Period-free for life?

February 27, 2008 2:02 PM

I'd like to suppress my menstrual period for the next twenty years. Is this a good idea?

I have not had a menstrual period in two years. At first I was pregnant, then I had a Mirena IUD inserted postpartum. I stopped nursing almost 10 months ago, so I'm pretty sure that my period is not coming back until I have the Mirena removed. Hooray!

My current thinking is that I'll just replace the Mirena every 5 years, thus suppressing my period for the next twenty years or so. Is this a good idea? I can't find any good research on this topic. Is somebody even studying this? Can I get myself on some list that will email me if it turns out that long-term period suppression is a really bad idea?

posted by crazycanuck to health (37 comments total)

No, it's not a great idea :(

Even when you take birth control without the placebos to stop your periods for months at a time, most healthcare practitioners will instruct you to have a period every 3, 4 or 6 months, depending on their interpretation of best practice.
posted by DarlingBri at 2:30 PM on February 27

I read an article a while ago from Fark that said researchers were theorizing that women, although biologically capable, are not designed to have their period every month. Their reasoning was that until man's recent history, women were generally pregnant for more time than they were not and that the recent rise in disease etc in women may be linked to it somehow. That being said, there was a whole bunch of more research that they said they needed to do so I don't know how good of a theory it was.

ps: I am in no way a doctor or even close to one. I know first aid read a lot, thats about it.
posted by ChazB at 2:33 PM on February 27

Even when you take birth control without the placebos to stop your periods for months at a time, most healthcare practitioners will instruct you to have a period every 3, 4 or 6 months, depending on their interpretation of best practice.

I was going to add something to this effect, but I couldn't remember what the recommended time frame was.
posted by ChazB at 2:35 PM on February 27

Healthcare practitioners advise having a period once in a while because (1) When the uterine lining builds up it's going to come out, even if you continue taking the pills and (2) nobody is quite sure of the long-term effects of not having a period. Of course, the periods you get on birth control are really just the absence of birth control, not a real period--you just go off hormones to allow the lining to drop out.

My guess is that at some point in the next twenty years--probably in the next couple of months--you are going to get some crazy, random spotting. Right now, your uterine lining is building up, and up, and up, and hasn't gotten the hormonal signal to release. It will reach a point where there will be enough of it that it will shed whether or not it gets that hormonal signal. Then the cycle will begin again. So this "not having a period" thing is not going to be for the duration of your Mirena.

Anyway, the point of the Mirena is that it gets left in. That's FDA-approved, right there. If you don't get a regular period as a side-effect, bonus! What are you going to do otherwise--get it taken out every four months so you can bleed and get a new one put in? That's not how the thing works at all.
posted by schroedinger at 2:38 PM on February 27 [1 favorite]

IANAD, but trying to circumvent eons of evolution just seems like a not-so-great idea to me.

Aren't we doing this already by using the pill to begin with, by taking Seasonale, or by using Mirena? Further research needs to be done on this matter, but I'm having trouble seeing how the OP's idea manipulates the menstrual cycle a whole lot more than is already occuring with available birth control.
posted by almostmanda at 2:50 PM on February 27

My OB advised me that if I had my Mirena inserted before my first postpartum period, then it would be unlikely that the period would come back. Googling tells me that 20% of women using Mirena stop having periods after a year with the IUD. It's been a little over a year since I had it inserted now. I don't think that spotting will be an issue. The Mirena is designed to be left in for 5 years at a time and neither I (nor my insurance company) would be pleased with yanking it 4 times a year. Suppressing periods using birth control pill and a hormonal IUD is not the same thing, I'm interested in the latter approach.
posted by crazycanuck at 2:50 PM on February 27

I was on depoprovera for 3 years and didn't have a period for that whole time. I did a lot of reading on it and it is my understanding that it is not mandatory for women to have periods, bypassing them is not dangerous to a woman's body. However, I found out that there are other things about depo that are dangerous so I went off of it.

Let me just say that those were three wonderful, wonderful years and if I could spend the rest of my life without periods I totally would in a HEARTBEAT. So if this is a healthy thing that has the side effect of no monthly visitor (as my grandma called it), I say go for it, sister friend. But as usual, IANAD so take that for what it's worth.
posted by miss lynnster at 2:51 PM on February 27

Most of the research/writing about it is based on constant hormonal contraceptive (pill) use rather than Mirena use, but googling "menstrual suppression" will give you a bunch of related information. You can use that as a reference regarding whether it's unhealthy to allow uterine lining to grow uninterruptedly for years.

One difference to consider, though, is that Mirena contains only progestagen (levonorgestrel) where the pills people use for menstrual suppression are usually combination pills (progestagen + estrogen), so presumably any hazards related to estrogen use (like increased risk of Deep Vein Thrombosis) are null.
posted by needs more cowbell at 2:53 PM on February 27

It seems safe.

John Rock's error
The Well Timed Period

I plan to do the same.
posted by rdc at 2:54 PM on February 27 [1 favorite]

There is some research being done on this but it's a pretty contentious issue. It was assumed for a long time that having a period is necessary and the pill was thus designed to make you have one. But the reasoning was mostly along the lines of what gnutron is saying, it just seems to make sense. Which actually isn't a good way to make health decisions. Lots of things that 'make sense' to a layperson have no basis in physiology and aren't supported by what ends up happening.

Once contraceptive pills had been around for longer and actual data was accumulated it was found that menstruating every single month wasn't so necessary after all, and now the guidelines are less clear. Whether there is any reason to menstruate at all and how often that has to be varies depending on who you talk to or what research you read. Longer term methods such as your hormonal IUD are still new enough that years-long menstruation-free periods (um, time periods not that other kind) are still relatively recent and long term effects haven't been studied. There are certainly women out there who have been taking the pill non-stop for long amounts of time without issue, but that may not work for everyone and may actually cause problems for those women down the line.

Back in the sixties when contraceptive pills first came out it was thought that you shouldn't take them all the time and that you needed occasional breaks. Research and the passage of time has shown this to be untrue and it's possible to take a hormonal contraceptive for many years but still be normally fertile once you come off it. Personally I think something similar will come from the menstruation argument although I don't have anything solid to back that up. Certainly all of these hormonal medications have very different effects between individuals, so that will have a lot to do with it.

Sorry I can't point you to any specific research right now. I know it's out there and trawling pub med is likely to find you a bunch of differing data and ideas. I don't know that we're far enough along with this to have a definitive review yet, although that would certainly help. Hopefully in another four years when you have to make your choice there will be more known about the longer term effects of implants such as yours. In the meantime you pretty much need to go with whatever your doctor says, since they're the one administering your implant and with your case history etc.
posted by shelleycat at 2:54 PM on February 27 [1 favorite]

I also have a Mirena, and haven't had a period since it went in. To be honest, I never even thought about the long term affects until now. My doc doesn't seem too concerned, at the very least. It's a known, fairly common side effect, and like schroedinger said, it is FDA approved. You've got another 3 years to go - why not just ask your gyno when they take it out? (i'm also thinking there might be more info available then, or better IUDs, etc).
posted by cgg at 2:54 PM on February 27

It would be irresponsible and possibly dangerous to tell you anything regarding your period without first knowing more about you. Age, gravidity, parity, menarche, characteristics of your periods, desire for children, family history of cancers (breast, ovarian, uterine, cervical, colon), and past medical history are all crucial in making this determination.

Please see your ob/gyn about this and be ready with the above information so he or she can make an informed recommendation to you. Best of luck.
posted by ruwan at 3:01 PM on February 27

I can't think of anything, marriage excepted, where making a decision about the next 20 years of your life is a good idea. Just do the smallest increment possible and then decide when that time is up whether you want to stay on the drug or not.
posted by Ironmouth at 3:05 PM on February 27

I read somewhere that the pill was originally designed with a "break" purely for marketing purposes, to make it seem more natural.

In any case, doctors in the UK at least are happy to prescribe back-to-back contraceptive implants lasting three years each, and resulting in no periods.
posted by emilyw at 3:10 PM on February 27

Emilyw is correct. The week of placebo pills give you a "false period", which was added in the belief that women would feel more comfortable if they had a "period" every month).

This article gives some more detail about skipping periods. The general consensus is that it's not a problem, and you're not doing any harm by skipping periods.
posted by stefanie at 3:17 PM on February 27

www.noperiod.com
posted by tristeza at 3:38 PM on February 27

Anecdotally, I can say that when my doctor inserted my Mirena, I asked about what happened after the five-year no-period period, and he said that you just take this one out and get a new one. Indefinitely. And we did discuss the no-period side effect, which he seemed to think was neat (and not unhealthy), and so do I.
posted by dizziest at 3:43 PM on February 27

also, from the Mirena site FAQ:

What if I want birth control for more than 5 years?

No problem. Mirena must be removed after 5 years. But your healthcare provider can insert a new Mirena immediately during the same visit if you want to continue using Mirena.
posted by dizziest at 3:46 PM on February 27

I think that all of the people commenting to say that it is horribly unhealthy are not properly reading your question and/or do not know what a Mirena is. Your uterine lining is not building up because Mirena thins the uterine lining as part of its mechanism of action.

I've read that having periods is not necessary. I really doubt that you'll have any problems with it, although I have read that some people with Mirena have spotting when they change the old Mirena for the next one. And, for what it's worth, I plan to do the same thing.
posted by mustcatchmooseandsquirrel at 4:07 PM on February 27 [4 favorites]

As far as I know, schroedinger and needs more cowbell are mistaken about the uterine lining building up over long periods of time. From The Well-Timed Period, which was linked above:

"a) Fluctuations in hormone levels cause the changes in the uterine lining. If your hormone levels don't fluctuate, the uterine lining will not thicken, and it will not shed (there's no need to shed it since it's not thick). No shedding means no menstrual period."

posted by Powerful Religious Baby at 4:07 PM on February 27 [1 favorite]

The paleoanthropology I've read suggests that hunter gatherer human femaes are *ahem* "designed" to be pregnant or too malnourished to be able to get pregnant or going through fertility cycles, so as to get pregnant. Obviously having a constant supply of food messes this up, so agricultural human females get monthly cycles. The more tenuous life style of hunter-gatherers means that there's some natural fertility control that agricultural females don't get. I don't have references to hand though I'm sorry.

Some evidence I've seen suggests that no periods is either harmless or maybe even slightly beneficial. Don't expect an ob/gyn to give you a terribly sensible answer to your question (although they might if it's an issue they're personally interested in). Doctors are generally good at dealing with things that might kill you or maim you, but this is not one of those things.
posted by singingfish at 4:25 PM on February 27

To all of you who are on Mirena and have no periods, I HATE YOU ALL. I've had mine for 3 years and still have regular periods. Good luck to you and I certainly wouldn't be worried about not having periods. The whole point of Mirena is that it is a long term solution. Of course, you're best off getting this reassurance from your doctor.
posted by goshling at 5:31 PM on February 27

Based on what my GYN told me, mustcatchmooseandsquirrel is absolutely correct -- Mirena acts via a different mechanism, so there's no lining building up during those 5 years. I would totally go for it, especially since Mirena can be removed at any time and you'll have to revisit the decision every 5 years, at least.
posted by katemonster at 5:31 PM on February 27

I have heard from my science-y/med-school-y friends, so take with a grain of salt, that having less periods is actually healthier for women because, as others have said, we aren't designed to have as many as we now do over our lifetime. This increased refreshing of the cells is also more likely to lead to cancer as there is an increased chance for cell mutation. As I understand it. Someone will probably find a medical journal article that will prove me wrong in T minus 1....
posted by wuzandfuzz at 5:48 PM on February 27

The week of placebo pills give you a "false period", which was added in the belief that women would feel more comfortable if they had a "period" every month

That's the dumbest thing I've ever heard!
posted by fshgrl at 6:22 PM on February 27 [1 favorite]

@fshgrl: remember, the pill was designed by men. :)

i don't get my period on my current pill, ever. we're not sure why. but four years in, everything appears to be in perfect working order, so i would imagine that you'll be fine.
posted by thinkingwoman at 6:34 PM on February 27

fshgirl: It's absolutely true.

And thinkingwoman: Don't blame men. The very early iterations of oral contraception had no placebo week. Greg Pincus pushed for it for a number of reasons, none of which had to do with his gender-limited knowledge of the ovarian cycle. There are polls and data to confirm that early on, before OCPs had gained acceptance, a lot of women really were uncomfortable with the idea of not having a period and feared the possibility of undetected pregnancy. This actually translated to poorer compliance. Moreover, there were political and religious concerns at that time which pushed him towards simulating what seemed like a natural cycle in order to avoid controversy. I think it was quite brilliant actually, and we really owe him a debt of gratitude because without the 7-day placebo it's quite possible that the landscape of women's reproductive health and freedom might have been quite different. Even now with Seasonale and Lybrel gaining popularity it's actually women's groups who are huffing and puffing about menstrual suppression and how it's unnatural.
posted by drpynchon at 7:16 PM on February 27 [4 favorites]

I have Implanon, a progesterone-only arm implant that has amenorrhea as a common side effect. I get occasional spotting, and even that will likely taper off over the first year. Implanon lasts a total of three years, and can be replaced at the same time the original's removed, and that's exactly what I'm planning on doing. Basically, it's the same as your Mirena except Implanon uses a slightly different form of progesterone, it lasts 3 years instead of 5, and it goes in the upper arm.

As you may have guessed, all the research I did showed that a lack of monthly bleeding wasn't a bad thing. Remember, many women don't menstruate not just when they're pregnant, not just when they're half-starved hunter-gatherers, but also when they're breast-feeding -- and, not that long ago, many women chose to breast-feed for years.

If you want to talk to a gynecologist about this, make sure s/he's up-to-date on the latest research. I'm lucky because Implanon is an automatic filter -- doctors who offer it must be relatively cutting-edge, since it's only been out in the US for a year and a half, although it's been used worldwide for about 10 years.
posted by booksandlibretti at 9:21 PM on February 27

As a former OB/GYN nurse, I can say with authority that what you want is very dangerous and can cause cancer. Even the very first poster (DarlingBri) has the answer dead wrong. You should never miss a period.

Clearly, you need to do some reading on what menstruation is and why you menstruate. There is a reason that your body does this. It isn't because it has nothing better to do. If you stop, you build up tissues that obviously are not sloughing off. The more build up you get, the higher the risk you have for cancer. Right now, you are in serious trouble and likely need a DNC.

It is very frightening, not to mention shocking, that anyone would think this is a good idea. That's like saying, 'I'm not going to eat another nutrient for twenty years.' It's a ridiculous theory.

Men have nothing to do with this at all. This is a scientific fact. Go to your local university and pull out a book on GYN, then read it for yourself.
posted by magnoliasouth at 10:18 PM on February 27

Clearly, as an former OB/GYN nurse, you need to do more reading yourself. Please to cite the studies that show increased cancer risk with Mirena. I'm happy to cite those that don't -- the consensus is that levonorgestrel intrauterine systems are protective against endometrial cancer if anything. What you say is patently wrong -- embarrassingly so for a nurse. Not one thing you said is remotely true. Not even remotely so in your inept appeal to authority.
posted by drpynchon at 10:56 PM on February 27 [6 favorites]

Magnoliasouth I'm not surprised you're a former Ob/GYN nurse having read your comment.

You are wrong. Please do a bit more research before making such definitive statements.
Besides what drpynchon says, there seems to be a suggestion in current reading that long breaks from periods may be beneficial.

Current researchers in ovarian cancer for example are positing a thesis that since for most of human history females were either gravid or nursing during their fertile years, the actual break in the ovary for shedding the egg only happened about 20% of the time compared to modern females.
posted by Wilder at 12:28 AM on February 28

Sorry, I meant to add, the Professor I was listening to was suggesting that the minor trauma as the ovary bursts every month may actually be happening too often in modern females and may explain why in ovarian cancers are seen more often in women who do not have children.

This is theory obviously, but there is no evidence to say that stopping periods as the Mirena does causes an increase in cancer risk.
posted by Wilder at 12:34 AM on February 28

magnoliasouth, what is the basis for your assuredness that having no periods due to hormonal contraception is not healthy? Can you cite any information that backs this up? Also, if you review the physiology of menstruation and the effects of hormonal contraception on the uterine lining, you will find that, as others have noted, the endometrium, under the influence of exogenous hormones, simply does not build up like it would during a normal cycle. If it did, imagine the enormous sloughing of tissue that would happen once a woman stopped her contraception - and we know this doesn't happen! Hormonal contraceptives like the Pill actually help prevent endometrial cancer and ovarian cancer because they stop the rapid cell turnover that occurs with regular endometrial shedding and ovulation. (for what it's worth, I am also a women's health nurse).

To the OP - as you can see, this is a controversial issue and the jury is still out. Until we have more data on women like you who choose to artificially stop menstruation for long periods of time, we won't know for sure. I think all we have now is theory. But Wilder is right - it was not until fairly recently that women had so many damned periods in our lives. Before the turn of the century, the time women spent either pregnant or nursing (and therefore amenorrheic) was astounding compared to now. My personal thought (theory only!) would be to be cautious about bone health, since there is no estrogen component in Mirena and with prolonged use there MIGHT be increased risk of bone loss as we have seen in long term users of depo-provera, another progestin-only method. I know that the progestin in Mirena is a much smaller amount than in depo-provera, but I think it would still be something to think about and reason to at least remember to take a calcium supplement and get regular weight bearing exercise as we all should.
posted by tuff at 2:43 PM on February 28

ack, meant to put regular endometrial buildup, not shedding. We often put women with anovulatory cycles (for example, women with polycystic ovarian syndrome) on birth control pills to prevent endometrial cancer due to excessive endometrial buildup and insufficient shedding. Hope that made sense this time!
posted by tuff at 2:50 PM on February 28

tuff, since you brought up bone density this might interest you.
posted by drpynchon at 5:08 PM on February 28

drpynchon, thanks for the link!
posted by tuff at 6:54 PM on February 28

It sucks to say that no one can answer this yet, but frankly I think you should be wary of anyone saying anything definitively on either side. There simply hasn't been enough time and hence enough data collected on this because until pretty recently women weren't even considering this/capable of this. And yes, I'm familiar with the (loved by guys on Mefi, I've noticed...) theory that women weren't supposed to have periods as often as we do now due to pregnancy, etc. I'm also familiar with the somewhat out-there theories of Margie Profet, who Natalie Angier discusses in Woman: An Intimate Geography. She argues menstruation serves as more than the rather inefficient-seeming (on a basic intuitive level, anyway) procreation regulator we take for granted--she thinks it also cleans out the system monthly of potential pathogens picked up from intercourse. I know guys roll their eyes at this as pretty feminazi stuff, but it's interesting, and on a personal level seems feasible. Anyway, my point is I think you should accept nobody can give you a definitive answer yet, and remember people feel very strongly about this topic (weirdly so, I think anyway) and tend to bring a "this must be true!!!000111!" tone to their argument even though we still don't know. Be wary. Sorry that's a non answer, but it's the truth.
posted by ifjuly at 10:43 AM on July 5