How often do you want to have your period?
When modern contraceptives first got formulated, back in the 1950s, the men in charge made a simple assumption that would affect millions of women over the next half century: They assumed that women wanted to bleed every month. A woman on the pill does not actually have a monthly cycle. The bleeding during her placebo week is withdrawal, not menstruation. From a medical standpoint, it is optional. Even in the 1950s, doctors knew that. But since they also "knew" women wanted a contraceptive that felt cyclical, they never bothered to ask.
More, recently researchers have asked, and they have found that less than a third of women prefer having a monthly flow. The rest would prefer to ditch or reduce their periods, assuming they could do so safely. In previous decades, it has been reported that menstrual symptoms like nausea, fainting, heavy bleeding, or cramps as intense as early labor cause American women to miss over 100 million hours of work annually. In Italy, such symptoms have been found to account for 15 percent of the gender gap in promotions. In the developing world they are a factor in adolescent girls missing and dropping out of school. Evidence suggests that our hunter-gatherer ancestors ovulated far fewer times, and the modern pattern may have long-term health costs.
Today, a growing number of doctors believe that all of their patients should be presented with the information available and allowed to make their own decisions. Deborah Oyer was medical director at Planned Parenthood of Western Washington and now has an independent family planning practice in Seattle, where she also trains medical students, residents, and other practitioners. Dr. Oyer asks all of her contraception patients, "How often do you want to have your period? Monthly? Every three months? Or not at all?" Until she asks, many women don't know they have a choice, and so she gets lots of questions, questions like these:
All will help to minimize or eliminate your period, so the question really is "Which method are you most comfortable with?" Long-acting methods are more effective for contraception, so I like the IUD, which you can have inserted and then forget about for years. But every woman has to be comfortable with her own method.
A copper IUD tends to increase bleeding and cramping in the early months of use. After an adjustment period, a hormonal IUD decreases bleeding by an average of 90 percent, and in over half of women takes their periods away altogether.
You can't count on it. If your priority is to reduce or eliminate menstrual symptoms it would be best to choose a different method.
You need to listen to your body in other ways. Common signs include nausea, breast tenderness, aversion to smells, bloating, dizziness, and needing to pee. It's a little-known fact that many women get periods in early pregnancy. A period should be reassuring only in the absence of other symptoms.
No. Your body's hormones will return to normal, generally within a month or two, and research shows normal fertility rates after that.
No. Fertility ends when our hormones change, not when we run out of eggs.
That depends on the method. A hormonal IUD doesn't suppress ovulation in most people. Many users can tell you exactly when they would be getting their periods because they have some monthly bloating, moodiness or headaches. Pills, "the ring," and "the shot," on the other hand, keep you from ovulating, so these symptoms occur less.
No. Combination birth control pills can increase the risk of blood clots, and thus are not safe for everyone. However if pills are safe for you, taking pills can decrease your risk of both ovarian and uterine cancer. Other benefits include decreases in anemia, benign breast masses, pelvic inflammatory disease, and acne.
The first few months with a hormonal IUD will be an adjustment period. You may have occasional cramping and some bleeding or spotting between periods. By the six-month mark you should know how your body is doing with it.
Most women using pills or the ring without a break won't get a period from the first pack/ring. However, starting on any hormonal method of contraception can be accompanied by some irregular spotting or bleeding as your uterus adjusts to the new hormone levels.
Unfortunately, no. If your hormones are slightly abnormal, your body can build up a uterine lining but not get the signal to slough it. When you are on hormonal birth control, however, you are not building up the uterine lining. As a result it is not necessary to get rid of it every month.
Long-acting methods have been used in Europe for over 20 years, and they have been researched since the 1960s and 1970s. That said, you need to decide what is right for you -- to gather information, weigh the risks and benefits, talk to your provider, and listen to your body.
Valerie Tarico is a psychologist and freelance writer. Her articles can be found at www.AwayPoint.Wordpress.com. Deborah Oyer is a family planning doctor and the medical director of Aurora Medical Services in Seattle, Washington.
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