultural and social reasons make period suppression unappealing.
Continuous birth control is not the right option for everyone. In fact, no single birth control option will ever be right for everyone. But everyone should have access to the information and health care they need to evaluate which birth control option is best for them.