Women on the pill don't need a period, say U.K. guidelines.

February 3, 2019 4:04 PM

There's No Medical Reason to Get Your Period While on the Pill - "If you take the pill but don't want to get your period, you can safely forgo that pesky week of placebos, according to new guidelines in the U.K. ... no need to fear: Just as with other hormonal birth control methods that lighten or skip periods, the report specifies that 'there is no build-up of menstrual blood' when you take the pill without breaks."

also btw...
You Had Me at Hello - "Comedian Jillian Welsh tells Diane Wu about one of the most romantic—and stressful—nights of her life, a night that paralleled the plot of a rom-com in several ways."

posted by kliuless (43 comments total)

I've known this was possible for years, but I think I'd be worried about losing my "early warning system" for an accidental pregnancy -- and possibly for other medical issues.
posted by orange swan at 4:13 PM on February 3, 2019 [8 favorites]

I thought this was common knowledge. For me my system doesn’t enjoy it and also my insurance wouldnt let me get my refill a week early.

Glad it’s getting into the official guidance now so maybe that can change.
posted by bleep at 4:20 PM on February 3, 2019 [3 favorites]

On the other hand, I was on the Pill for years anyway for hormonal reasons that had nothing to with pregnancy--in fact, being as I was in a long-distance relationship with another asexual person incapable of impregnating me even if we'd wanted to the last time I was on it...

Well, a pregnancy warning system is fundamentally a non-medical reason to want to choose whether or not any individual woman has a period or not on the Pill. I would have chosen differently. I would have liked it if I had been given much of an option to choose what I wanted to do with my body at the time.
posted by sciatrix at 4:22 PM on February 3, 2019 [10 favorites]

I’ve been doing this for years. It’s the best thing ever. But it was really annoying to figure out the correct way for the doctor to write the prescription in order for my insurance to cover it. I think it took her four tries of wording the instructions differently before my insurance said ok.
posted by ilovewinter at 4:29 PM on February 3, 2019 [14 favorites]

Well, that only took 60 years.
posted by eotvos at 4:33 PM on February 3, 2019 [53 favorites]

I've done this for years, with Nuvaring. I cannot imagine going back. It's one of the best things that ever happened to me.
posted by unknowncommand at 4:52 PM on February 3, 2019 [3 favorites]

I'm pretty sure I heard this news like, what, 15-20 years ago?

Also, Depo-Provera also makes your periods go away, so if you don't have drug/hormone issues with that, that works for the same purpose too.
posted by jenfullmoon at 5:07 PM on February 3, 2019 [3 favorites]

I read somewhere that placebo week was put into the pill originally to please the pope. I don't know if that's true, but hey, I'd believe it...
posted by HypotheticalWoman at 5:08 PM on February 3, 2019 [5 favorites]

Oh gosh, ilovewinter, my doctor had to fight with my insurance (in the U.S.) to get me 13 packs of 4-week pills in a year because there's only 12 months, you know. and while she was trying to work it out, I also called because I was incredulous and first three agents I talked to--all men--could not even understand that there was a problem. The first woman I talked to knew before I finished explaining what the problem was. (but by then my doctor's office had straightened things out).

Anyway. It would really really really be nice to see U.S. insurance companies step up for this but I ain't holding my breath.
posted by crush at 5:17 PM on February 3, 2019 [26 favorites]

The first woman I talked to knew before I finished explaining what the problem was.

Sadly, the first 2 women I talked to at my insurance ALSO had no idea. I’m like, “you know how the last week of your pills are just sugar, right? Not real bc in them so you actually get your period that week?” Stunned silence. Took me screaming at my workplace HR until they got involved and just told my insurance to cover it anyway and bill them or whatever.
posted by greermahoney at 5:25 PM on February 3, 2019 [10 favorites]

Depo-Provera also makes your periods go away, so if you don't have drug/hormone issues with that, that works for the same purpose too.

Depo-Provera also may give you osteoporosis so choose carefully. It I can do significant, irreversible damage, in as little as two years.
posted by greermahoney at 5:31 PM on February 3, 2019 [10 favorites]

I read somewhere that placebo week was put into the pill originally to please the pope. I don't know if that's true, but hey, I'd believe it...

This is absolutely true. It almost worked too, 64 of the 69 members of the pontifical commission on birth control agreed it should be allowed until Paul VI overruled them.
posted by Proofs and Refutations at 5:36 PM on February 3, 2019 [10 favorites]

This was known back in the 1970s. Insurance wasn't involved because we didn't have any, but the Pill was only $1.75 a month. But the doc wouldn't refill your prescription early if you went through too many packs. The trick was used to make sure you weren't having your period on your honeymoon.
posted by Miss Cellania at 5:39 PM on February 3, 2019 [9 favorites]

Oh no, the thing the men were missing was not that the week was sugar pills. They could not grasp that you'd need more than one pack each calendar month--you know, that you need 13 packs in a calendar year, not twelve. They thought one pack in January, February, March et cetera would cover you. Could not grasp that you need one, you know, one every 28 days. So they were not even authorizing me to have 13 4-week/28-day packs in a year. I should only need one pack in a calendar month. It was enraging.

I have not even bothered to try to skip the placebo week cause I don't have periods on hormonal birth control whether I skip them or not.
posted by crush at 5:53 PM on February 3, 2019 [23 favorites]

I literally only take birth control to suppress my periods. Barring sexual assault there's 0 chance of me getting pregnant, and I don't have a hormonal issue or anything like that. My periods are just a week long and cause huge chronic illness flare-ups so a few years ago I said fuck it, never again. I love it when the doctors ask me when my last period was.

Shockingly, I've never had any issues refilling my 3-month birth control early--even when I have a week of regular pills left + the week of placebo. If I had to fight over that I might consider switching to one that's actually continuous with no placebos, but as it is it's not worth the risk of different side effects.
posted by brook horse at 5:53 PM on February 3, 2019 [8 favorites]

It was not so much to try to please the pope as to shoehorn it into the existing framework the church had.
posted by Candleman at 6:00 PM on February 3, 2019 [3 favorites]

No Shit from the land of Sherlock!
posted by The Underpants Monster at 6:02 PM on February 3, 2019 [2 favorites]

Yeah, when doctors ask for the date of my last period, I like to say, "Oh, I don't do that," as though it's just a boring decision that people can make, which it fucking should be.
posted by unknowncommand at 6:05 PM on February 3, 2019 [72 favorites]

I've done this since several years now. My insurance and pharmacy providers have been fine with it (BCBS, express scripts).

Losing the 'not pregnant' signal is a bit scary, especially with abortion restrictions getting worse by the month. Losing the PMS is worth it.
posted by Dashy at 6:12 PM on February 3, 2019 [4 favorites]

especially with abortion restrictions getting worse by the month.

Yeah, if I had the option* I'd probably pick no periods, but it'd be a bit scary.

* This never seemed to work very well for me. I'd usually wind up putting off bleeding for a few days only to have "breakthrough" bleeding for the entirety of the following month. And I'd feel a bit off in general. But that just seems to be how my body rolls; without hormonal BC I tend to have really short cycles. On the pill I'd still get a lot of "spotting" sometimes pretty much all the time. I frequently hate my whole reproductive system.
posted by ghost phoneme at 6:31 PM on February 3, 2019 [6 favorites]

Why don't doctors suggest this option to every girl or woman who has low iron or difficult periods? This degree of negligence seems on the level of criminality. I know hormone pills can have terrible side effects, but if i was a general practitioner OR gyno i would ask each female patient who wasn't trying to get pregnant if they had any problems whatsoever with their periods, and I would let them know that this life changing option is available if they ever do. I personally never knew that birth control pills lightened your periods til my 40's. I just thought my friends had naturally light periods. WTF.
posted by serena15221 at 6:43 PM on February 3, 2019 [29 favorites]

One thing that may make the difference between success and intolerability is the type of birth control pill taken. Monophasic pills have a steady dose of both hormones while biphasic or triphasic pills vary in a way that’s meant to mimic the homonal cycle. In theory, monophasic pills should be more compatable with avoiding menstruation. I’ll also point out that some women will still have slow growth of the endometrium and will develop irregular bleeding after a time without menses. This can happen with continuous pill usage or with Depo-Provera. In both cases, withdrawal of progesterone (delaying a Depo shot or pausing pills) should allow shedding of the endometrium and then restarting medication.
posted by Emmy Noether at 6:51 PM on February 3, 2019 [11 favorites]

Why don't doctors do ALOT OF THINGS is my constant question.
posted by bleep at 6:51 PM on February 3, 2019 [28 favorites]

I've done this for more than a decade and it is among the best things I have ever done for myself. I end up taking the placebos one or two weeks a year, after I've had enough breakthrough bleeding that it's annoying, but that's it. However, continuous BC was only prescribed to me because I had a history of ovarian cysts -- I don't think anyone would've even mentioned the possibility otherwise, which is wild considering how debilitating my periods were. (But you know -- that's just "normal" pain that women are born to put up with, right?)
posted by goodbyewaffles at 6:53 PM on February 3, 2019 [11 favorites]

Oh wow, I never considered it could help with low iron, that’s clever! BCP has been suggested to me for painful periods, but I had to say no (stroke risk, but also I didn’t enjoy crying so often). Wish I could use it for the low iron, though!
posted by cotton dress sock at 7:47 PM on February 3, 2019

The Guardian disputes the Pope thing.

There's also this Twitter thread on the topic.

The majority of the media reporting seems to go along with the story that it's to please the pope though.
posted by edd at 10:08 PM on February 3, 2019 [4 favorites]

My last psychiatrist, a man, asked me how heavy my periods are, immediately after I had told him that I'd had a hysterectomy 6 months ago. I said "after the hysterectomy, they are very light." (This douchebag also asked me how big my breasts were, so there's that as well).
posted by b33j at 11:51 PM on February 3, 2019 [11 favorites]

I went to a talk by a doctor who founded a boutique primary care start-up (I know, I know) and heard that "withdrawal bleeds" from the placebo week on hormonal birth control aren't really periods (as in, don't tell you anything about your cycle, or how your fertility is doing).

I'm fuzzy on the context so I'm hoping that someone who knows what they're talking about can fill in this tidbit (or debunk it) ¯\_(ツ)_/¯
posted by batter_my_heart at 12:40 AM on February 4, 2019

Well when you're on hormonal bc, you don't ovulate, so you are chemically infertile. The period happens when the hormones (estrogen, progesterone) stop, and you get a withdrawal bleed. But every non-bc mediated period is a withdrawal bleed too, just from endogenous non pill hormones, so I have no clue what that doctor was trying to say.
posted by basalganglia at 12:52 AM on February 4, 2019 [4 favorites]

For example, you can continue to contrive a withdrawal bleed with the pill for many years after that uterus would otherwise have stopped doing anything due to menopause. I would not trust a withdrawal bleed on the pill as proof of lack of pregnancy - there's too many variables. you can get a massive pack of pregnancy test strips for a couple of bucks and take one every month instead. In taking the pill with a withdrawal bleed for the "insurance" of a pregnancy test of sorts you're making it more likely you will actually fall pregnant.

FWIW, I tell everyone I prescribe the pill to to skip their periods. Not everyone takes the option.
posted by chiquitita at 1:46 AM on February 4, 2019 [8 favorites]

Pincus & Rock did their first tests of hormonal contraceptives on women attending a fertility clinic - not least because contraceptive research was illegal in the state where they were working. For these women the 'false alarm' of the loss of menstruation was a significant issue.

They were also deeply concerned about the 'acceptability' of their discovery to the pharmaceutical companies, upon whom they partially relied for funding and supplies, and they believed that the non-menstruating woman would be seen as 'unnatural' and that the pharma board would be anxious about marketing such a drug.

'Pleasing the Pope' is useful shorthand, but true in the more metaphorical sense where 'the pope' is patriarchal expectations about what women's bodies are for.

It is, however, true that early iterations of the Pill were very complicated and often involved breaks as part of what was essentially a massive doseage experiment.
posted by AFII at 2:12 AM on February 4, 2019 [6 favorites]

Last time I was researching birth control options there was a lot of info/narrative along the lines of "well of course you still want a period while you're taking the pill, to reassure yourself that your reproductive system is working as intended".

Nope, categorically don't care if the damn thing works or not. I'm consistently weirded out by the idea that I have this mammalian reproductive cavern inside me, have zero intention of using it and would prefer to forget it exists for the rest of my life. Fuck the assumption that birth control is just for now, until I inevitably choose to make use of all of those tubes and holes like a good compliant reproductive unit. I would burn my own womb to the ground if it weren't too damp up there.
posted by terretu at 2:18 AM on February 4, 2019 [19 favorites]

Excellent! I always did this on the contraceptive pill, after realising that a) it stopped the bleeding and b) nobody could give me a good reason why that was a bad thing. The brand I used didn’t have placebo pills so it was just 7 pill-free days, which sounds like a nice break from the constant stress of “oh shit did I remember my pill this morning?” but in fact just made that even more stressful.

I still gave up on the pill, though. No bad reactions to the hormones, I just got sick of it, along with every other form of contraception.

Pill - had to remember to take it daily, too stressful, also couldn’t go back to it now because I get migraines now so it raises the stroke risk.

Condoms - failure rate too high.

Depo-provera - mostly great, very reliable, but meant injections every 3 months plus you can’t take it long-term because of the osteoporosis risk.

FAM - fine... as long as I’ve got the time and effort to take reliable readings of all available datapoints every day, and get a regular amount of unbroken sleep. Nope.

Nexplanon - ended up with this by default and it’s mostly great. Lasts 3 years, no room for user failure outside that, very very effective, only a minor procedure with scalpels and needles to get it inserted/removed/replaced, zero bleeding. Oh, but after two years I started bleeding again, randomly and unpredictably. Know what they suggest you do to fix that? Take the sodding Pill again.

I live in hope of a long-term, reversible, effective male contraceptive method. Maybe in like 300 years or something.
posted by Catseye at 3:02 AM on February 4, 2019 [3 favorites]

Not having one can mask other medical conditions. I didn't have one for years with a certain BCP, then got new insurance and a new doctor who thought that was weird (old doctor shrugged at it), did a simple blood test and...I had something else that was causing no periods. I'd love not to have them, but they do function as a health indicator sometimes.
posted by agregoli at 5:13 AM on February 4, 2019 [1 favorite]

Not having periods was one of the greatest things about Mirena, which worked well for me for years.
In the second year of using it, I went on a motorcycle trip across Africa. Having periods during that trip would have been unpleasant and a hassle. It was wonderful not to have to worry about it at all.
posted by Too-Ticky at 5:35 AM on February 4, 2019 [2 favorites]

Oh, but after two years I started bleeding again,

Getting my Nexplanon swapped out for a fresh one a couple months early solved that for me. Next time I'm scheduling replacement the minute I feel the least bit menstrual.
posted by asperity at 5:38 AM on February 4, 2019 [1 favorite]

I live in hope of a long-term, reversible, effective male contraceptive method. Maybe in like 300 years or something.

Vasalgel has been just around the corner for something like 10 years now. The technology is apparently solid, but approval is slow.
posted by jackbishop at 6:41 AM on February 4, 2019 [2 favorites]

I'm on the pills where you can skip months of periods and I've been on it since 2010 at least. My OBGYN put me on the exact pill she was using and I have not looked back since. I usually have breakthrough bleeding at around the 3 month mark, so that's been my cycle.

I'd been going to male GYNs for years because I could get an appointment sooner and I didn't think I had anything beyond the most basic needs. I switched practices after some bad medical advice and lucked into a practice where all of the doctors were women and around my age. It was really nice to get a birth control recommendation based on direct experience.
posted by Alison at 7:14 AM on February 4, 2019 [3 favorites]

I think it’s wonderful and meaningful that this has been stated officially, instead of everyone having to just use stuff slightly off-label. Personally I sometimes have trouble “breaking rules” so if you give me a pack of pills with a week off built in, I’m probably going to take the week off and curse The Man. (At least, that’s what I used to do; now I have an IUD that works great for me.)
posted by Secretariat at 8:34 AM on February 4, 2019 [5 favorites]

One thing you should know before going this route is whether or not you have hemochromatosis, which is a build up of iron in the blood. For most of my mom's adult life, she was asymptomatic because menstruation hides it. Post menopause, this was no longer the case and it ended up contributing to her death.
posted by plinth at 1:45 PM on February 4, 2019

Am I the only woman in the world who'll miss her period when she's menopausal? Hard to explain really. Perhaps since the pill tends to "moderate" the hormonal rollercoaster somehow, it's this cyclical reminder of, like, being a sexual animal or something. It feels very...Pachamama... or something. Not to be terribly woo about it.

I also don't take the sugar pill, just skip them altogether and restart new package one week later. My partner is great at reminding me if I forget (I hardly ever do).
posted by ipsative at 8:18 AM on February 5, 2019

Possibly. In the best case scenario, I hate uncontrollably leaking blood that I have to hyper vigilantly tend to lest anyone become aware I am uncontrollably leaking blood.
posted by Secretariat at 9:07 AM on February 5, 2019 [3 favorites]

also btw: "Didn't realise the 'women's menstrual cycles sync up' thing had been overturned, let alone overturned for such an interesting reason"
posted by kliuless at 3:45 AM on February 7, 2019 [1 favorite]