"What do you mean, how often do I want to have my period? Are you saying I have a choice?!"
We women hear a lot about side effects of birth control, but we don't hear as much about the side benefits. If you haven't had a conversation with your doctor lately about family planning, you may be in for some surprises, like the fact that lighter, less frequent periods may be healthier for you.
Modern birth control methods are not only safer and more effective than ever before, they offer an array of bonus health benefits. Of course the biggest health gains of contraception come from being able to avoid ill-timed or unwanted pregnancies along with related wear and tear. But depending on which method you choose, your birth control can help you to avoid a number of other problems as well, from pimples and miserable monthlies to cancer.
- Acne -- Physically, acne is just a nuisance. But for many young women, chronic speckles or monthly hormone-related outbreaks take a toll on self-esteem, and the scars -- both physical and psychological -- can persist. All birth control methods that contain estrogen can help to clear or prevent acne. That includes combined oral contraceptives (most pills) and the ring. In fact, some birth control pill brands have even sought and received FDA approval for this purpose.
- Painful periods -- Monthly aches and cramps are common among teens but can affect women of all ages. For an unfortunate few, cramps are as intense as early labor and may even trigger vomiting or fainting. Needless to say, painful periods can make it hard to do everyday activities and tasks! Eight to 12 percent of young women say they miss some work or school every month because of period symptoms. Birth control options that reduce cramps and related misery include hormonal IUDs (Mirena and Skyla), the implant (Nexplanon), the shot (Depo-Provera), the pill or the ring (NuvaRing).
- Heavy monthly bleeding -- Heavy bleeding, which can cause anemia and fatigue, affects about one in three women. In one study, missed work meant that women with heavy menstrual bleeding earned almost $1,700 less each year than women with normal periods! Excessive bleeding can be a sign of other health problems, but about half the time there's no clear cause. The top treatment for heavy bleeding is a hormonal IUD, which over time can reduce blood loss by an average of 90 percent. Other options include the implant or shot. A woman using the pill or ring can either regulate her monthly period or choose to bleed less frequently if she prefers.
- Premenstrual Syndrome -- PMS symptoms vary widely. They include headaches, fatigue, cravings, bloating, tender breasts, irritability and mood swings. Because PMS is caused by estrogen cycling, improvements in physical symptoms are likely to come from birth control methods that suppress ovulation. Mood cycles are harder to treat. Some women with PMS appear to respond positively to hormonal IUDs, newer pill formulations such as Yaz or Beyaz, or pills that skip the placebo week.
- Endometriosis -- Normal endometrial cells line the uterus, where they grow and then slough off each month if no pregnancy starts. But in 4-10 percent of women these cells grow in other parts of the abdomen as well, where they also bleed monthly, sometimes causing intense pressure and pain. Endometriosis is associated with infertility, painful sex, and aching of the lower back and legs. It can't be cured, but it can be managed to reduce pain and protect fertility. Birth control that eliminates menstruation can slow the growth of endometrial cells and reduce symptoms, delaying or preventing the need for surgery and possibly preserving a woman's ability to get pregnant. Hormonal IUDs, the shot and the pill or ring, when used without a break, all are options.
- Pelvic Inflammatory Disease -- When common sexually-transmitted infections like chlamydia travel up into the uterus and fallopian tubes, they can become PID, a common cause of infertility. Back in the 1970s, a defective IUD created a pathway for such pathogens to enter the uterus. Today's state-of-the-art hormonal IUDs such as Mirena and Skyla have the opposite effect. They prevent pregnancy by thickening the mucus at the cervix, creating a natural barrier that also protects against uterine infections. Women who use the pill for 12 months or longer appear also to have a lower rate of PID during the time they stay on the pill.
- Fibroids -- About one-fifth of women over the age of 30 have benign uterine tumors known as fibroids. Most fibroids never get noticed, but some cause symptoms like pain, pressure, constipation, or abnormal bleeding or -- for those who are trying to get pregnant -- repeated miscarriage. Hormonal IUDs and the shot both can help reduce abnormal bleeding caused by fibroids and may shrink the tumors themselves. Alternately, the pill or ring may be prescribed to reduce bleeding.
- Ovarian Cancer -- Ovarian cancer is the most lethal of all cancers associated with the female reproductive tract. Researchers now believe that many ovarian cancers start in the fallopian tubes, which means that when the fallopian tubes are removed during a sterilization procedure, the source of these cancers is gone. The good news for women who haven't finished childbearing is that several reversible contraceptives also protect against these cancers. (Even pills that may slightly increase the risk of breast cancers can help reduce the risk of metastatic cancer overall.) Taking the pill can reduce ovarian cancer by 40-80 percent, and the effect persists for more than 20 years afterwards.
- Endometrial Cancer -- In a healthy woman, the uterine lining thickens and then thins each month unless she gets pregnant, but sometimes this cycle breaks down, creating a condition called hyperplasia, in which the cells build up. This can be a sign of high risk or the presence of endometrial cancer. By thinning the lining, hormonal IUDs can help reverse hyperplasia and prevent endometrial cancer, which is also reduced for women using the shot or pill.
- Cervical Cancer -- Cervical cancer is now thought of as an infectious disease caused by the human papilloma virus (HPV). Now that the cause is known, preteens -- both girls and boys -- are being vaccinated, and better condoms for women and men are in the works. A generation from now such cancers may be almost unheard of. In the meantime, both hormonal IUDs and hormone-free copper IUDs appear to help reduce these cancers by close to 50 percent.
No one birth control method fits for everyone, but with known exceptions the health benefits of modern contraceptives vastly outweigh the risks. Of American women who take birth control pills, almost three quarters use them, at least in part, for reasons other than family planning. Hormonal IUDs get rave reviews from some young women not just because they are highly reliable "set and forget" contraceptives, but because lighter, less frequent periods make it easier to exercise consistently or to excel in other parts of life, like parenting, military duty, work, and sports.
Gone are the days when family planning meant crossed fingers and carefully washed reusable condoms, or metal pessaries or worse. Even today, researchers are busy exploring next generation contraceptives, and better options are in the pipeline. But modern women have choices beyond the wildest dreams of our mothers and grandmothers.
Co-authored by Robert Hatcher, M.D.
Dr. Hatcher is professor emeritus of obstetrics and gynecology at the Emory University School of MEdicine and serves as lead author for contraceptive technology, now in its 20th edition. He answers questions about contraceptives at www.managingcontraception.com.
This article is adapted from a presentation by Dr. Robert Hatcher, "So Much More," made available by Contemporary Forums medical continuing education as a part of the bi-annual Contraceptive Technology conference.