What Do Birth Control Experts Say

A conversation with Patricia J. Sulak, MD, Professor of Obstetrics and Gynecology, Scott & White Clinic, Temple, Texas. Read Dr. Sulak’s bio.

What is a Pill period?
Is not having a period every month safe?
Isn’t it unnatural to not have a monthly period?
Why do most hormonal contraceptives have a monthly regimen?
When is a monthly period necessary?
What are the risks associated with using hormonal birth control?
What are common side effects of hormonal contraceptives?
Are there additional health risks associated with having fewer periods?
What will my period be like if I have fewer periods?
If I have fewer periods, how will I know if I become pregnant?
Will having fewer periods affect my ability to get pregnant in the future?
Is the option of having fewer periods something new?
Why is birth control changing to offer fewer periods?
How do I know if fewer periods are for me?
How do I talk to my healthcare professional about having fewer periods?
Any final words?

1: What is a Pill period?
It’s important to understand the difference between a Pill period and a spontaneous period when you’re not on hormonal contraception. Women not on hormonal contraception are having periods because they ovulate every month. If you’re not on the Pill or any other manner of hormonal contraception and you’re having a period every month on your own, you’re having those periods because you’re ovulating every month. In other words, you’re releasing an egg. During that natural cycle the hormone levels do go up, and what they’re doing is preparing the inside lining of the uterus for pregnancy. And then when you don’t get pregnant that month, you shed the lining and it repeats the process over and over and over again. So when you’re having a period every month on your own, your body, every month, is getting ready for pregnancy.

When you’re on birth control pills, they inhibit ovulation, so you don’t have the rise in hormones. When you’re on the Pill, you have 3 weeks of constant hormones, and then when you start your placebo pills, you have this withdrawal bleed, or what we call the Pill period. So when you’re on birth control pills, you’re not ovulating. That’s the big difference between a Pill period and a natural period.

2: Is not having a period every month safe?
Women may wonder, is it safe not to have a period every month? And the answer is yes, if you’re on hormonal contraception. If you’re on hormonal contraception, you’re not ovulating every month, so having a monthly period is not necessary. Many studies have been done where women do reduce the number of periods per year by taking their pills 12 weeks in a row and then having a period. And studies have shown that this is just as safe as taking the pill in the standard way. We can now safely reduce the number of periods per year, and often by doing so reduce many of the monthly problems women experience.

3: Isn’t it unnatural to not have a monthly period?
Having a period every month is natural. What’s not natural are the number of periods we’re having now. Today, women have many, many more periods than their mothers or grandmothers. Years ago women stayed home, they didn’t work outside the home, they had more children, they got married earlier, and look at the number of children they had: sometimes 5, 6, 7 kids. They breast fed. They might go a long time without having a period. They might have a few periods and then get pregnant again. Now compare that to today’s modern woman. We’re having fewer children, we’re having children later, and we’re not breastfeeding. In fact, think about it. The average age of starting to have periods today is about 12. And let’s say a woman doesn’t have her first child until age 27. Well that’s 15 years of periods, you know, month after month after year after year after year. Our bodies really weren’t designed to have all of these periods. Today we’re having hundreds of periods in our lifetime, whereas a century ago we were only having a few periods. One might say that that’s not natural; that’s not what we were designed to do.

4: Why do most hormonal contraceptives have a monthly regimen?
When the Pill was introduced more than 40 years ago, it was designed to mimic the natural menstrual cycle. The Pill was new. Women wanted to know, is it safe? Is it natural? By creating a period every month, women felt comfortable using the Pill. This was an arbitrary decision to make it socially acceptable, but it was not medically necessary. In fact, from the beginning when the Pill was approved 40 years ago, instead of having 3 weeks of real pills in it, they could have had 5 weeks, 7 weeks, 10 weeks, 12 weeks. But they put 3 weeks in it to create this Pill period to make it socially acceptable because it was new. And now we know that’s just not necessary.

5: When is a monthly period necessary?
Monthly periods are necessary in reproductive aged women, say between the ages of 15 and 45, if they’re not on a hormonal contraceptive method, if they’re not pregnant or breastfeeding. Because in those situations, you’re not ovulating. And if you’re not ovulating then you’re not expected to have a period every month. Otherwise, you should. So women who are not on a hormonal method of contraception, who aren’t having periods every month, might want to see their healthcare professional to see if something is wrong, if there’s a medical disorder.

6: What are the risks associated with using hormonal birth control?
Today’s hormonal birth control products, whether taken in a standard monthly fashion or in a fashion where you decrease the number of periods per year, have serious risks, which can be life threatening. They include blood clots, stroke, and heart attack. Smoking increases these risks, especially if you are over 35. So if you’re over 35 years of age and smoking and on hormonal birth control, you should quit smoking or use some other method of contraception.

Some women should not take hormonal birth control, including women who have blood clots, certain cancers, a history of heart attack or stroke, as well as those who could be pregnant.

7: What are common side effects of hormonal contraceptives?
When many women begin the Pill, they can experience some nuisance side effects, such as breast tenderness, bloating, swelling, sometimes a little nausea and some irregular bleeding. In the majority of these women the side effects go away in the first few cycles. If the problems persist, then you definitely need to see your healthcare professional.

8: Are there additional health risks associated with having fewer periods?
Are there health risks from reducing the number of periods per year? The answer is no. There is no known increased risk associated with reducing the number of periods per year with a hormonal contraceptive. Studies have compared women who take the Pill in the standard fashion where they have a period every month and those who take it reducing the number of periods per year, and there are no increased risks.

9: What will my period be like if I have fewer periods?
Many women are concerned if they do reduce the number of periods per year that when they finally do have a period, it’s going to be extremely heavy. And the fact is, the bleeding is no heavier than if they were taking the Pill in the standard monthly fashion.

10: If I have fewer periods, how will I know if I become pregnant?
Some patients ask how do I know if I’m not pregnant if I’m not having a period every month? Well, first of all, if you’re taking the Pill correctly and not skipping any pills, the odds of pregnancy are very unlikely. If women take their pills correctly, not missing any pills, not taking them late, they are very effective, and pregnancy is rare. Most pregnancies occur on the Pill because women are missing their pills, or they’re not starting the next pack on time. There are other signs of pregnancy also besides missing a period: morning nausea and breast tenderness are common signs.

11: Will having fewer periods affect my ability to get pregnant in the future?
Many of my patients ask me if reducing the number of periods per year will affect future fertility. And the answer’s no; it will not negatively affect their future fertility. Whether you’re taking the Pill in the standard monthly fashion or you’re reducing the number of periods per year, once you stop the Pill you go back to your normal cycle. So it does not harm future fertility.

12: Is the option of having fewer periods something new?
The concept of reducing the number of periods per year is not new. We’ve been doing this for many years in medicine: reducing the number of periods in women who have particular disorders with their periods, such as severe cramps and women who want to eliminate their period during a special occasion, such as a honeymoon, a vacation, or test week. In fact, many female healthcare professionals have been eliminating periods now for a long time, and we feel very comfortable with this.

13: Why is birth control changing to offer fewer periods?
The concept of having fewer periods is the wave of the future. Pills today, which induce a monthly period, will be a thing of the past. More women are understanding that they don’t need to have a period every month as long as they’re on hormonal contraceptives, and that they can reduce the number of periods per year. We’re evolving the Pill to really create a more natural state. We weren’t meant to be having years and years and years of periods, whether they’re spontaneous periods or fake Pill periods. So now the Pill is evolving to reduce a lot of these periods and create what I would think is a more natural state.

The Pill is really no different than any other medicine that we have. They're designed originally, but then over time they change to meet the needs of whatever condition you’re looking at. In the case of the Pill, they’re being redesigned really to meet the needs of women.

14: How do I know if fewer periods are for me?
Any woman who’s a candidate for hormonal contraceptives, such as the Pill, is a candidate for reducing the number of periods per year. Women who have problems with their periods, such as cramps and headaches, or PMS, may have added benefits, but a lot of women just have the benefit, the convenience, of not having a period every month.

15: How do I talk to my healthcare professional about having fewer periods?
Any woman who’s interested in reducing the number of periods per year should talk to her healthcare professional. There are products that are approved by the FDA for reducing the number of periods per year.

16: Any final words?
It’s really important that women understand that they can safely reduce the number of periods that they have per year. For many women this can be an incredible benefit. Reducing the number of periods per year is safe, and it’s going to be mainstream. Having a period every month is something that is new to modern women. It’s not something that our mothers or grandmothers experienced because they had more children and breastfed longer. Today women are having more periods and because of that they’re having a lot of menstrual problems. As a gynecologist I see women every day who are suffering from monthly periods, and it’s really interfering with their lives. Monthly periods are out the door.

Duramed is a subsidiary of Barr Pharmaceuticals, Inc.

This site is intended for residents of the United States only.