IUD or IUDon't?
August 9, 2022 1:11 PM   Subscribe

Thinking about getting an IUD and I have some friends who have had them for years who said their periods stopped at some point and haven’t come back. They are pretty happy with that and honestly I would be too except for the fact that it doesn’t seem “natural” for me for a woman not to have her period.

Regardless of how I feel, though, I wonder what the science says? I just keep thinking that a period is like the body’s way of cleansing itself but I don’t actually understand the biological mechanism behind that. Is there any harm in stopping that process?
posted by massofintuition to Health & Fitness (22 answers total) 2 users marked this as a favorite
Vice - The Man Behind the Pill Decided Women "Need" to Have Periods - But They Don't

Mayo Clinic - Delaying your period with hormonal birth control

Main risks are breakthrough bleeding and a possibility of missing pregnancy symptoms of a missed period.
posted by Crystalinne at 1:24 PM on August 9 [3 favorites]

Literally none. None whatsoever. I haven't had a period in years and years due to either IUD or running pill packs back to back. There is absolutely no medical necessity to bleed, at all. Medical science has at last allowed us all to move past that burden.

Further, I am not trying to be cruel here but please consider that this thought process is not inclusive of women who don't have a fully functioning reproductive system, women who have reached menopause, folks with endocrine disorders, folks who have had hysterectomies or other removal of reproductive organs, women who are pregnant or breastfeeding, and is transphobic.
posted by phunniemee at 1:25 PM on August 9 [33 favorites]

There isn't. The uterus isn't cleansing itself, it's just responding to hormonal stimuli. If you remove those stimuli (with hormonal contraception, like the pill, the ring, or some IUDs) then the uterus won't grow a lining to shed.

Have you talked to your OBGYN though? Because some IUDs can stop your period, like the Mirena, and some can't, like the Paraguard. They can explain the whole process to you better than we can.
posted by lydhre at 1:26 PM on August 9 [5 favorites]

Not to be glib but sounds like you need to do some google researching on the basics of the menstrual cycle and the hormones that control it. It’s the shift between estrogen and progesterone levels that controls whether a period starts or not.

This may help change your thinking (which tbh sounds “magical” thinking) about whether that shift in hormonal levels has any “cleansing” properties (cleaning what?)

Also ask yourself what your take is on pregnant women: does she not “cleanse” because her hormone levels are different? What about people without uteruses due to hysterectomy?
posted by St. Peepsburg at 1:28 PM on August 9 [4 favorites]

If it freaks you out and you want an IUD, I have a paraguard (which is a brand name for the copper IUD). I love it, partially bc hormonal bc even in the small amount in hormonal IUDs, don't work for me. I'm on my second. They last 10 years.
There's no reason at all, health/science-wise, to keep getting periods while on birth control, but it is an option.
You continue to ovulate as normal while on a copper IUD, so, I guess a tiny benefit is that you can continue to track your cervical mucus and the moment you get the copper IUD out, if you want to try to get pregnant, you cycle is as it was.
Some women do complain about heavier bleeding w the copper IUD. I had heavy bleeding before and I found it unchanged. Who knows!
posted by atomicstone at 1:32 PM on August 9 [2 favorites]

It sounds like you're realizing your feelings are due to feelings or biases (e.g, Women are "unclean" or "dirtier" than men) rather than facts. It sometimes helps me to push my thinking in those situations by thinking through all the logical outcomes of my thoughts. For this one, that would be:

Do I think prepubescent girls are gynecologically unclean because they don't menstruate?
Do I think postmenopausal women are unclean?
Do I think people whose anorexia has caused their periods to stop to be unclean?
Do I think people whose sports training has caused their periods to stop to be unclean?
Do I think people with PCOS are unclean?
Do I think my friends with IUDs are unclean?
posted by lapis at 1:33 PM on August 9 [3 favorites]

Total anecdata, but I actually *stopped getting UTIs* when I got my Mirena. I’m on my second now, I don’t get periods anymore, and it’s great. Really really great and I wish I’d gotten one when I was fifteen. (FWIW even among the hormonal IUDs likelihood of stopping menstruation varies; part of the reason I chose the Mirena again, and in fact called around town a bunch to find a place that stocked it, was because of this fantastic benefit.)

I don’t think periods were causing my UTIs, but fewer infections isn’t a result of being “less clean”.
posted by nat at 1:48 PM on August 9

i agree with everyone who said that a period is not necessary. i myself stop it with continuous birth control.

however, it was a common thought for a long time, and one that is still espoused by lots of people including those in medicine, that a period is necessary to "clean out your uterus" and that your uterus could "fill up" with shed lining if it didn't bleed out every month.

there are also doctors out there who will handwavey say that you MUST get a period every month and that it is "unnatural" not to.

so don't be too hard on OP for asking an honest question in which i didn't sense any malice.
posted by misanthropicsarah at 1:52 PM on August 9 [45 favorites]

While science says you don’t need it, it’s totally valid to pick a birth control type where you have regular bleeding if it’s important to you. Look into the copper IUD which has no hormones.
posted by genmonster at 1:53 PM on August 9 [4 favorites]

If having a period feels good and natural to you, it’s totally fine for you to opt for a form of birth control that supports that. But no, the current medical consensus does not seem to support that a period is necessary, as far as I currently understand it.

Your idea of “cleansing yourself” has some unfortunate nuances as mentioned above, but to the extent it’s an analogy you might think of it this way - forms of birth control that stop periods are doing so by stopping the buildup of the uterine lining that would need to shed in the first place. It’s not that your uterus is merrily stuffing itself full of lining and never ever cleaning it out, that buildup isn’t happening in the first place. There is nothing *to* cleanse.

To me, a hormonal IUD isn’t any more or less natural than the birth control pill, which could skip periods or not depending how you take it. But if the whole realm of hormonal contraception feels bad to you, there are other options! I hope you find one that works for you.
posted by Stacey at 2:07 PM on August 9 [5 favorites]

I've had no periods due to the contraceptive implant for a couple of decades now. It's fantastic. I spend a whole lot less time having to cleanse my nether regions, for a start.

I also understand that pre contraception, lots of women spent most of their fertile years not menstruating, because they were either pregnant or breastfeeding. So I guess "very few periods" is the natural thing.
posted by quacks like a duck at 2:21 PM on August 9 [3 favorites]

Wow ok I think people are grabbing onto your use of "cleaning" and "natural" --both of which you recognize are not science-based-- and reading a bunch of stuff into it that I'm not entirely sure you meant.

Dunno how old you are, but I was also taught, as in from a textbook by a teacher in school, that menstruation is the default behavior of a healthy post-puberty unpregnant uterus. It's easy to go from there to a general feeling of "so if I'm not having periods, something has gone wrong." And this is often the case! The thing is, textbooks are often written by non subject-matter experts or folks with a weak grasp on science writing, who try to make concepts simple and accessible and in doing so make them incorrect.

So no, there is no reason why a given person MUST have a period. But there may be plenty of reasons why you, Individual Asker, would prefer it, or indeed why you shouldn't use hormones to stop it (for example, if you have a poor tolerance for the hormones, or certain stroke risks etc.). So that is why this stuff gets decided in context, with your OB.
posted by We put our faith in Blast Hardcheese at 2:24 PM on August 9 [15 favorites]

Modern women menstruate much more than women did through most of human history (and prehistory). Until recently, with the advent of women’s education and women’s rights, it was common for women to spend much of their adult lives either pregnant or nursing a child, ie not having regular periods. Having a monthly period year after year, decade after decade would have been unusual in the past, not the norm. It’s monthly periods over long spans of time that are unusual.
posted by Winnie the Proust at 2:30 PM on August 9 [11 favorites]

I have had a Mirena IUD for the past 13 years and have absolutely no regrets. I'm on my third and plan to have one until menopause unless I decide to have kids. I think back upon all the pain and discomfort from having my period: it's crazy how much easier and more comfortable my life is now. I have a friend who didn't want to lose her period so she got a ParaGard IUD and now her period is more intense than ever. She also has no regrets. There are many options for birth control and all have pros and cons. I'm very pro-IUDs but they're not for everyone. The cool thing is that, should you get one and not like it, you can remove it and go back to "normal." My only warning is that a lot of people post horror stories online so take everything with a grain of salt. Ultimately, you know what's best for you, and it's ok to decide against an IUD for any reason even if it seems "silly" or "unscientific." It's your body and you have the right to choose!
posted by smorgasbord at 4:11 PM on August 9 [1 favorite]

I had similar feelings to you OP. (Which hey, you're allowed to have feelings about this! Also seconding the sentiments of "We put our faith in Blast Hardcheese.")

Then I went on hormonal birth control with the instruction to skip several periods in order to rectify an anemia issue. I was shocked to find that my feelings about it changed drastically after having had a few period-free months. I felt FREE. No more cramping, no more missing out on sleep due to cramps in the middle of the night, no more aching anatomy, no more menstrual products to buy and monitor and change. No more feeling sick for a week out of every month. I switched to a Mirena IUD and haven't looked back. I still can sense some cyclic fluctuations of my hormones, but they're rarely debilitating or behavior-altering in the way that menstruating was for me. And as far as I know, I had average periods.
posted by purple_bird at 4:40 PM on August 9 [1 favorite]

Stacey forms of birth control that stop periods are doing so by stopping the buildup of the uterine lining that would need to shed in the first place.

That's the science you're looking for. And you're not silly for deciding whatever you decide is best for you. You're also not silly for asking. Sex/Human Biology education has been terribly lacking in some areas/cultures/families for a very long time. (I myself have been seriously failed by these systems)
posted by MuChao at 4:45 PM on August 9 [2 favorites]

I haven't had a period since age 21 when I went on Depo-Provera. I ABSOLUTELY LOVE NOT HAVING MY PERIOD and not having cramps all the damn time. Happily, my gyno says I can stay on it until menopause. I have thrived on this (note: not everyone does, YMMV, etc).
posted by jenfullmoon at 4:47 PM on August 9 [1 favorite]

My second Mirena is at the end of its run. I still get light spotting and emotional symptoms on a regular schedule, which I find interesting to track but it doesn't mess with my life the way my period used to. I recently asked my doctor if there would be any benefit to taking a break from hormonal BC. She told me, if I understood correctly, that the IUD can reduce the chances of endometrial cancer by preventing the buildup of uterine lining, so if I tolerate it well there's no reason not to get a third.
posted by doift at 6:52 PM on August 9

Soooo, humans menstruate because we have *weird* placentas.
And it's an evolutionary war of the welfare of a fetus vs the best interests of the mother.

Most other animals require the placenta to attach to the uterus, like plug into a socket, and if the mother is under stress, food restriction, the body will cut off the blood supply causing a miscarriage (categorised as level 1, or 2 placenta).

So, a human egg doesn't even need to implant into a uterus, it'll just attach to any old thing, this is incredibly dangerous (eg ectopic pregnancies, it tries to connect to the tube, and busts it), but a very few mothers & babies have even *survived* after the placenta connected to something with high blood flow like the liver (primary hepatic pregnancy). Muuuch common to die from this though.
Anyway, this is a level 3, 'parasitic' placenta. Like, that's actually the term.

So, there's kind of a misunderstanding that the mothers body is 'providing' food to the fetus, or that the mother's body can cause a miscarriage. Mostly... This isn't the case.

The placenta directly wires into the mother's blood supply, and *takes* whatever it wants, regardless of whether this leaves the mother with say, calcium deficiency.
Also, it's the fetus that releases chemicals triggering birth (there's a genetic condition where it doesn't, and before c-sections this was very, very bad).

So, once the placenta and fetus is hotwired into the mother's blood supply, you're... Kinda screwed. Even if the fetus has severe genetic abnormalies that your own immune system can detect as being haywire, you're just along for the ride, and pregnancy has a atrocious mortality rate, you come out with higher risk of osteoporosis, etc etc.

So what does the human body do to defend against this parasitic placenta & fetus?

It builds a *decoy uterine lining*.
It is suuuuper thin, but this decoy lining gives the mothers body a couple of days to detect the egg attaching, detect any abnormalities, and then if there are - pull the plug! So most miscarriages happen in the first week. This is the only window in which your own body *can* kind of detect and allow a miscarriage.
But once the placenta has attached and gone through that micro-thin uterine lining, it's wired in, and the risks of pregnancy are kind of locked in.

So this is a very recently evolved defense mechanism in the evolutionary war against the parasitic placenta. It is very high investment, you have to create and shed it each month. The bugs aren't worked out, so sometimes this decoy lining grows places that it shouldn't, and that's what endometriosis is, basically.
Other primates? Don't menstruate. (Dogs bleed to indicate oestrus, it's not menstruation).

So yeah, it's ok to just opt out of building and shredding this fake lining when you don't have a risk of pregnancy. As pointed out, menstruation used to start at a later age, you wouldn't menstruate while pregnant or breastfeeding, so compared to hunter gatherer societies, we have about 10 times as many periods over our lifetime, which isn't very normal either.

On the mirena, you're likely to have lighter periods or have them stop altogether.
I had/have Pcos and irregular periods. After being on the mirena for 10 years, in which I considered my self lucky to be in the, they stopped entirely category, I came off and my periods have now 'normalised' into 31-35 days, so there was no real downside for me.

Additionally, I couldn't tolerate any of the birth control pills because of the mental side effects (depression, sex drive), but the mirena iud releases 1/10th the dose of the *lowest* dose contraceptive pills into your blood stream, because it's releasing it directly into your uterus, right where it's needed.

Meanwhile with the pill, (or patch, or implant) you're digesting it into your blood, just so a portion of the hormones can get to your reproductive system, while just as much of it is going to your brain.

Finally, if a copper IUD seems more 'natural', actually copper is a mild irritant? (Or not so mild for my friend with what turned out to be a copper allergy).
Its kind of irritating your uterus and making body think there's something hostile there, and additionally, you're likely to get 1/3 heavier periods.

Apologies for the casual simplifications here, but you get the gist. Fascinating, eh?
posted by Elysum at 7:28 PM on August 9 [26 favorites]

I’m an NP (TINMA/etc). A levonorgestrel intrauterine device works mostly because the hormone it releases (a progestageen) counteracts the estrogen that causes the uterine lining to build up, so it reaches a sort of stasis point. With people who have light/average periods, often that means their period goes away; for people with prolonged/heavy periods, usually it’s lighter and shorter (and sometimes goes away, too). This is completely safe and actually protective agains endometrial cancer (and has some benefit against ovarian cancer, too, most likely).

The copper IUD works because the copper is toxic to sperm and eggs so they can’t meet to fertilize, and also copper creates an inflammatory reaction on the uterine lining, so if an egg does fertilize, it’s difficult to implant. This tends to make periods heavier and with more cramps (maybe 1-2 days on average).

You are not at all alone in your questions or feelings; many people wonder if it’s safe to skip periods and the answer is yes (unless you’re skipping them without knowing the reasons why, in which case you would want to check in with your gyn/PCP). Both the hormonal and non-hormonal IUC are highly effective contraceptives and many people are quite happy with them. The good thing is that if you don’t like it, you can always take it out! Generally, the rule of thumb is to try any method for about three months and then decide (except if experiencing severe side effects).

Hope you can find a method you are happy with.
posted by stillmoving at 9:30 PM on August 9 [7 favorites]

I just want to applaud you for asking questions about your health and exploring your options! I find it scary to question assumptions I’ve had, so I might be projecting about the bravery required but I love this question and I’ve learned things from the answers, despite thinking that I was pretty well informed. Thank you for asking!
posted by Bottlecap at 12:24 AM on August 10 [15 favorites]

There are situations in which you do need to have a period. For me personally, when i'm not on any kind of birth control, my hormones don't work quite right, and i'll build up lining. The right hormones will either kick in and i'll eventually have a heavy as all get out period, or i don't and if I happen to have an ultrasound or something the doc will say "Jeez! Your lining's thick" and induce a period. But for that reason, i take birth control, and i've been known to run the packs back to back to not have one, which isn't a problem because there isn't any build up.
posted by BlueBear at 9:54 AM on August 10 [1 favorite]

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