Women don’t have to have a period every month, doctors say, and it’s safe to use birth control pills to space out your periods to every few months — or even have none at all — if you choose.
The U.K.’s Faculty of Sexual and Reproductive Healthcare issued new guidelines on combined hormonal contraception — which includes the birth control pill, transdermal patch and vaginal ring — this week. This sparked a discussion online about why birth control pills traditionally included a seven-day break from active pills, if there was no health benefit to having that period as the guidelines say.
Those sugar pills were originally put in to mimic a woman’s natural cycle and make the Pill more socially-acceptable at a time when birth control was taboo, said Dr. Nicole Todd, an obstetrician-gynaecologist at B.C. Women’s Hospital and Health Centre.
Although Canada has had guidelines on the practice since 2007, many women still aren’t aware that they can use birth control pills to have fewer periods, Todd said.
“I think that there is still a common belief that women should have a period every month.”
But medically, she said, they don’t.
“Now we’re giving women the opportunity not to have a period,” Todd said. “And that’s completely safe to do so.”
About your period
Dr. Amanda Black, a professor of obstetrics and gynaecology at the University of Ottawa, and lead author of the Canadian guidelines, said that the periods that women who are taking birth control pills experience are not exactly the same as a normal period.
On a normal hormone-free menstrual cycle, the uterine lining builds up over time and gets shed at the end of the cycle — which is what your period is. When you’re on birth control, the progestin in the pill prevents the uterine lining from thickening, so there’s no need to shed it, she said. Instead, you bleed due to withdrawal of the hormones, while you’re taking sugar pills for seven days.
“People always worry that the lining of the uterus is building up, there’s all these toxins building up in my body and there’s blood building up in my body, but it doesn’t do that at all,” Black said.
“There’s nothing saying you have to have that every four weeks. You could have it every eight weeks, every 12 weeks, or you could not have one at all.”
And no, if you only have a period every three months, you’re not going to have three months’ worth of blood all at once, she said. There’s no need to worry about a super-period.
Extended-cycle birth control
Taking an “extended cycle” of birth control can be done a few ways, Todd said. There are some brands of pill on the market that come in packages of 24 active pills, meaning the woman would have just four hormone-free days per 28-day cycle.
There are other packages that contain three months’ worth of continuous pills, with seven days off at the end. These might be good choices for insurance purposes, Black said, since you’d only have to buy a few packs a year.
Or, you can take packages of 21-day pills back to back, she said, though she recommends choosing a “monophasic” pill, where the dose of hormones is the same in each pill if you choose that option.
Advantages and drawbacks
Some studies show that taking pills on an extended cycle can actually make them more effective than a 28-day cycle, said Dr. Rob Dmytryshyn, medical director of the Bay Centre for Birth Control at Toronto’s Women’s College Hospital.
This is mostly because there’s less chance for human error, he said. Missing your first pill after seven days off means there’s a chance you could ovulate that cycle. That won’t happen after just four days off, he said, and if you’re taking a pill every day, you lessen the chances even more.
WATCH: Five factors that can impact the effectiveness of your birth control.
And if you do get pregnant while on an extended-cycle pill, it’s possible you won’t notice as quickly because you’re not having periods — since missing a period is a clue for many women that they might be pregnant, he said. Other clues, like breast tenderness and nausea, will eventually give it away, though, and in the meantime there’s not any evidence of harm to the fetus.
“Theoretically we prefer not to use hormones in pregnancy, but on the flip side there haven’t been any harms to women who have been taking their pills in early pregnancy because they were not aware of the fact that they were pregnant,” Dmytryshyn said.
While some women can take back-to-back pills indefinitely without issue, others experience spotting when they’re on an extended cycle, he said. “The longer you go, the more likely you are to have irregular bleeding.”
A short break of four or five days should be enough to solve that, Black said.
Doing an extended cycle of combined hormonal contraception carries the same medical risks as a regular 28-day cycle, Dmytryshyn said, and as such it might not be for everyone. Women who are over 35 and smoke, who experience migraine headaches with aura, or who are at higher risk of blood clots may not be appropriate candidates for this kind of birth control.
But some women who experience especially heavy periods, have endometriosis, or have painful periods might welcome the chance to have fewer of them, Todd said.
When patients come to her seeking contraception, Todd said, she asks them what their motivation is for wanting birth control. Although some people simply want to avoid pregnancy, other people are looking for non-contraceptive benefits, like reducing pre-menstrual symptoms.
“To a lot of women, I say, ‘Would you like to have a period every month? Is that important to you? Or, would you like to skip your periods?’”
She recommends talking to your health care provider if you’re interested in this option. B.C.’s Options for Sexual Health also has a fact sheet on the practice.
“We are now realizing that women are having way more periods than they were having before,” Todd said. “They’re delaying childbearing, they’re having less children overall, so they’re having more periods.”
“We live in an era right now where women can choose the number of periods that they wish to have.”
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