July 30, 2013

To Bleed Or Not To Bleed: Is That The Question?

Young women are increasingly using birth control pills to avoid menstruation as well as pregnancy, for the sake of convenience rather than health.

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Birth Control Pills

Birth Control Pills

In the mid-2000s birth control pills such as Seasonale and Lybrel began to appear. Unlike other pills, these brands reduced periods to only a few times a year, or eliminated them entirely. However, it is possible to prevent bleeding with almost any birth control pill by skipping the placebo pills at the end of the pack. OB/GYNs have used this trick for decades to treat patients with endometriosis, dysmenorrhea, and other menstruation-related disorders that benefit from an uninterrupted dose of hormones. It is only in the past decade that this practice (known as “continuous contraception,” “stacking,” or “menstrual suppression”) has gained popularity with young women as a lifestyle convenience, rather than a treatment for menstrual disorders.

Understanding menstrual suppression

Because ovulation typically does not occur when women take birth control pills, the bleeding experienced by women taking traditional pills cannot be considered true menstruation. Withdrawal bleeding is a shedding of the uterine lining that is triggered by the drop in estrogen levels that occurs while taking the placebo pills. Studies indicate that this bleeding is not necessary for health, and that using the pill continuously is safe, and does not reduce the pill’s contraceptive efficacy. There is even a growing contingent of physicians who believe that menstrual suppression can be a healthier choice for women taking the birth control pill, as hormone levels remain stabilized throughout the month.

Motivations for skipping periods 

While hormonal menstrual suppression was historically used to treat menstruation-related disorders, pills specifically indicated for reduced menstruation are often marketed as being more convenient than traditional pills. This paradigm shift was reflected in a recent study of female students at the University of Oregon who reported manipulating their bleeding schedule for reasons of convenience rather than to control menstruation-related symptoms. Women in physically demanding jobs (such as military personnel and athletes) may prefer not to menstruate for the sake of job performance, while others may find monthly bleeding to be messy, uncomfortable, or something that interferes with their sex lives.

Some psychological professionals and researchers have expressed concern that  this desire to eliminate menstruation for convenience sake may be a reflection of women’s negative feelings towards their bodies, and cultural stigmas related to menstruation. Others argue that in an age of greater reproductive choices, women (and gender variant people) should be free to choose whether or not they menstruate, just as they choose birth control methods, and that menstruation should not be considered essential to womanliness.

Disconnect with medical providers

One of the noticeable outcomes of the University of Oregon Study was that while 47% of women learned how to use continuous contraception from health care providers, almost a third received this knowledge from family or friends instead. Research from 2004 indicated that only 52% of a sample of 512 physicians were willing to prescribe these drugs, and in most cases it was because the patient specifically requested them. More disturbingly, 2008 research indicated that young women’s primary source of information about menstrual suppression were advertisements and the media, rather than their doctors. Other research indicates that while many women use the pill to eliminate or adjust bleeding, most of them lack understanding about how continuous contraception works, and believe that it is necessary to experience withdrawal bleeding each month .  As continuous contraception becomes an increasingly popular option for young women, it is important for physicians to educate patients about their options for taking the pill, and play an active role in their treatment. Regardless of whether women choose to alter or eliminate bleeding for convenience or health reasons, it is critical that they receive accurate, detailed information from the medical providers that prescribe their pills.