A Brief History of Your Period and Why You Don’t Have to Have It

Seattle family planning doctor Deborah Oyer routinely asks new female patients, “How often do you want to have your period? Monthly? Every three months? Or not at all?” Until she asks, some don’t know they have a choice. Like every other aspect of reproductive health, menstruation is a fraught topic. A woman who is actively managing her period is in control of her fertility; in Judeo Christian folklore, she is cheating Eve’s curse. Even talking about menstruation can violate taboos. Consequently, most of us are astoundingly under-informed about a facet of womanhood that affects anyone who either has a uterus or loves a person who does.

For example, did you know that:

  • Modern Western women have four times as many periods over a lifetime as our hunter gatherer ancestors and triple the number for women just a hundred years ago.  In other words, what seems “natural” now is very different from what our bodies have historically supported or have evolved to support.
  • In the 19th Century there was approximately a five year gap between when females started their periods and age at first marriage; now the gap is closer to fifteen years, with many girls starting in grade school.
  • Girls who start early are more likely to have painful cramps and heavy bleeding.
  • Menstrual contractions can be as severe as early labor and can trigger vomiting or blackouts.
  • Menstrual symptoms cause over 100 million lost work hours annually for American women; they are the number one reason young women miss school or work. In the developing world menstruation is a factor in adolescent girls leaving school.
  • A woman can now choose to regulate her periods using either short acting contraceptives like pills or rings or a long acting method like an IUD or injections.
  • Given an option, about one third of women would choose to keep their period; the other two thirds would prefer to ditch it.
  • There are no known long term health consequences of menstrual regulation or suppression in healthy women.
  • IUD’s (which are as effective as sterilization from a contraceptive standpoint) were recently approved by the FDA to decrease menstrual symptoms and endometriosis and are rapidly becoming a first-line treatment for many menstrual problems.
  • A hormonal IUD reduces menstrual bleeding by on average 90% and many women have no period by the end of the first year –yet menstruation and fertility return within a single cycle after removal.
  • Italian researchers found that menstrual symptoms and related absenteeism accounts for approximately 15% of the wage and promotion gap between men and women.

Over the centuries, many religious leaders have taught that women were made for childbearing, and some, known as complementarians, take this position today. Fortunately, few go as far as Reformation father Martin Luther: If a woman grows weary and, at last, dies from childbearing, it matters not. Let her die from bearing; she is there to do it. Complementarians are right in one sense: our bodies are optimized to produce the greatest number of surviving offspring, even if it costs us in other dimensions of health or wellbeing. In past centuries this meant a high level of mortality for women and babies. Historically, one woman died for every hundred pregnancies. When that is multiplied by a traditional number of pregnancies per woman, you get a maternal death rate close to ten percent, similar to what it is in Afghanistan today. Globally, half a million women die each year due to complications of pregnancy and childbearing.

Producing babies with big brains is rough, and our bodies work very hard each month to ensure that we have surviving offspring despite the odds. In a sense, each menstrual period is an incident of failed pregnancy. The uterine lining thickens just in case some lucky egg-sperm fusion should come along and attach itself to the endometrium. Even with this month-after-month cycle of preparing for pregnancy, it is now thought that most fertilized eggs fail to implant. From a biological standpoint, gearing up for pregnancy each month is costly, which has made evolutionary biologists curious about the advantages.  The evolutionary disadvantages are easier to spot: anemia, for example, and a blood or scent trail that might attract predators.

Menstruation and reproduction are as entangled with culture and religion as they are with each other. The ancient Hebrews justified the pain and trauma of childbirth, along with subjugation of women, through the Eden story. In it, Eve is created from Adam’s rib to be a “helpmeet” to him. Later, God punishes her for eating from the tree of knowledge: I will greatly increase your pains in childbearing; with pain you will give birth to children. Your desire will be for your husband, and he will rule over you. (Genesis 3:16)  In the Hebrew religion, menstruation was not only physically unclean, it was spiritually unclean, as was childbearing, and a woman was unclean for twice as long when she gave birth to a baby girl as a baby boy. On the other hand, in many cultures and for some women in our culture, menstruation is a point of pride. Childbearing is a form of power, one of the greatest powers in the world, and menstruation is a sign of that power. Onset is accompanied by rituals as solitary as days of isolation or as social as community feasting and dancing.

Given the cultural significance of menstruation, it should come as no surprise that a variety of groups and individuals are uncomfortable with the idea of women choosing or not choosing to have periods. In this regard religious conservatives find themselves in unfamiliar company. Some of their fellow advocates are wary of the medical establishment and instead promote natural living and alternative medicine. Some hate the “medicalization” of women’s bodies and reproductive health and think we should embrace menstruation as part of what it means to be powerful, female and sexual. Some believe that the ovulatory system has other health functions and shouldn’t be messed with. (Until the Population Council developed what is now the Mirena, it was not possible to actively manage menstruation without also suppressing ovulation.) Some have had bad experiences with hormonal contraceptives. Some find a spiritual rhythm and serenity in the monthly cycle. Unfortunately, the cultural or spiritual weight given to menstruation means that matter of fact, pragmatic information can get pushed to the periphery, distorted or even suppressed.

That is unfortunate for women who simply want to manage their lives. It is especially regrettable for millions of girls and women with debilitating cramps, severe bleeding or menstrual migraines. For most of us, how often we menstruate is not some form of cultural advocacy. It is a practical, personal question. Evolutionary programming aside, most of us don’t want to maximize our number of pregnancies. Many of us don’t care particularly about what religious leaders think of “Aunt Flo.” We simply want to take care of ourselves, our sex lives, and our children or future children. We don’t want cramps, bloating, back aches, nausea, fatigue, mood swings or migraines. But we do value our fertility and want to make sure that we can have babies when we feel ready. We are interested in avoiding anemia and endometriosis and plain old monthly malaise, but we are cautious about profit driven medical treatments that affect our reproductive tracts. Some of us also like to dance in leotards, swim in bikinis, race in triathlons, work in military combat zones, backpack in bear country, or wear white in the summer. All of this means that we want accurate, practical information and options when it comes to our periods.

Ironically, when research first began on the Pill in the early 20th Century, menstrual symptoms like dysmenorrhea (pain) and menorrhagia (heavy bleeding) were front and center in the conversation. Preventing conception itself was so controversial that it was listed as a side effect on an early application for FDA approval. In 1873, at the behest of anti-obscenity crusader Anthony Comstock, the U.S. Congress had passed the Comstock laws which made all contraception illegal. Condoms could be sold only for “feminine hygiene.” Such was the situation when Margaret Sanger’s mother died at age 50 after eighteen pregnancies and eleven live births. Sanger herself was tried for a Comstock violation in 1936. After that, prosecutions dropped away, but thanks in part to advocacy by Catholic leaders and conservative Protestants contraception remained controversial.  Feminine hygiene products, on the other hand, flourished, and so it was natural that as contraceptive technologies emerged so did carefully worded conversations about hygiene and menstrual management.

From the beginning, doctors recognized that there was no medical reason for women on the Pill to bleed, but they thought Pills would be more accepted by the public and by Catholic authorities if they mimicked a monthly menstrual cycle. For women who are taking oral contraceptives, monthly bleeding triggered by seven days of placebos isn’t actually menstruation, but rather a response to hormone withdrawal. Real menstruation is evidence of a feedback loop in which a functioning hypothalamus and pituitary signal the ovaries and uterus, causing a follicle to develop and egg to be released into an environment that is ready to receive it. The hormones in most oral contraceptives suppresses this cycle of ovulation. In other words, women who are on the pill to regulate their periods aren’t actually regulating them. They are suppressing them and replacing them with withdrawal bleeding, and benefits of menstrual suppression accrue whether the monthly bleeding occurs or not. For two generations, women using hormonal contraceptives have bled monthly for cultural reasons, most without knowing there were alternatives.

Fortunately we now have other options. No matter how often a woman wants to have periods, monthly, every three months, or not at all, there are state-of-the-art top tier contraceptives that can fit the choice. That is why Dr. Oyer’s question, “How often do you want to have your period?” is a reasonable one for her to ask her patients. If you are female, it is also a reasonable one for you to ask yourself.

—-

Read more about contraception by this author:
Picture a Technology Revolution. In Contraception. It’s Here!
Dramatic Drop In Teen Pregnancy Really a Technology Tipping Point
Pamper, Pamper, Pamper – Plus 9  Other Tips for Falling in Love With Your IUD
Hey Ladies!  Thinking About Ditching Your Period?  A Doctor Answers 12 Puzzling and Hopeful Questions
The Big Lie About Plan B – What You Really Should Be Telling Your Friends

Valerie Tarico is a psychologist and writer in Seattle, Washington.  She is the author of Trusting Doubt: A Former Evangelical Looks at Old Beliefs in a New Light and Deas and Other Imaginings, and the founder of www.WisdomCommons.org.  Her articles can be found at Awaypoint.Wordpress.com

At Jezebel: A Brief History of Your Period and Why You Don’t Have to Have it

About Valerie Tarico

Seattle psychologist and writer. Author - Trusting Doubt and Deas and Other Imaginings. Founder - www.WisdomCommons.org.
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37 Responses to A Brief History of Your Period and Why You Don’t Have to Have It

  1. Interesting… I had never quite made the connection that using OC to regulate bleeding wasn’t actually regulating, but replacing. It’s changed the way I’m thinking about an up-coming decision, and I have another question for my doctor. As always, thanks for the thoughtful and informative post!

  2. Good luck with your decision. Ask lots of questions! My daughters, who are 16 and 17, both have Mirenas. I have a copper IUD and love it, but they were both interested in having their periods reduced for different reasons and after doing the research it seemed like a better thing to try than OC. The hormone dose is way lower, the long term cost is lower, the contraceptive efficacy is higher, and you don’t have to remember to do something at the same time every day (which given that they are genetically related to me would have been a real challenge.):) With an implant you get a higher dose of hormones–more like the Pill, and less predictable effect on periods. The ring that is available now is more like the Pill in terms of mode of action.

    • Thanks you! I’m especially interested in hormonal affects and regulating my period due to a medical condition I have, but contraception seems to always be on my mind lately – it’s hard not to think about it with all the debate going on about it right now.

    • Geek Goddess says:

      Great piece. Thank you. I didn’t experience problems until I reached my 40’s, at which time my menorrhagia became so bad my entire life, especially business travel, was arranged around my 10 day periods. I had to change napkins every 30 minutes, which made it impossible to stay seated in an airplane!

      A uterine ablation worked for a while, then a took shots for a couple years. The excess bleeding started again until a kind doctor suggested I didn’t really need a uterus any more. That surgery changed my life, for the better. I can travel, work in my (nearly) all male industry, do anything or wear anything I want. The idea that women are frequently slaves to their biology is antiquated.

      How does the Catholic Church view Viagra?

      • Here’s one Catholic take on viagra: “Use of drugs such as Viagra to help overcome pathological conditions can certainly not be immoral. The difference between use of such drugs and artificial contraceptives is that contraceptives do not help overcome a pathological condition. Being fertile is not a pathology. There is quite a difference. Viagra does not go against nature — it assists nature. Artificial contraception does not assist nature — it goes against nature.”

        I’m not quite sure what the term “nature” means in this context — other than being synonymous with fertility.

  3. Tim Miller says:

    Wow, fascinating stuff. I had no idea about most of what you say above. All your posts are good but I learned more from this one than any of the others.

  4. mikespeir says:

    Can’t really identify, being a non-female type. Interesting read, though.

    • Philip Quillen says:

      Ummm .. Mike, you do not have to be a female to experience the misery of severe menstruation issues. All you have to do is live with a woman unfortunate enough to have such problems. A lot of understanding and empathy goes a long way toward helping with the situation.

  5. KB says:

    Mostly I think this is a well developed article with a good message. I am all about more information for decision making. For myself perhaps it is a little irrelevant: I have long, over a month cycles and rarely experience pain, but to those women who might want to choose reduced periods, more power to them. However, three things stand out which jar so painfully to me that I feel like I need to comment on:

    “Modern Western women have four times as many periods over a lifetime as our hunter gatherer ancestors and triple the number for women just a hundred years ago. In other words, what seems “natural” now is very different from what our bodies have historically supported or have evolved to support.”

    A great deal of that (and the paper you cite supports this) is due to the fact that pre-modern women were constantly in a cycle of pregnancy and breastfeeding (which is a lot shorter a period these days due to logistics than it used to be). Taking the model as simply that we used to have fewer periods ignores the actual complicated system of ebbing and flowing of hormones that our bodies have evolved to handle. Maybe taking those hormones artificially to reduce periods without actually experiencing pregnancy isn’t a bad thing (remains to be seen), but historical precedence doesn’t justify why it would be a good thing either unless you wish to make the case that we should be pregnant and nursing more often. I’d of course have to disagree with you then (haha!)

    “In the 19th Century there was approximately a five year gap between when females started their periods and age at first marriage; now the gap is closer to fifteen years, with many girls starting in grade school.”

    According to what you cited, the average age has dropped in France from 15 to 13. It is something to ponder (why? what does this mean?) but I think the way you present this information is a little misleading. The difference between 2 (the change in age of first menstruation) and 10 (the change in span between first menstruation and first marriage) is significant. 80% of that change is due not to biology, but the culture of delaying marriage.

    “There are no known long term health consequences of menstrual regulation or suppression in healthy women.”

    Well of course not. People haven’t been using menstrual suppression long enough and in enough numbers to make that assessment. At this point it is informed speculation.

    That’s all. Thanks for the read!

    • Hi KB –
      Thank you for taking the time to comment! You are right about the primary reasons for fewer periods in the past and that just because something used to be common doesn’t make it good. Nature optimized us to produce lots of babies that die. That said, and maybe I didn’t link this, there is some evidence that more ovulation and more periods actually increases the risk for cancers including endometrial cancer. A progestin IUD mimics suppresses the endometrial cycle by using a synthetic version of the same hormone our bodies use during pregnancy.

      You also are right about the marriage gap. I should have been clearer because you are right it isn’t mostly about changing biology but rather about changing cultural patterns. The point I meant to make is that there is quite a significant lag between girls’ bodies start getting ready to produce babies and when they actually might want to begin childbearing.

      With regard to your third point, also a good one there is now about 20 years of data on women using progestin IUDs in Europe. Their health and return to fertility has been monitored closely. This is not to say that the researchers haven’t missed something–only that the data looks good over at least half of a normal reproductive lifetime. I don’t know the data as well for menstrual suppression with oral contraceptives, which have a much higher dose of systemic hormone and so more side effects generally. No medication is risk free, and I think all we can hope for is to look at a preponderance of evidence and then we end up weighing the risk-benefit on both sides of the equation and trying to take care of ourselves as best we can.

      • Jane says:

        Thanks for the great article!
        I was curious to know if you have any information or understanding of the increase in breast and ovarian cancer – which I can’t tell if it has statistically increased or that we have just become more aware of it. Do you think these medical occurrences are connected to our synthetic hormone regulation? I remember reading a contraception site saying there wasn’t a correlation, but maybe that’s just for promotional purposes. These are our bodies! We deserve the safest information :)

      • Good question, I should do more research on it. I am not a medical expert, so don’t construe this as medical advice. Based on the research I’ve seen, the use of a hormonal IUD like the Mirena appears to lower the risk of cervical and uterine cancer. I haven’t heard anything about it reducing the risk of breast cancer. Then again it releases only a (mostly local) microdose of the progestin Levonorgestrel, and the questions about increased cancer risk have to do primarily with estrogen, which continues to cycle with a Mirena even when menstruation itself has stopped.

        Here is information from the National Cancer Institute about Combined Oral Contraceptives. It looks like some cancers are increased slightly and some are decreased.

        A number of studies suggest that current use of oral contraceptives (birth control pills) appears to slightly increase the risk of breast cancer, especially among younger women. However, the risk level goes back to normal 10 years or more after discontinuing oral contraceptive use.
        Women who use oral contraceptives have reduced risks of ovarian and endometrial cancer. This protective effect increases with the length of time oral contraceptives are used.
        Oral contraceptive use is associated with an increased risk of cervical cancer; however, this increased risk may be because sexually active women have a higher risk of becoming infected with human papillomavirus, which causes virtually all cervical cancers.
        Women who take oral contraceptives have an increased risk of benign liver tumors, but the relationship between oral contraceptive use and malignant liver tumors is less clear.

  6. Marilyn says:

    Regarding the younger and younger age at which today’s girls are starting their menses, I have an interesting viewpoint. I worked in the medical field for 30+ years and can remember when the term “precocious puberty” was used during the early 70s. It usually meant a girl starting her period before age 10 or 12, sometimes as young as age 7. I doubt that term is even used any more, considering that a lot of girls are starting secondary development at age 7 (i.e. breast development) or age 8 (BOTH of my daughters did) and first onset of menses began at age 10. I’ve always wondered why this seemed to be happening more and more frequently, but finally decided that a good possibility is the added hormonal steroids added to the poultry & livestock (i.e. beef) that we eat in this country. I greatly enjoyed your much researched article and thank-you!

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  10. Here’s a new development: the Intra-Uterine Ball. Not out of the lab, apparently, but perhaps interesting.

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  12. Irene says:

    This is so interesting and maybe you can help with the question no doctor has answered for me. I´m 36 and highly irregular in my cycle, sometimes 3 months and have been rellying on pills to get a monthly period. But I am not interested in having kids so I have asked time and time again and also different doctors on whether it is important for me to keep taking these pills if I am not interested on having a period. Thanks!

    • Hi Irene –
      My impression is that it all depends on why your period is inconsistent or absent. It’s not that having a period is healthy in itself–in fact more and more research is showing health benefits of fewer periods. It’s the underlying nutritional status, hormonal balance, and health of your reproductive system that doctors worry about when women spontaneously have inconsistent periods. I don’t know the answer to your question, but I should think it’s worth posing to a medical specialist. In Seattle I might suggest calling Deb Oyer, M.D. at Aurora Medical or Karen Bohmke, M.D. at Northwest Women’s Health Care.

  13. Irene says:

    Thanks for answering so quickly! Thanks for the contact info but problem is I live in Mexico City. All the checkups (from me being 20 to last year) show perfect health (hormonal chekcs, etc) – but I´ve always been overweight (currently with a nutrition expert and about to reach the mark) so my concern is exactly that = what is really wrong but most doctors seem to focus on me being “regular”. Thank you again for the response and will keep looking for answers =)
    Regards,

  14. Anna says:

    Have you come across any research with women born with streak ovaries and not having periods? Is it needed for someone with streak ovaries to have them?

    • My understanding is that women with streak ovaries are typically given estrogen and progestin supplements which cause breast growth and menstruation. They don’t produce eggs, and so can’t get pregnant except with a donor egg. I don’t know if induced menstruation has health benefits for them or not.

  15. tosha wilson says:

    I haven’t. Had a cycle in 13yrs but I want to. Have another child. What can I do

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  17. Melinda says:

    Im 19 Years old and have just been to the gyno and my periods are fricking nuts unfortunately ! Sometimes i bleed for months at a time sometimes i wont have a period for months and months I have gone to the doctor they did everything checked me by ultra sound pelvic exam thyroid pylop etc they say everything is normal but I still dont feel this is normal i just started nuvaring so far its ok . . . Im worried after all the research ill never have children . . Its A journey )= cause i still am confused why my periods are so out of Control

    • Hi Melinda –
      I’m so sorry that things have been rough for you. What a roller coaster. I spend a lot of time reading research in contraception, and if it is any reassurance I see no evidence that regulating your period with oral contraceptives or Nuvaring or an IUD will increase your risk of infertility. We all have some risk of infertility either way, and as I’m sure you know fertility tends to decline with age, but there’s no reason at least to feel like you’re doing something that stacks the odds against you. I do wonder what’s going on with your body, and since it sounds like you would like to have a child at some point, I would persist in trying to get some answers about that.

      • Melinda says:

        Thats good to know hopefully this birtcontrol will regulate it after taking it a few years MEN ARE SO LUCKY thanks for writeing me back wish me luck girl.

  18. Ceyda says:

    Hello Dr. Tarico,
    I have been suppressing my periods by minipill for about two years without any break.
    How many years can I use the minipill more, without any break?

    Thank you.

    Ceyda

  19. Rosie says:

    Does stopping the bleeding also help control the emotional roller coaster associated with the beginning of a period as my life is one big roller coaster with about a week of relative normality in it. I am 50 and sick of it.

    • I’m not a doctor, but my understanding is that the emotional roller coaster is related to estrogen cycling. If so, managing your period via continuous oral contraceptives might help, but using a state-of-the-art hormonal IUD wouldn’t as it releases only a local micro-dose of progestin and doesn’t change the estrogen cycle. But please don’t take my word for it. If you’re in Seattle, a great specialist is Dr. Deborah Oyer at Aurora Medical.

  20. Rosie says:

    Thank you I’m in N.Z but will follow up with my Doctor.

  21. Christina B. says:

    I’ve been using OC to suppress my periods for over a year now and it works most of the time. At first I was on Loestrin24 and when it discontinued I was switched to Minastrin(a chewable tablet that is supposedly the same thing) I’ve found that even being 2-3 hours late taking the pill can cause spotting. And even though womans periods “syncing up” is supposedly a myth, I’ve found that even when I’ve been taking the pill perfectly I always cramp and bleed some when my roommate/best friend is on her period. It really doesn’t make any sense but it happens every month without fail even though its usually only one day(I’ll suddenly bleed normally for a few hours then it will taper off and disappear until the next month). At first I thought I was doing something wrong, but I figured it can’t be coincidence that every single time I’ve had breakthrough bleeding has been while my roommate was on her period. I started this after doing some research when I was having issues with my period. In late 2011 I went several months with no period(which was normal for me) and I wasn’t worried because I wasn’t sexually active, then the first week of January 2012 my period started and by the 2nd week of March I was begging for an appointment because it hadn’t stopped and had been heavy(again normal for me) the whole time. I had started taking iron supplements because I had been starting to get lethargic and sleeping all the time. I was able to get an appointment and had an exam, blood tests, and an ultra sound. Even the doctor and ultra sound tech seemed surprised at how much I was bleeding during the exams. However all tests came back normal and no reason was found that caused it. I was given a shot of estrogen, estrogen pills, and given the prescription for OC and sent home. Even while taking the pill as instructed my periods where still relatively heavy and after doing some research about Loestrin I learned that it was the most used pill for suppression of periods and decided to give it a try and it changed my life for the better. I had looked into Mirena but I thought that I had read that it was only for those who already had at least 1 kid and didn’t think I would have much luck in getting my Dr to let me try it out, because I definitely want something that works like my pills but that I don’t have to remember to take at the same exact time every single day.

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