Updated December 16, 2014.
The impact of having a monthly period, for some women, can be experienced as a minor inconvenience; yet it can also be a major health concern for women suffering from menstrual disorders and/or conditions that are aggravated during menstruation. In fact, up to 80% of women report physical changes in association with menstruation; 20–40% of women endure negative cycle-related symptoms. Due to an earlier onset of menarche, later first births, fewer pregnancies, less breastfeeding and later menopause compared to generations past, women today have three times as many menstrual cycles over their lifespan.
The Rationale for Skipping Periods:
The use of birth control pills gives women the choice to decide when and if they become pregnant; oral contraceptives (OCs) also afford women the ability to control when and if they have a period. Research shows that if given the choice, most women would prefer extended menstrual cycles. In one study, 91% of women who use birth control pills expressed the wish to be able to extend their cycles. Many women also have medical reasons for desiring to skip a period. The most common medical reasons that women state for wishing to extend their monthly cycle are headaches, cramping, painful periods, heavy bleeding, and PMS.
A Menstrual Period vs. Withdrawal Bleeding:
When birth control pills were first introduced, they were marketed to be sold as 21 days of hormone pills and 7 days of placebo pills (21/7) to minimize the perception that these pills change the menstrual cycle. According to Dr. Steven Goldstein, professor of OB-GYN at New York University School of Medicine, “scientists who invented birth control pills back in the ‘50s thought that women would be more likely to take them if they included a period week.”
The original developers of OCs decided upon the 21/7 regimen for other reasons as well. This cycle length was also determined because it most closely mimics the natural menstrual cycle; this way, people would not get the false impression that birth control pills interfere with one’s “normal” period. Additionally, this regime (of a “normal” cycle) was chosen to ward off potential concerns of women, doctors, and varying religious views.
Finally, at that time, there was a lack of accurate and easily accessible home pregnancy tests. The pill developers felt that having a monthly period would help to reassure women that they were not pregnant. When put into this historical context, one can see how the 21/7 regimen is more a reflection of the time in which the pill was developed rather than based on a scientifically established medical need.
Is It Safe to Not Have A Period?:
Many don’t realize that the period one has on OCs is not a REAL period; it’s actually withdrawal bleeding. Withdrawal bleeding is NOT necessary to maintain gynecologic health.
Some women falsely believe that without a period, blood or other toxins may begin to build up. Although some claim that it's unnatural or harmful to manipulate a woman’s monthly cycle by completely stopping her period, in reality, women are already controlling their menstrual cycles just by using birth control pills. Given that few women naturally have a 28-day menstrual cycle, pill use automatically directs a woman’s cycle to be 28 days.
The "period" that occurs during 21 or 28-day combination birth control packs has no medical function other than reassuring a woman that she is not pregnant. In women who do not desire to or can't become pregnant, there is no physiological requirement for an actual menstrual period or for a monthly withdrawal bleed (that occurs with hormonal contraceptives). Doctors have long-realized that OCs can be used to prevent a period or to produce a desired cycle length. For decades, doctors have been advising women on how to properly use 21/28-day regimen birth control pills to manipulate monthly cycles and to skip periods.
This has been done successfully and safely to help manage menstrual-related health disorders or severe period-related symptoms; women also choose to avoid their periods (through manipulating their birth control pills) due to physically demanding jobs, upcoming vacations, and/or honeymoons. Thus, many pill users have chosen to avoid having a period by starting a new pill pack during the fourth week (when one’s period usually occurs).
Research on the Safety of Fewer Periods:
- Anderson et al. (2003): was the first large-scale controlled study of the effectiveness and safety of an extended cycle OC regimens in women under 40. This study demonstrated that extended cycle OCs are effective, safe and well-tolerated. When taken daily for 84 days followed by 7 days of placebo, extended cycle pills were effective in preventing pregnancy and had a safety profile that was comparable to that of 28-day pill regimens. Extended cycle pills represent a change in the paradigm of OC therapy by allowing women the option of decreasing the number of withdrawal bleeding intervals from 13 to 4 per year.
- Henzl & Polan (2004): found that eliminating withdrawal bleeding through extended or continuous use of oral contraceptives may actually have health or lifestyle-related benefits.
- Anderson et al. (2006): the primary objective of this study was to demonstrate the safety of Seasonale for up to an additional two years. The researchers found that the negative side effects reported in this study are typical of all birth control pills (with the exception that break through bleeding is more common with extended cycle pills). This study also confirmed the long-term safety of Seasonale, a 91-day extended cycle pill.
Conclusion:
There is no medical evidence that women need monthly withdrawal bleeding or menstrual periods; there are also no health problems associated with skipping or eliminating monthly bleeding. Studies conclude that continuous use of the pill to stop monthly withdrawal bleeding is a safe and effective option for preventing pregnancy. For years, women have been safely choosing to extend their 28-day cycle by manipulating the use of 21/28 day packs of oral contraceptives. Research has also confirmed that the use of continuous or extended-cycle OC regimens (to prevent periods or increase menstrual cycle length) represents a viable and attractive option for many women. The quality of life for women who suffer from menstrual-related disorders can be greatly improved by the ability to suppress one’s monthly period, and the availability of more pill choices to either eliminate or postpone monthly cycles can serve as a great convenience for women with busy and active lifestyles.
Sources:
Anderson, FD, Gibbons, W, & Portman, D. (2006). Long-term safety of an extended-cycle oral contraceptive (Seasonale): a 2-year multicenter open-label extension trial. American Journal of Obstetrics and Gynecology, 195(1), 92-96.
Anderson, FD, Hait, H, & The Seasonale-301 Study Group. (2003). A multicenter, randomized study of an extended cycle oral contraceptive. Contraception, 68(2), 89-96.
Henzl, MR, & Polan, ML. (2004). Avoiding menstruation: A review of health and lifestyle issues. Journal of Reproductive Medicine, 49(3), 162-174.
Lin, K & Barnhart, K. (2007). The clinical rationale for menses-free contraception. Journal of Women's Health, 16(8), 1171-1180.
Sulak PJ, Cressman BE, Waldrop E, Holleman S, & Kuehl, TJ. (1997). Extending the duration of active oral contraceptive pills to manage hormone withdrawal symptoms. Obstetrics & Gynecology, 89, 179-183