Daily, we’re bombarded with messages to control the flow, perfume the evidence, and banish the bloat. But now, with contraception that allows us to go months at time without shedding our lining, women are asking, “Do we really need to bleed?” For some women, periods are positive proof there’s no pregnancy. Others see their monthly bleed as cleansing and a sign that all is well within. But for others, especially mid-life women dealing with sporadic menses, periods are a source of discomfort, and oral contraceptives can provide relief. The withdrawal bleed experienced on the Pill tends to be shorter and lighter, it’s associated with fewer premenstrual symptoms, and it’s more predictable. Extended-use contraceptives restrict the bleeding episodes to just four or fewer each year.


For most women, menstrual bleeding is the natural response of the body in a cyclical fertility dance to shed the lining it prepared for the implantation of a fertilized egg. When the anticipated egg fails to appear, hormonal changes trigger the shedding of the lining. This monthly ballet continues through its final act, with mood swings, irritability, bloating, cramping and diarrhea, culminating in three to four days of bloody show.

Oral contraceptives prevent ovulation (the releasing of an egg from an ovary) and alter hormonal levels in the blood so that the uterus fails to build up a lining. In each pack of oral contraceptives, there are 21 active pills (containing hormones) and seven inactive pills (usually sugar pills). During the seven days a woman spends on inactive pills, her hormone levels drop, and the uterus sheds whatever lining it may have made. This “withdrawal bleed” is not a menstrual period as would occur naturally. When the Pill was developed, scientists believed women taking it would prefer to mimic regular menstrual cycles, as this would also prove that they weren’t pregnant. So the decision to include a hormone-free week of pills was made for reasons irrespective of safety, effectiveness, or overall health concerns.


In 2003 a new regimen emerged that allows women to take the Pill for 12 weeks, go Pill-free for seven days, experience a withdrawal bleed, and then begin again. The pills are marketed as Seasonale—women using it will have four bleeds, one bleed each season. The only side effect seems to be spotting during the first three months of use. Interestingly, what Seasonale introduced to the market was a practice many care providers had been advocating “off-label” (without an official indication for the medicine) simply by advising women to skip the seven sugarpill days and move directly to the next pack of pills. Continuous contraception has also been used by women who suffer menstrual migraines, severe premenstrual syndrome, and women who want to avoid bleeding for an important event such as a wedding or a holiday.

The risks of extended-use contraceptives are the same as with any form of hormonal contraception. Opponents say extended-use contraception hasn’t been proven safe because there have been no long-term studies on its effects. They argue that women on oral contraceptives for extended periods of time are exposed to greater amounts of hormones, and that the effect on breast tissue, bones, and long-term fertility is unknown. On the other hand, oral contraceptives are proven to decrease risks of ovarian and colorectal cancer. And for women who experience distressing pain with their periods, skipping periods can mean avoiding medications for cramps and bloating


Since the jury’s still out on the long-term effects of extended-use oral contraceptives to stop menstrual bleeding, this option may be best for healthy women bothered by regular or heavy bleeding—as long as women know the risks of increased estrogen. Teens considering extended-use contraception should be aware that a long-term return to fertility has not been studied or established. There’s no one right answer for all women. By discussing with your care provider your risks regarding increased amounts of estrogen compared with the symptoms and effects of cycling on your overall health, you can make the decision that’s best for your body.


Non-oral contraceptives affect cyclical bleeding as well. Women who use the injectable contraceptive Depo Provera tend to stop having regular bleeding, usually within about a year of regular use. Women using an intrauterine contraceptive device (IUCD) that contains progesterone (Mirena) also tend to stop bleeding after 12 months of use. The contraceptive implants Norplant or Jadelle can suppress cyclical bleeding. Studies are under way to establish the safety and effectiveness of extended-use contraception for both the contraceptive patch and vaginal ring.


Are You At Risk?

• Do you have high blood pressure or a personal or family history of stroke, blood clots, or liver disease? Oral contraceptives can increase your risks of clots.


• Have you or anyone in your family been diagnosed with breast or uterine cancer? It’s unclear how oral contraceptives may increase cancer risks in susceptible women.


• Are you age 35 or older, and do you smoke? Smoking increases the risks associated with the pill.