Why Periods? False Hopes, Popes, and the “Grandfathered” Withdrawal Bleed

The birth control pill and other hormonal contraception are popular. Menstrual periods are not. Hormonal contraception can be used to suppress menstruation — so why isn’t this method, called “continuous contraception,” more popular?

For decades, packets of birth control pills have typically contained 21 “active” pills and seven “placebo” pills. These placebos — sugar pills — trigger bleeding (which most people think of as a menstrual period, even though it’s technically called a withdrawal bleed). Because menstruation is natural, some people think this withdrawal bleed must somehow be healthier. But there are actually no health benefits — and it might also increase risk for pregnancy.


There is no reason to have a period when on the birth control pill — unless you want one.


Last month, British medical guidelines were revised to recommend continuous use of the birth control pill — that is, with no week-long “break” designed to trigger a withdrawal bleed. We could have been skipping our periods since the Pill was introduced in 1960 — so why is it only now that we are coming to see them as optional?

A flurry of recent articles has touted a rather conspiratorial claim: that the monthly bleed was included in an attempt to make the Pill more palatable to the pope. The Telegraph quoted reproductive health expert John Guillebaud: “John Rock devised [the week of placebo pills] because he hoped that the pope would accept the Pill and make it acceptable for Catholics to use. Rock thought if it did imitate the natural cycle then the pope would accept it.”

Many journalists, pundits, and bloggers have expressed outrage that we’ve been putting up with decades of unnecessary bleeding (and all the attendant pain, headaches, and missed work) just because of an unsuccessful attempt to appease the pope before most women of reproductive age were even born. But the history of the placebo week is more complicated. Continue reading

No, the Morning-After Pill Is Not the Abortion Pill

The other week, I was talking to a family member about the threats to contraception access in this country, “thanks” to our new president and his fanatical administration. He thought it was ridiculous that abortion opponents also fight tooth and nail to put obstacles in front of birth control — after all, reliable contraception prevents unintended pregnancies, which itself prevents untold abortions. It seems like a win-win for everyone, regardless of where their opinion on abortion falls.


The morning-after pill prevents pregnancy. The abortion pill ends pregnancy.


Then he said, “Of course, I understand them not wanting tax dollars going toward the morning-after pill, since that causes abortion.”

I had to stop him right there: “Nope.” A bit self-conscious of appearing to be a persnickety know-it-all, I summarized the vast differences between the morning-after pill and the abortion pill — differences that many people, even full supporters of reproductive rights, don’t understand. Opponents of abortion and contraception exploit this misunderstanding, pretending these two pills are one and the same, hoping to elicit “compromise” from “reasonable” people. Compromises that harm real people with real lives and real families. Just as women’s health opponents have been so successful at chipping away at abortion access, so too do they hope to erode access to contraception.

The morning-after pill and the abortion pill are completely different medications, used for different purposes and made up of different ingredients. Let’s look at a quick rundown of the two. Continue reading

Ovarian Cancer, Endometrial Cancer, and the Pill

The most popular method of birth control in the United States is the Pill, followed by tubal ligation (permanent sterilization, or getting your tubes tied) and condoms. The Pill is a hormonal method of contraception, while sterilization and condoms are nonhormonal. The distinction between hormonal and nonhormonal methods of birth control are simply that the former contain synthetic versions of human hormones, while the latter do not.


By suppressing ovulation and thinning the uterine lining, the Pill can reduce risk of ovarian and endometrial cancers.


Glands in our bodies, called endocrine glands, produce hormones; additionally, testes and ovaries — which are parts of the human reproductive system — manufacture hormones. Human hormones are powerful chemicals, which do all sorts of jobs, from triggering puberty to helping us extract energy from the foods we eat. So it’s not a huge stretch to wonder if exposure to the hormones present in certain birth control methods — such as the Pill, in addition to the patch, the ring, the shot, the implant, and some types of IUDs — might have unintended effects on the body. Because hormones can play a role in cancer — either in protecting against it or aiding in its development — researchers are very interested to know if the Pill might increase or decrease risk for various types of cancer.

It’s actually a bit tricky to investigate the possible associations between the Pill and various types of cancer. First of all, there are dozens of types of birth control pills, all with different versions of synthetic hormones, at different dosages, and in different proportions to one another. Furthermore, the types of oral contraceptives on the market change over time — today’s birth control pill is not your mother’s birth control pill. Studying “the Pill” as a single entity could obscure differences between brands. Secondly, most cancers tend to develop later in life, many years after someone may have taken oral contraceptives. Researchers need to be careful to control for all the variables that might increase or decrease cancer risk. Continue reading

Will St. John’s Wort Affect Birth Control?

Herbal remedies are very popular around the world. Many people prefer them to pharmaceuticals because they believe herbs can elicit positive results without serious side effects. However, plants produce a wide variety of chemicals at varying concentrations, and might have a number of effects on your body, both good and bad. Furthermore, since herbal supplements are not evaluated by the FDA for safety or effectiveness, consumers often don’t have ready access to evidence about herbal products. We can’t even be sure that they contain the ingredients that are listed on the label!


St. John’s wort might decrease the effectiveness of birth control pills, and might be unsafe during pregnancy.


One popular herb is St. John’s wort, or Hypericum perforatum. While the scientific evidence is mixed at best, many people believe that St. John’s wort can be used as an antidepressant. However, people often treat themselves with herbal supplements without guidance from a medical doctor or pharmacist — and without knowing whether or not these herbs are safe to use with any medications they might be taking.

Over the millennia, plants have evolved all sorts of powerful chemicals, such as toxins, to defend themselves against insects and other predators. For this reason, we can’t assume that plants only contain inert chemicals that won’t affect us or interact with the chemicals in other drugs and supplements we use. St. John’s wort, in fact, contains chemicals that interfere with other medications. It has been banned in France, and other countries require or are considering warning labels on St. John’s wort products so consumers can be aware of possible drug interactions. Continue reading

Supreme Court Rules Against Women in Hobby Lobby and Buffer Zone Cases

Five out of six male Supreme Court justices voted in favor of Hobby Lobby's right to deny full contraceptive benefits. Their opinion does not represent the entire male population. Photo: NARAL

Five out of six male Supreme Court justices voted in favor of Hobby Lobby’s right to deny full contraceptive benefits. Their opinion does not represent the entire male population. Photo: NARAL

On the morning of June 30, the U.S. Supreme Court (or should I say the men of the Supreme Court) ruled in favor of two corporations, Hobby Lobby and Conestoga Wood, who argued that they should not have to provide insurance coverage for their employees’ birth control, as required by the Affordable Care Act, because of the business owners’ personal religious beliefs.

The court stated that when corporations are “closely held” and it can be shown that the owners operate the business consistently with certain religious beliefs, then these corporations can be exempted from federal laws that burden those religious beliefs.


Emergency contraception and IUDs work primarily by preventing fertilization, and won’t interfere with existing pregnancies.


The “beliefs” in question held by these two corporations concern two forms of birth control — emergency contraception and IUDs (intrauterine devices). But their “beliefs,” that emergency contraception and IUDs are abortifacients, aren’t rooted in actual science.

Here are the details.

Hobby Lobby believes that “life begins at conception.” They define “conception” as the time at which a sperm and egg combine to create a zygote.

The medical community, including the American Congress of Obstetricians and Gynecologists (ACOG), defines conception as the point at which a fertilized egg implants in the uterus. According to ACOG, the term “conception” properly means implantation. Continue reading

Let’s Talk Contraception: Can I Use Birth Control to Skip a Period?

In 2003, the FDA approved Seasonale, an extended-cycle birth control pill. This pill, a combination of estrogen and progestin, is taken daily for 84 days followed by one week of inactive (placebo) pills, allowing a woman to have her period once every three months — four times per year.

Since that time, several other extended-cycle birth control pills have been marketed, including Lybrel, released in 2007, which offers women continuous contraception coverage with only one period per year.


Using birth control to skip periods doesn’t result in side effects quite this exaggerated.

Prior to Seasonale’s debut, certain types of birth control pills could be taken back to back, allowing users to have period-free weddings and honeymoons, or to treat certain conditions, such as endometriosis. But there was no consensus about how to use birth control pills this way, and no actual product marketed specifically for this type of use. Early studies on extended-cycle pills reported that users were highly satisfied using pills to have fewer periods — and wanted to continue using these pills to reduce periods after the study was completed.

Can skipping periods be beneficial or harmful? Is this a lifestyle choice that’s not “natural”? How many “normal” periods do you need in a lifetime? Continue reading

Mythbusting: Does Emergency Contraception Cause Abortion?

The Centers for Disease Control and Prevention reported recently that one in nine sexually active women, or 5.8 million women, has used emergency contraceptive pills, such as Plan B. Emergency contraception is a woman’s back-up method to prevent an unwanted pregnancy, and women report using it when they feel their contraceptive method has failed, such as a broken condom, or they do not use a regular contraceptive like birth control pills.


The latest scientific evidence shows that Plan B works mainly by delaying ovulation — not by affecting a fertilized egg.


Some conservative politicians have been stating publicly that emergency contraceptive pills (ECPs), such as Plan B, cause abortions. They may believe that life begins at conception (fertilization of the egg by the sperm) and argue that ECPs disrupt a fertilized egg’s ability to implant in the uterus, which they consider equivalent to abortion. The American Congress of Obstetricians and Gynecologists and experts from the Food and Drug Administration and the National Institutes of Health consider a pregnancy to be established when a fertilized egg settles itself on the wall of the uterus — implantation. A woman is most likely to become pregnant when she ovulates, which is usually about two weeks before her next period. Sperm can live for up to three days. So, if an egg is fertilized, there are still possibly six to 12 days before the implantation may take place.

When ECPs were first developed and information about them was submitted to the FDA for market approval, the drug manufacturers included mention of every possible mechanism on how the pill might work to prevent pregnancy. This included wording about preventing or delaying ovulation, making the sperm or egg less able to meet, and possibly preventing implantation. However, the latest scientific evidence has shown that ECPs such as Plan B mainly work by delaying ovulation — Plan B does not affect implantation and has no effect on existing pregnancies. Several prominent researchers have stated that if in fact Plan B disrupted implantation, it would be 100 percent effective at preventing a pregnancy, and that is not the case. Continue reading