How often do you want to have your period?
When modern contraceptives first got formulated, back in the 1950’s 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 1950’s 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 decrease their periods, assuming they could do so safely Menstrual symptoms including 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 wages and 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, like these:
- I’ve heard that you can eliminate your period by using Pills, the Shot or a hormonal IUD. How would I decide which one? 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 most 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.
- What’s this about IUD’s decreasing cramps and bleeding? I heard that IUD’s make your period worse! A copper IUD tends to increase bleeding and cramping in the early months of use. By contrast, 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.
- What about an Implant? Does it have the same effect? You can’t count on it. If your priority is to reduce or eliminate menstrual symptoms it would be best to choose a different metho