Period Optional?

Is it really safe to not get your period on purpose? Going no-flow might sound like a dream, but it’s important to know what you might be getting into before skipping those sugar pills long-term. We've got the facts for you!

How hormonal birth control works

Combined birth control pills use synthetic versions of progestin and estrogen — hormones that your body produces — to mimic a 28-day cycle. Seven of your 28 pills are actually placebo pills, aka the sugar pills (which contains zero hormones). There is a critical difference: the bleeding that happens during your week of sugar pills is actually what’s known as “withdrawal bleeding.” That's when your body reacts to the cessation of the hormones. So the “period” that you get if you’re on hormonal birth control like the pill, the patch, or NuvaRing isn’t actually a period per se, and that matters, because it means that with oral contraceptives, you can safely use birth control to hack your cycle to delay or even indefinitely opt out of monthly bleeding.

So how do I skip my period?

This might sound complicated, but it’s actually quite simple—on the 22nd day of your cycle, some women choose to toss the sugar pills and start a fresh pack. Women have been quietly doing this, often with MD support, for years, and the potential benefits of menstrual suppression have been carefully studied by clinicians. In response to the need articulated by this trend, pharmaceutical companies have introduced lines of pills that make official this home hack: enter extended-cycle, or continuous birth control. Quartette, Seasonique and Seasonale (which are now joined by a number of generic versions) provide 12 weeks of active hormonal pills, followed by placebos—and withdrawal bleeding—in the thirteenth week, while Amethyst is all active pills and is meant to be taken continuously for a full year, which, yes, means no bleeding from New Year’s Day to New Year’s Eve.

Is this safe?

It’s a fair question, and an important one to consider. The official answer is “probably, depending”—which is to say that the same risks that come with traditional cyclic birth control are still factors, and that your personal medical history and condition, as well as your OB/GYN, will determine the answer for you. The most common side effect of continuous BC (whether prescribed or off-label) is irksome rather than dangerous: “breakthrough bleeding,” which is exactly what it sounds like. You bleed a little bit, often unexpectedly. This tends to decrease over time and subsides completely for most people after a year of continuous protocol.

Why would you want to skip your period?

There are as many reasons to skip your periods as there are people with periods, ranging from the serious—medical conditions that are exacerbated by menstruation, such as endometriosis, dysmenorrhea, premenstrual dysphoric disorder (PMDD), menstrual migraine, and ovarian cysts—to the more practical—the love of white jeans, not wanting to ruin another set of expensive sheets. For many, like active-duty military, who work in environments where access to clean bathrooms is an issue, menstruating at work is more than inconvenient, it can be unsanitary and stressful.

For people with endometriosis, in particular, the benefits of skipping periods can be life-altering. The condition, in which endometrial tissue grows outside the uterus, is marked by intense pain—way beyond normal cramps or PMS—with menstruation, along with long and heavy periods. Endometriosis can be treated through laparoscopic surgery, which removes the tissue and temporarily alleviates symptoms, or a hysterectomy.

Emotional and physical conditions that flare with menstruation—we’re looking at you, PMDD and menstrual migraine—do not get activated when you skip periods. And for those who suffer from ovarian cysts, which form during and immediately after ovulation, any hormonal birth control will ameliorate cyst formation and growth.

Why you might not want to skip

There are a few reasons to consider staying in the rhythm of a monthly cycle, however. For one, bleeding monthly is confirmation that you are not, in fact, pregnant—which you probably don’t want to be if you’re on birth control. Hormonal BC pills are 99% effective if used perfectly, but that stat drops to 91% if you, like most people, suffer the occasional human lapse of memory, so the visual confirmation that you aren’t pregnant can soothe anxiety. The period, too, is an indication of general bodily functioning, and not getting it when you’re expecting to can be important information to bring to your doc. Amenorrhea can indicate myriad conditions; common culprits are insufficient body fat, too-low or too-high BMI, PCOS, over exercise, and stress. That monthly cycle can serve as an affirmation that your body is humming along properly.

If getting some breathing room from the exhausting pain of endo or going on vacation without packing tampons appeals to you, it behooves you to work with a doc who can help you weigh your options, and walk you through the process of transitioning to continuous hormonal contraception if you choose to do so. Initial breakthrough bleeding can be disconcerting, and knowing that you’re in the hands of a practitioner who understands your history, condition, and fertility goals is vital.

Can going period-free interfere with fertility?

If your period goes away for a year or more, can you count on it to return when you’re ready for it? For 94.7% of subjects in a Columbia University study, the answer was yes, within 60 days. Another study out of UPenn showed 81% of subjects achieving pregnancy within a year of stopping the pills.

So even while you’re preventing pregnancy in the short term, be sure to stay on top of your long term fertility. You can test your hormone levels with Modern Fertility, discuss the results with your doctor, and keeping tabs on the latest in fertility science right here.

Margo Steines

M.K. Steines is a writer based in Tucson, where she is an MFA candidate in nonfiction at the University of Arizona. Her work can be found around the web and in print. Instagram @redstateblues

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