On the Continuous Use of Contraceptives

I take contraception and have been doing so for several years now (since I was 18). I take contraception for two reasons: 1) I do not currently desire to become pregnant, so I do not wish to be actively fertile, and 2) I wish to suppress my menstrual cycle.

In fact, I’ve been using oral contraception, “the pill,” continuously (meaning I do not take the placebo pills) for several years now. I have periods very infrequently. The longer I have taken the pill in this manner, the less I have any sort of uterine bleeding whatsoever.

And you know what? It’s wonderful. I don’t feel like total shit for a week out of the year as I do when I have regular periods. I don’t have to carry menstrual supplies and I don’t have to experience the extra hassle and effort of their use. I don’t produce extra waste via tampons and pads. (For women who do menstruate, I highly, highly recommend the DivaCup. Seriously, it changed my life when I was menstruating as much as realizing I could stop my menstrual periods altogether.)

No one told me I had to suppress my menstrual cycle. I first heard about doing this while getting ready for my first Burning Man. Another women noted that if I were scheduled to get my period during the event and didn’t want to deal with it while in the dessert (a real concern given the pack it in, pack it out nature of the event, lack of hand-washing facilities and port-o-potty conditions), that I could just skip the placebo week of pills and immediately start a new pack.

Learning this was incredibly empowering. Already I had experienced the empowerment of being able to choose when to be fertile. Now I could choose not to have a period. I started using this method whenever the timing of a period would be inconvenient: it coincided with travel, a job interview, etc.

A few years later I learned even more about the periods that occur when taking birth control. I learned that you could stop them all together by taking birth control continuously. Even more wonderful! I asked my doctor about this, she said it was okay to do and re-wrote my birth control  prescription to indicate continuous use so that my insurance would cover each refill. (Sometimes if the prescription is not written for explicit continuous use, insurance companies will not want to cover the “early” refills. If you’re considering continuous use, be sure to have your doctor write the prescription as such.)

Lately I’ve noticed a number of women speaking out against continues use of contraception for the purposes of menstruation control and suppression. One Op-Ed by Karen Houppert published in the New York Times declared that “war has been declared on menstruation.” Another blogger named Julia says “If it ain’t broke, don’t fix it.” And an article by Heather Corrina on a sex-education site for teens goes so far as to directly equate the desire to control one’s menstrual period as a form of internalize misogyny (see I, Being Born Woman and Suppressed). These are just a few examples of the many, I think, mis-informed reactions against the use of continuous contraception for period suppression.

An argument of these critical responses is that this solution is overly marketed to women. Corrina writes that menstruation suppression is “being given the hard sell,” and Houppert in her NYT articles warns women to prepare to protect themselves “for a barrage of advertising and research highlighting the debilitating effects of periods and the joys of menstrual suppression.”

I agree that women are overly marketed to. Actually, we all are. We’re bombarded with advertisements on TV, in print and on the Internet. We’re told that if we buy all manners of products that we’ll be thinner, happier, fitter, wiser. We’re told this in disingenuous ways and its incredibly harmful. There’s no doubt about this. There’s no doubting the power and clout that the big pharmaceutical companies have in our economy and culture. These companies certainly have an interest in developing drugs that we need (or want) to take with regular frequency because this means a recurring revenue source. An unfortunate side-effect of this is that these companies may benefit from health issues that to be maintained by a daily medication. So, these companies have a potential economic interest against finding/promoting preventions and cures for the source of ill-health. Cholesterol maintenance medication is a prime example. People would not have cholesterol issues if they followed a healthful vegan diet. The problem simply wouldn’t exist, nor would the market for the very lucrative cholesterol-lowering medications.

However, this does not mean that all regular-use medications that pharmaceutical companies create represent arbitrary and selfish market creation. Women have a very real need for contraceptive, fertility and reproductive health maintenance options. I think its okay for the companies who make these drugs and for doctors to inform women of their existence.

Opponents seems to think that the marketing of these options to women is an implicit attack on femininity itself, one which in turn gives women no real choice about using these options:

“Do pervasive cultural attitudes about menstruation, and about the female body as being a great annoyance and a burden — attitudes so ingrained and accepted that even some doctors perpetuate them — allow women a real choice as to whether or not, and why, they WANT to suppress menstruation?” (Corrina)

Houppert further dramatizes the supposed attack on femininity by saying, “Western civilization, it seems, hinges on our ability to wrangle our messy cycles to the ground and stomp ’em out once and for all.”

In no way have I ever felt that the availability of options to control my menstrual cycle is implied judgement that having a menstrual cycle is a bad thing. What I detect is that there are valid reasons why a women would want control over when and how she menstruates. Menses is the number one cause of iron-deficiency. A percentage of women have incredibly painful, heavy periods (dysmenorrhea), some women have especially difficult PMS (Premenstrual dysphoric disorder). Both of these can be helped by the pill (via continuous or regular use). For women who have mild periods, there is still a very valid benefit in the convenience of not having a period. I want all women to know this option is available as I do think it can be enriching and empowering.

Some women feel that their femininity in part originates from their menstrual cycle. Blogger Julia writes, “I am a woman and my periods are part of that womanhood, which I love.” I appreciate that some women feel this way. However, not all do, including myself.

My period is not my source of femininity. Nor is my fertility, my genitals or my breasts. I am my source of femininity and I alone define it. The act of taking contraception does not inherently or implicitly endanger femininity. Women who make the decision to use contraction in this manner aren’t necessarily demonstrating an internalize misogyny.

That’s not to say that we don’t have a ways to go in our cultural understanding and acceptance of menstruation. Many women are ashamed of their periods, of any “accidents” they might have during their period, of even talking about their periods. I cringed during the scene in the movie SuperBad when one of the party guests, a male, discovers he has period blood on him. He proceeds to freak out and so does the rest of the party. The scene wasn’t funny to me, as I imagine it was written to be. A mature person should be able to handle fluids associated with normal bodily functions. As should an adolescent who is or on the verge of being sexually active. So, just like all aspects of women’s reproductive health and sexuality, we need to continue to promote open, honest dialog and education.

Some opponents site the unknown health effects of using contraception continuously for period suppression. These health concerns are largely exaggerated:

We know that suppressing your period long term is not detrimental (actually, there’s evidence it’s beneficial, but I digress). And how do we know that? From decades of observing the effects of menstrual suppression in women who, you know, don’t menstruate for extended intervals: Pill users, pregnant women, breastfeeding women.

(from The Well-Timed Period blog)

Using hormonal contraception continuously carries no greater side effects than taking contraceptive pills plus the placebo pills intermittently.

I think that women who are opposed to the use of contraception for period control do not have a complete understanding of how the menstrual cycle works particularly in relation to hormonal birth control. All hormonal contraception, regardless of whether you take it continuously or not, suppresses the menstrual cycle. There’s a very good overview of this available in the article Menstrual Suppression vs. Continuous Use .

In short: Fluctuations in hormone levels cause changes in the uterine lining. The uterine wall thickens in preparation for possible pregnancy. When pregnancy does not occur the thickened lining of the uterus is shed, along with any unfertilized ova. This is a menstrual period.  If you’re not planning for a pregnancy, there is no reason to have cyclical changes in your uterine lining. Hormonal birth control forgoes this uterine/menstrual cycle by maintaining a thin uterine wall. There’s nothing to shed when you’re taking hormonal birth control, so there’s no reason to have a menstrual cycle. There’s no evidence to suggest that regular bleeding is necessary or even good for the uterus beyond its function as stated above.

When you bleed while taking the pill you aren’t really having a menstrual period:

“What you do have when you use the Pill is a monthly withdrawal bleeding episode, or a fake period. This withdrawal bleeding and the menstrual period are not one and the same thing. Briefly, by manipulating the dose of hormones in the Pill, you can destabilize the thin uterine lining enough to cause some bleeding.” (from Menstrual Suppression vs. Continuous Use )

In fact, these withdrawal bleeding episodes are not medically necessary. Rather, the decision to induce them was a marketing one, as mentioned in this NPR interview:

“Marketers at the manufacturing company which developed the pill,” says Segal, “felt at the time that an oral contraceptive might or might not be accepted by the public. These were very different times. Not only was this the first oral contraceptive but it was the first medication given to healthy women for any purpose at all.”
Taking away ovulation and imposing synthetic hormones was already a big change, and apparently marketers felt it might be too much to also take away monthly periods.
“You have to remember also that this was a time before drugstore pregnancy tests, so that if a woman was not bleeding, having a regular menstrual period, she wouldn’t know for sure whether she was pregnant or not,” says Segal.

“Such anxiety about unintended pregnancy was another reason why marketers felt it was better to have one week off, to allow this artificial menses to occur,” he explains.

To be clear: I am not criticizing a woman’s decision to use birth control or not use birth control, for whatever reason and in whatever manner (continuously or otherwise). That is a personal decision. If you aren’t comfortable taking medication, if you have other means of contraception that you are comfortable with, that’s fine. If you take contraception but don’t mind having regular periods, that’s fine too. If you choose to take birth control continuously to eliminate or reduce withdrawl bleeding, that’s also okay.

What I am criticizing is the notion that women who use technology to control their fertility and/or their menstrual cycle are somehow doing so out of an internalized misogyny, or are otherwise betraying the feminist cause.

It is possible to be fully unashamed of your period and still make the decision to banish it from your life. It’s also possible to feel some negativity about your period and decide to banish it from your life. This doesn’t mean you hate yourself, your femininity, or that of your sister’s (biological and otherwise).

I’m curious to hear from other women out there. Have you chosen to take contraception continuously? Did you feel pressured into doing so so? Does it make you feel empowered? Do you choose not to take birth control in order to stay connected to your “natural” femininity? Has the availability of birth control affected you in a positive way? A negative one? How so?

4 comments

  1. Meep

    My concern with taking contraceptives originally was from the mental health problems that ensued. My depression and mood swings got worse, and I felt frequently irritated. After three months I stopped taking them because it caused my own mental defenses for my moods to wear down.
    Second, I worry about the pharmaceutical companies – even when taking medication I know these people are not necessarily on my side. I do not trust their reports or their commitment to allowing science to be done. I suspect that many factors have caused female periods in the West to become heavier, such as our diet and our levels of exposure to toxic chemicals like rBGH.
    As an aside, I often wonder how “heavy” is heavy. I would consider my period normal (if not annoying), but I would love a comparison of volume and chart this statistically. Does the DivaCup have mL or cc readings?

  2. Audrey

    I’ve been thinking about writing a post on this for ages. I started using NuvaRing in this manner about 3 years ago so I wouldn’t have to deal with my period while backpacking, and kept it up because it worked so well for me.

    I had other experiences with hormonal bc before this that were less positive, though. It can definitely take some experimentation and patience to find one that doesn’t seem to have side effects. Even with NuvaRing, the first month I had some nausea.

    For me, the biggest advantage is skipping that week every month I feel so tired and sluggish. I’ve had problems with anemia in the past, and I’m sure this helps in that regard as well. It doesn’t make me feel less female, just more level and productive.

  3. Christie

    @Meep:

    It’s true that not all women tolerate hormonal birth control well and that some experience side-effects significant enough to outweigh their benefit. I think sometimes these side-effects will mitigate over time as the body adjusts, or can be mitigated by switching to a different type of hormonal contraceptive. But of course, not for every women. If taking birth control exacerbates your mood swings and depression, that is definitely a valid reason for concern and a valid reason for discontinuing use.

    I share your concern about the pharmaceutical companies. I try to research anything that I am prescribed and examine critically if it’s really necessary/beneficial/worthwhile to consume a given medicine. In my determination the risk is low (especially since we’ve had the pill for so long now) and the benefit is high. This of course will not necessarily be the same outcome for all women.

    I also share your concern about hormones, antibiotics and other contaminants and unhealthy components in the foods that comprise to the Standard American and Western diets. We don’t know what affect this has had upon the female (and male for that matter) reproductive system. You probably already know my response to this is to promote and follow a healthful vegan diet.

    And, yes, the DivaCup has a CC reading! The geek in me thinks that is so cool. I don’t know about the other menstrual cups.

  4. Sherri

    Ever since I started having a period I would get awful cramping in my lower back and lower abdomen. During my cycle I’d get headaches, nausea, over all body-ache (in addition to the cramps) and run a low-grade fever. It was generally miserable especially on weeks when I’d still need to show up for things like swim team practice.

    Since 1999 I’ve been managing a condition which causes chronic pain in my lower back and hips. During the weeks I’d get my monthly cycle I’d be utterly miserable, in bed, and profoundly grateful for a job that allowed me to telecommute. Despite significant weight loss and a dramatic change in my diet, including switching to a vegan diet, did nothing to improve the flu-like symptoms and pain. My cycles caused me so much discomfort that it was impossible to feel empowered and feminized by them. I merely felt ill once a month, without fail. More than anything else this situation caused me to internalize a hatred of my femininity.

    A few years ago the use of continuous birth control to suppress my cycle was suggested to me when I changed to seeing a new gynecologist. In her opinion the use of continuous contraceptives should be part of my pain management, the effect on my fertility was secondary. Since I did not have any plans to have a baby she said there was really no reason for me to go through that kind of pain each month. I was astounded; here I was in my mid-30s and I had no idea I could do this.

    The past few years of suppressing my monthly cycle have been tremendously empowering. I don’t dread one week out of every single month. Nor do I spend another week each month just getting back to “normal. I have pretty significant allergies and if I don’t manage them I can be utterly incapable of functioning for days at a time. I see managing the menstrual cycle in pretty much the same light now.

    Yes, as women our bodies are capable of an amazing biological process. As tired as I am of being told that this biological process must be controlled and legislated, I’m equally tired of being told that I need to embrace some mystical power tied to my menstrual blood. I don’t feel in any way like I’m internalizing some kind of hatred of myself for being a woman. I also don’t feel that a basic biological process defines me as feminine or not.

    Really, I’d prefer to believe that we all are possessed of remarkable, significant power. This spark of Buddha Nature (Divinity, God/Goddess Power, Holiness, whatever) is shared by each an every one of us. This universal power is genderless, without race, common to us all, and utterly extraordinary. It is not touched by the function of the body that contains it until such time as that body ceases functioning and the spark moves on.