Story by guest writer Caroline Thompson
When was the last time you had a period? Most women can answer this question without hesitation, easily recalling the moment their last period began. With the help of new applications, they know how long it lasted, how heavy it was, and whether they experienced any side effects like cramps, bloating or mood swings.
But despite being the proud owner of a fully-functioning vagina and uterus, I have a hard time answering that question. For the past six years, I've been using birth control to skip my periods, ignoring the week of sugar pills and starting my next pack of pills right away. At this point, I've been doing it for so long that I literally can't remember the last time I had a period.
And that's fine with me. As a teenager, my periods were heavy and horrible, a source of pain, embarrassment, and crippling migraine headaches that lasted for days on end. These symptoms were curbed slightly when I started taking birth control at sixteen, but I still dreaded the first Sunday of every month when I'd have to start worrying about leaking tampons, cramps and feeling emotionally off. So when my doctor in college told me it was fine for me to skip them if I wanted, I took her advice and never looked back.
My current lack of a monthly bleeding cycle isn't exactly something I advertise, but when the subject does come up, people almost always react in one of two ways: women usually express casual jealousy ("Ugh, that must be SO nice!") and men typically tell me what I'm doing is "unnatural" or "unhealthy."
I find this gendered difference striking. As a feminist, I have to wonder: why are some men so hostile to the idea of a woman without a period? Although the men who feel the need to express these concerns are never medical experts, I've found myself getting caught up in their panic. "You won't be able to have kids!" exclaimed one ex-boyfriend, who was set on the idea of marrying young and having babies, like, yesterday. "Aren't you worried about getting cervical cancer?" asked a friend from my college work-study after he falsely assumed my bad mood was due to "being on the rag." "That CANNOT be good for your body," chided a casual acquaintance when he overheard a conversation between myself and a female friend.
Sure, I've had five separate doctors prescribe me the same birth control regime, and none of them have ever told me I needed to worry about these kinds of side effects. But I'll admit I don’t know enough about the way birth control works to intelligently put these mansplainers in their place, and while my go-to response of "Oh! I didn't know you were a licensed gynecologist! Please, tell me everything you know about how hormonal birth control affects the female body!" usually shuts them up, I thought it was about time for me to educate myself on what, exactly, is going on inside my lady parts on a day-to-day basis. Here’s what I found.
The Doctors Weigh In
I spoke with two OB-GYNs, Dr. Renee Cotter, who runs a practice in West Hills, California and also writes about women’s health on her Well Woman Blog, and Dr. Teresa Tam, who runs a private practice in Chicago and is currently the president of the Chicago Gynecological Society. They both assured me that the practice of using birth control to skip my period is completely safe.
When you’re on birth control, the period you get isn’t a real period at all, it’s what Dr. Cotter calls “withdrawal bleeding.” The pill provides you with a daily dose of the hormones estrogen and progestin (a synthetic version of the hormone progestogen), which stop you from ovulating, because on a normal cycle, high hormone levels mean you’ve already produced enough eggs. When you get to the sugar pill week, your hormone levels drop, signaling to your body that it’s time to flush out the uterine lining that would build up during a normal cycle. But when you’re on birth control, there’s not much there to get rid of.
“The pill keeps the lining thin the whole time, so there's nothing to clear out,” said Dr. Cotter, explaining why periods are noticeably lighter and shorter for women on birth control, and why some women don’t get them at all—even if they don’t skip the sugar pill week.
So if you’re on birth control, why do you have a period week at all? John Rock, the co-creator of the pill, was a devout Catholic who wanted the Church to sanction the use of hormonal birth control. In an effort to get them to see the pill as a “natural” contraceptive akin to the rhythm method, he developed a 28-day cycle that kept monthly menstruation steady in an effort to appease the Church. Sadly for Rock, the Church couldn’t be convinced, and to this day they still condemn the use of the pill. Basically your monthly period, if you’re on birth control, is only a thing because Mr. Rock decided it should be. It’s not medically necessary.
There is no correlation between the continuous use of birth control and infertility.
This was a relief for me, as I’ve found “but you won’t be able to have kids!” to be the piece of unsolicited advice most often chucked at me—despite the fact that I rarely (if ever) tell these people whether I even want children. For the record, I would like to have kids one day, but there are plenty of women out there who don’t ever want to be pregnant, so these comments reek of sexist assumptions and standards about what women’s bodies “should” be for. No one ever watched Jackass and worried about whether or not any of those groin hits would keep Steve-O from reproducing. But I digress.
Both Dr. Cotter and Dr. Tam told me that being on continuous birth control would not negatively affect my fertility.
“There is no correlation between taking birth control and infertility,” said Dr. Cotter. “If anything, being on birth control can actually improve fertility. Women who take birth control are less likely to have endometriosis, a condition which causes infertility in about 15 percent of women. In fact, this condition is often treated with birth control.”
When I do want to get pregnant, I won’t have to wait long.
I was under the impression that, since I’ve been taking the pill continuously for six years, it would take me a while after going off birth control to be able to conceive. My impression was way off.
“We used to tell patients to wait three to four months after being off birth control before trying to conceive,” said Dr. Tam. “But that is no longer the recommendation since there's evidence that ovulation could return almost immediately after stopping oral contraceptives.”
Dr. Cotter echoed Dr. Tam’s advice. “You can get pregnant right away no matter how long you’ve been on birth control,” she said. “It leaves your system within two to three days and you usually start ovulating pretty quickly after that."
I now have a renewed appreciation for the daily birth control reminder alarm on my phone.
Birth control has been shown to reduce the risk of certain forms of cancer—and potentially increase the risk of others.
I’ve heard conflicting advice on this subject, and as these days everything from deodorant to Diet Coke has been deemed cancer-causing, it was hard for me to sort out the truth from the fiction. Dr. Cotter laid it out for me:
"Birth control does not prevent cervical cancer,” she said. “Cervical cancer is a sexually transmitted disease, caused by HPV, and women who use birth control may actually be more likely to contract this virus, because they're less likely to use condoms during sex. What birth control DOES help out with is ovarian and endometrial cancer. Women who use birth control for five years or longer typically see a 25 percent reduction in their risk of developing these cancers, which is amazing."
Don’t be afraid to ask your practitioner for clarification if you’re confused.
I mean, it took me six years to actively look for answers to my many questions about the way my body is affected by birth control. And Dr. Cotter told me she gets questions like mine all the time.
“There's a lot of misinformation out there. I hear this all from my patients too, but at the end of the day if you're a healthy non-smoker without a history of blood clots or high blood pressure, you can safely be on birth control up until the age of 55.”
The fact that it took me so long to seek out clarification on this issue is perhaps a result of the way society sweeps women’s health issues under the rug. Despite being brought up by a highly feminist mother who did her very best to instill within me a sense of pride and ownership over myself, I still managed to internalize the idea that periods, birth control, and the inner workings of my female body were somehow shameful. I was so embarrassed when I got my first period that I didn’t tell anyone—not my mom, not my best friends—for months. When I wanted to start having sex as a teenager, I went in secret to the doctor and paid for the birth control prescription on my own, even though my mother told me to come to her if I ever wanted or needed to go on it. I was empowered with choices and body-positive education, yet I still felt shame and confusion, and this is a problem.
My experience with hormonal birth control has been overwhelmingly positive, but the pill can cause serious side effects--from mood swings and weight gain to life-threatening blood clots--in some women. They're rare, but every body reacts differently to the synthetic hormones in birth control, so it's extremely important that we feel comfortable enough to discuss these issues, both with our doctors and our friends. There is actually a growing movement (headed by women, no less) which seeks to empower women with alternatives to hormonal birth control. Some women don't want to disrupt their natural cycle, and some just don't feel like themselves when taking a daily dose of hormones. This movement focuses on natural contraceptives, like Natural Cycles, a fertility tracking app which uses a daily thermometer reading to pinpoint the days when you're most likely to get pregnant, and providing education on how to best use condoms, diaphragms and the rhythm method.
Hormonal birth control works for me, and I like being able to stop my period, especially now that I know it's healthy for me to do so. But I see nothing wrong with flooding the market with other options, especially if those options help women become more aware and in control of their own bodies. What I’ve learned from my research into how my birth control method affects my body is that I’m not alone. Women need to feel comfortable discussing these kinds of things out in the open, and we need to be empowered with enough knowledge to know what's best for each of us individually. The first step to figuring that out is getting over any lingering fear, embarrassment or shame about our bodies and just asking the right questions. Once you have the answers, life is a lot less scary.