We don’t need to bleed’: why many women are giving up on periods

We don’t need to bleed’: why many women are giving up on periods

For some, it is about bringing an end to debilitating pain or dark thoughts. For others, it is as simple as being liberated from the sinking realisation that you need a tampon – but you left them in your other handbag.

When a new wave of feminist authors and activists are calling on women to embrace their periods, the idea that some do not want a monthly bleed and are seeking to avoid having them altogether can seem radical.

The technology is there, in contraceptives. They don’t only prevent pregnancy. A recent drop in tampon sales has been linked to women using contraceptive methods that stop, or lighten their periods. About a fifth of women using the contraceptive implant no longer bleed (myself included), while many who take contraceptive pills without a break often achieve the same result – and they are not the only methods.

The impact can be life-changing. “I started taking the mini-pill purely for the fact it would stop my periods,” says Jaimi Kendall, 25, from Exeter. “For years, I had extremely heavy periods that would drag on for eight weeks or so and left me severely anaemic to the point where I started experiencing pulsatile tinnitus. Not having periods any more is a blessing.”

She is not alone. Catriona Clarke, 25, from Cambridge, was thrilled when she realised she could stop having periods thanks to her contraceptive pills. “My periods weren’t even that bad,” she says, “just uncomfortable and a mess. And, given how expensive period products can be, an expensive mess.”

Let’s be clear: removing stigma around a normal bodily function should be celebrated. Proposals to end the tampon tax, distribution of free sanitary products, better education for boys as well as girls, and the introduction of menstrual leave are all positive moves towards ensuring women are not held back by their periods. But seeing them as a fundamental part of the body’s rhythm – something to be endured, or even celebrated each month (the author Maisie Hill writes in her book Period Power of embracing their natural high) – is only one side of the story. The other is a tale of pain, bloating, bad skin and mood swings. Many women feel trapped in a cycle that can be unpredictable, inconvenient and unpleasant.

Menstruation is the process by which the body sheds the lining of the uterus and unfertilised egg, triggered by fluctuating levels of the hormones oestrogen and progesterone. Not having periods does not create a “backlog”, nor are they necessary to “cleanse the body”. Menstruation can, however, exacerbate incapacitating physical or mental health problems including endometriosis and depression; it can also be distressing or problematic for people with gender dysphoria. According to a recent survey of 7,500 women by Public Health England, half those aged 16-64 reported menstrual issues in the last year, rising to 75% of those aged 16-24.

Dr Jane Thomas, a consultant gynaecologist at Homerton university hospital in London, says that having so many periods is a modern phenomenon: historically, women would spend much of their time pregnant or breastfeeding (which can delay the return of periods). “It would be a minority of people who had a couple of children only and menstruated all the way through their lives.”

So, if women do not want a period, is there a medical reason that they should? Many may be surprised to learn that the short answer is: no.

While Thomas notes that regular periods are an indicator of good health, Dr Anne Connolly, the clinical lead for Women’s Health for the Royal College of GPs, says there is no health benefit to them: “Ninety-nine per cent of women don’t need to bleed.”

Judith Stephenson, the Margaret Pyke professor of sexual and reproductive health at University College London, says the same. “In some ways, it seems like one of God’s great design faults … It is not helpful to have these periods – in fact, if you don’t have them, one of the biggest benefits would be reducing iron deficiency anaemia.”

The option not to have periods is rooted in hormonal contraceptives, which use synthetic versions of oestrogen and progesterone to interfere with the menstrual cycle. This prevents pregnancy (meaning the decision to stop bleeding is not compatible with trying for a baby), sometimes with other effects – including lightening bleeding or stopping it altogether. Many new forms of contraception – including the contraceptive implant and injection, intrauterine system (the hormonal coil) and the progestogen-only “mini” pill – are designed to be taken continuously, meaning many users can safely go months or years without any bleeding.

The benefits can be myriad, from saving money to mitigating health problems, including polycystic ovary syndrome (PCOS), in which there is a risk of problematic cells building up in the lining of the womb. While regular natural periods prevent this buildup, and thus can be beneficial for the condition, so too are hormonal contraceptives (even if they stop periods), because they keep the lining of the womb thin.

The idea that bleeding is necessary has been fuelled by decades of advice that women on the combined pill should take a break for one week a month. This results in a withdrawal bleed, or “fake” period (which is why the combined pill is often referred to, somewhat misleadingly, as “regulating” periods). Some claim that this was contrived by the pill’s inventors to make it acceptable to the Catholic church; others argue it was chiefly a practice to reassure women that they were not pregnant and to give them a break from the high doses of hormones.

Strips of contraceptive pills
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 Many new forms of contraceptive pill are designed to be taken continuously without any monthly break. Photograph: Getty Images/iStockphoto

Experts say women today take this seven-day break as a hangover from earlier practice, even as the makeup and dose of the combined pill has changed over time. When, in January, the Faculty of Sexual and Reproductive Healthcare (FSRH) updated its guidelines to make it clear there were no health benefits to taking the break, many women felt they had been cheated into having a monthly bleed.

Thomas says doctors have known for years that the combined pill could be taken without a break, but many women I spoke to said that they had no idea until they read of the change in guidelines. For 27-year-old Cinzia DuBois, from Edinburgh, the impact was huge. When she was forced to take a gap in her pill, the week before and after her bleed would often leave her feeling suicidal. “I’ve attempted to kill myself four times, so it’s not a light matter,” she says. “Having to go through this every month was exhausting for both myself and my partner.” Since she stopped taking a break in her pill, “I haven’t had a single suicidal episode and have found my spells of depression much less frequent than they were and not as extreme,” she says.

For the more than 3 million women who take the combined pill in England, the FSRH announcement made no monthly bleed a possibility. But not everyone is comfortable with that idea, or of ditching natural periods. Holly Grigg-Spall, the author of Sweetening the Pill: Or How We Got Hooked On Hormonal Birth Control, says that while she understands why some women might choose not to bleed, there is limited research on the long-term impact of continuously taking the combined pill. Telling women they can stop their periods without giving them all the information could reinforce taboos around bleeding, she says. “It is really just an exaggerated form of saying to women keep your periods quiet, hide them, be secret about them, don’t talk about them, don’t show your tampon when you walk to the bathroom, your boyfriend doesn’t want to know about your periods.”

Some have also raised concerns that bleeding is a sign that a woman has not conceived. But Thomas is clear that the only way to be sure you are not pregnant is a pregnancy test: “You can definitely bleed and be pregnant. So having a period or withdrawal bleed from the pill isn’t a guarantee.” Experts also stress that stopping periods won’t affect future fertility. “When you stop taking the hormones, they get flushed out of your system very quickly, and your periods will return to what they were before you started taking the pill,” says Connolly.

It is, however, easier to reliably stop bleeding with some contraceptives than with others. The majority of women taking methods that contain synthetic versions of both oestrogen and progesterone can achieve that outcome, but it is less predictable for some methods containing synthetic progesterone only. Some women experience bleeding that is regular, irregular or prolonged (albeit often light); it differs between methods. About 20% of women on the contraceptive implant no longer bleed, compared with 68% on the injection at two years of use.

Some women may also prefer not to use hormonal contraceptives, as they can bring unwanted side-effects such as fluctuations in weight and mood. Some methods can also slightly raise the risk of certain cancers, including breast cancer (although they reduce the risk of others, including womb cancer).

Thomas agrees that more research is needed into the long-term effects of taking hormonal contraception. However, she and other experts say there should be greater awareness of the benefits of contraceptives beyond preventing pregnancy, from tackling acne to alleviating premenstrual symptoms.

Stephenson says the option of having periods is naturally addressed in consultations about contraception choices, but should be talked about more widely. “It is absolutely a sensible discussion in its own right,” she says. Earlier this year, she co-launched ContraceptionChoices.org, a website that recommends contraceptive options to women on the basis of what they say matters to them – including whether they want to have periods.

Some do, some don’t, each for a variety of reasons. But perhaps the most empowering approach for all women is simple: to let them choose for themselves. Sophie, 24, from Glasgow, no longer bleeds thanks to the contraceptive implant, and says it has made a huge difference to her mental health – she couldn’t be happier. “Just because something is natural, I don’t think it in any way means we should have to go through it,” she says. “Different things suit different people, and that’s fantastic.”

www.theguardian.com