Death To The Period
Pull the plug on your monthly red tide – your career could thank you
Sitting at my desk, I look composed, but I’m about to pass out. Or at least, that’s how it feels. Pain from my lower torso is paralysing every inch of my body. A colleague asks me a question, but I can’t work out what her lips are saying – my brain, functioning three seconds ago, has turned to mush and I have a desperate urge to vomit, cry and curl up for a long nap. I take a few more deep breaths and start to feel human again, until the next flow of agony. What’s happening to me? Nothing more serious than it being my time of the month. And yet this painful episode – and the week of suffering that surrounds it – reminds me why it’s my first period in six months. Like a growing number of women, I decide exactly when I have my period – and for me, that’s not very often. I control mine by running several combined pill packs together in a row, only stopping to allow for infrequent withdrawal bleeding that forces me to scramble to the back of the bathroom cabinet for a tampon. Others choose the progestogen-only pill or a longacting reversible contraceptive (LARC), such as the implant, injection or intrauterine device (more commonly known as an IUD), all of which can make periods less heavy or less frequent or stop them altogether. I started taking hormones every day nine years ago, at the age of 15, to ease excruciating, heavy bleeds. As a result, I’ve had far, far fewer periods than my peers have had in that same time. “That’s unnatural,” and, “It’s not good for you,” are just some of the comments people have made. But I’ve only felt the benefits: freedom, control and lack of distraction. And I’m not alone. In 2016, New York City passed a bill that pulled the plug on tampon tax and sparked a global conversation about the woes of paying extra for our anatomy. One way to cut your tampon budget? Skip your period.
According to a study in the South African Journal of Obstetrics and Gynaecology, 89 percent of young females (18 to 24 years) are using contraception tools – with 26 percent opting for injectables, which can lessen or completely stem the monthly flow. “After one year of using the injections, up to 50 percent of women experience amenorrhea (a halt in periods),” says Dr Jireh Serfontein, a sexual health physician at My Sexual Health. With longer use, up to 80 percent of women have zero flow. LARCs, which last longer and require less maintenance, are becoming more popular. “There’s been a huge change in the past five years in the sorts of contraception women ask for,” says sexual and reproductive health expert Dr Jane Dickson. “The emphasis has changed to IUDs – they’re convenient because once they’ve been fitted you can forget about them. More women are running their pill packs together too, thanks to an increase in awareness that it’s safe to do so.”
THE HISTORICAL PERIOD
While few women enjoy having periods, there’s a belief that putting up with them is the natural thing to do. As well as being a sign that you’re not pregnant, they’re a signifier of health, right? “Periods are a strong signal that your body is functioning as it should,” says Dr Ulrike Sauer, a consultant in sexual and reproductive health. “Aside from pregnancy, the most common reasons women don’t get periods are that they’re under-eating or over-exercising. If a woman who isn’t on contraception doesn’t bleed, it’s a sign that the womb lining might have changed and that something more serious could be going on.” Katie Ann Hasson, assistant professor of sociology and gender studies, agrees that it’s a psychological reassurance and adds, “To some women, having a period is also an important part of their sense of femininity.” Well, what if I told you that it’s not actually natural for you to have regular periods? “Our bodies evolved to be almost constantly pregnant or breastfeeding once we hit puberty,” says Sauer. “Centuries ago, women would rarely bleed and most of our female ancestors died before menopause.” Indeed, research has found that, today, modern Western women will have four times as many periods over the course of their lives as our ancestors did. So, what does “natural” even mean? The “period” you have when you take a break from the pill every three weeks isn’t natural. “A ‘withdrawal bleed’ occurs when the lining of the uterus sheds in response to the pill’s artificial hormones being taken away; while a period is the lining of the uterus responding to the changes in natural hormone levels that occur when a woman is not pregnant,” explains gynaecologist Dr Kate Guthrie. “If you run packs together, eventually you’ll get a ‘breakthrough bleed’, where the lining builds up to a point where it needs to shed. This can be after a couple of weeks or up to several months depending on the person and can become less frequent as your body adapts.” “If you’re not having a withdrawal bleed, it just means the womb lining hasn’t built up to a level at which it needs to shed,’ says Dickson. “You have a built-in progesterone protector that tells your body when it needs to bleed.” I’ve seen my body adapt from lasting just two consecutive pill packs before spotting
QWHAT’S THE DEAL WITH BREAKTHROUGH BLEEDING?
“The major downside of skipping your period is that you might get breakthrough bleeding during the first few months,” says sexual health expert Dr Jireh Serfontein. It’s caused by a build-up of the uterus lining that needs to shed, but as your body adapts, you’ll have less of them. No reason to panic.
to not seeing anything before six months. There’s also a misconception that regular bleeds while on the pill confirm you’re not expecting. “You can’t rely on that – in the same way you can’t even if you’re not on the pill, as some women have periods when they’re pregnant,” explains Guthrie. “Similarly, the absence of your withdrawal bleed could either be that you’re pregnant or that there isn’t enough of a reduction in hormones to trigger a breakthrough bleed.” So, if a monthly bleed while on the pill is neither real nor reassuring, well, what’s the point? “It’s all set in history and tradition,” explains Dickson. “The creators of the pill designed it to be taken with a seven-day monthly break, even though they knew it wasn’t medically necessary. By mimicking a monthly period, they believed it might be better accepted by the church and other religious institutions.” Gynaecologist – and devout Catholic – John Rock, along with biologist Gregory Goodwin Pincus, tried to maintain as much menstrual “normality” in their invention as possible so it would secure FDA approval, first in 1957 as pain relief and then in 1960 for contraceptive use.
GO AGAINST THE FLOW
Yet today, when feminism has never felt stronger, many women remain beholden to a monthly bleed. But what if you knew the salary and promotion gap would be 15 percent smaller, according to Italian researchers, if your menstrual symptoms and period-related absenteeism weren’t factors? In a recent YouGov survey, 52 percent of women said periods affected their ability to work and a third of those said they’d had to take a sick day. Menstrual symptoms are also
QDOES IT MATTER WHICH PILL I TAKE?
“Not really. Monophasic pills, like Yasmin, have the same amount of hormones per pill, whereas triphasic pills, like Trigestrel, mimic your body’s natural hormonal fluctuations,” says sexual health expert Dr Jireh Serfontein. Essentially, you’re more likely to be spotting on triphasic pills and less likely to on monophasic ones. But as your body adapts, this could happen less frequently. one of the main reasons girls miss school. So throughout your life, your period could really affect your education and career. “Suppressing your period means you can skip the mood swings, headaches, PMS and disruption to your life – many women perform less well during exams and in sport – and for those with endometriosis it can make life more manageable,” says Guthrie. I, for one, notice my productivity dips at work, thanks to pain disrupting my sleep and the fact that I spend chunks of the day keeled over in a toilet cubicle. But now, 58 years after the pill changed everything for women, there’s still confusion surrounding its long-term safety. “Hormonal contraception has pros and cons,” says Sauer. A 2014 study published in the journal Cancer Research discovered a 50 percent increased risk of developing breast cancer while using the combined oral pill, while a 2007 study published in the medical journal The Lancet found that being on it for five years or more doubled your risk of cervical cancer. Should we be worried? “You are slightly more likely to develop breast cancer, but only when you’re on the pill, not once you stop – there’s no lingering effect 10 years after or into your fifties and sixties,” says John Guillebaud, emeritus professor of family planning and reproductive health. “Most pill-takers are under 35, the age when breast cancer is very rare anyway, so a 50 percent increase on top of extremely small numbers leaves total cases in this scenario still very low.” The hormone doses in the present-day pill are much smaller than they used to be. “When it was first invented it contained 100mg of oestrogen, which is what past research on increased breast cancer risk has been based on,” explains Guthrie. “Now it
QDO I NEED TO HAVE MY PERIOD AT LEAST FOUR TIMES A YEAR?
Short answer? No. “There’s no scientific evidence that supports this,” says sexual health expert Dr Jireh Serfontein. only contains 20mg, so future studies may find there’s even less of a link or none at all.” This lower dose of oestrogen means bloodclot risk has been lowered even further too. “Thrombosis is much more likely during pregnancy or in the weeks after you’ve given birth,” says Sauer. There’s evidence that the pill can, in fact, be protective against cancer. “A woman taking it is less likely to get cancer than a woman whose partner uses condoms because it reduces risk of ovarian, large bowel, endometrial and rectal cancer while in use and for 10 years after,” says Guillebaud. A 2008 study published in the The Lancet estimated that the pill may have stopped around 100 000 women dying of ovarian cancer as it suppresses activity and disruption to the surface of the ovaries – a number that outweighs the increased risk for other types of cancer linked to taking it. Dickson agrees, pointing out that other factors can play a much more significant role in cancer risk. “Being overweight, smoking and family history pose a much greater risk to your health than taking the pill,” she says. Then there were last year’s headlines claiming that the pill has psychological, as well as physical effects, upping depression by 23 percent. “In a small minority it can lead to depression or severe mood changes,” says Guillebaud. “But depression is sadly very common and what the study actually found was that out of every 123 pill-takers with depression, only 23 could truly blame their contraceptive. The other 100 would have expected to be diagnosed anyway.” There are other negative side-effects associated with the pill, including the risk for stroke, changes in eyesight and even an abnormal growth (for more on the last bit, check out our website). But these are rare cases and you should chat to your doc if you suspect something’s up.
But what does switching off your ovaries mean for fertility? While, at 24, I’m not looking to have children any time soon, it’s a concern that does cross my mind. “It won’t make you infertile, but you can’t be sure how long it’ll take for your natural cycle to return,” warns obstetrician and gynaecologist Dr Shazia Malik. She suggests coming off the pill or LARCs and using condoms six months before you plan to start trying to allow ovulation to get back to normal. But not every woman will need that long. “With the exception of the injection, which can take up to a year to wear off, your cycle should return to normal almost straight away when you stop taking contraception,” says Guillebaud. “In fact, it could even make you more fertile. A 2002 study found that ex-pill takers were more likely to fall pregnant in the six months after coming off the pill than those who’ve never used it.” And if you don’t want to get pregnant just yet, running your pill packs together can actually make it more effective as a contraceptive. “All the time you take the pill, your ovaries are asleep, but in the seven days you stop taking it, your ovaries start to wake up again and begin ovulating,” explains Dickson. Taking it every day keeps your ovaries on snooze for weeks, if not months, meaning that you’re less likely to forget to restart a pill pack and fall pregnant.
Of course, while choosing not to have a monthly period becomes more mainstream, it’s important to consider what your motivation really is. It’s no secret that society is anti-bleeding. “Our cultural attitude is that menstruation is dirty and shameful and that we should avoid it at all costs. We don’t talk openly in society about the nitty-gritty of our bleeds and we don’t have any reference points for comparison,” says Hasson. “Taking hormones to get away from it means that we often don’t know our own healthy baseline.” Contraception and painful bleeds are reasons enough to stop periods, but we shouldn’t be stopping our periods for the sake of it, points out Sauer. That said, contraception is starting to reflect a period-less lifestyle. Over in the US, the birth-control pill is normally 24 days on, with four days off, and a continuous pill, Lybrel, was approved there in 2007. With many of our family-planning trends coming from the US, where there are huge funds for research and a very rigorous FDA, we may start to see those options over here too – once our government has caught up, that is. “The 21st-century way to take the pill is continuously or running four packs in a row with what we call tricycling – in the future I believe everyone will take it like this,” says Guillebaud. Dickson adds that it’s about changing a culture. “Understanding that women can run their packs together is often against everything doctors have been taught” she says. “And many patients aren’t told how contraception can make their lives easier.” Guthrie agrees: “The knowledge is there, but it hasn’t trickled down into action yet,” she says. “GPs have it tough – they’re meant to know everything about everything – but so many women are simply handed the pill and told to use it in the traditional way because it’s quicker to explain.” If being on an equal footing with men is the ideal, ditching our periods might just allow us to catch up in the workplace, not have to enlist a hot-water bottle to remain calm enough not to kill anyone and be free to spend our cash on items other than sanitary wear. “Women should be able to control their own lives,” says Guthrie. “Their bleeds should fit in with them, not the other way around.”