We somehow got on the subject of periods.

She mentioned that she, and most of the doctors she knows, do not suffer through periods anymore.

They are too inconvenient, too unpleasant, and apparently not physiologically necessary.

Now, this probably won't come as a surprise, but I don't get periods.

Still, I found this conversation fascinating, so I hope you don't mind me, a non-period-having guy, covering menstruation and contraception.

Also, I should say, I did not write this episode.

I pitched it and then other people on the SciShow team took it on.

But the reason I did that is that I started to wonder if menstrual suppression is okay for the human body.

Like, doing that must have other effects, right?

And answering those questions is what SciShow is for.

So let's look at the research.

Is ending your period really safe?

[♪ INTRO ♪)]

Menstruation is essential to humanity.

If we don't do it, we can't make more humans.

And our species has been doubling down on menstruation lately.

We're having way more periods than we used to.

Like, 2.8 times more than we had in prehistoric times.

That increase is probably due to the fact that people spend less time in pregnancy and breastfeeding than they used to.

But today, we also have a lot of ways to not get periods.

And as I mentioned, I hear periods are not pleasant.

So maybe it shouldn't have been such a revelation to learn that people are using birth control methods to do more than just prevent pregnancy.

Complete period suppression is a thing.

What I'm talking about here is intentionally pausing your menstrual cycle and not having to deal with it every month through the power of birth control.

Now, this can actually happen naturally.

Some people end up skipping periods and going into a state called amenorrhea without the help of contraceptives.

But when your body naturally does this, it's not always a good thing.

Amenorrhea can be a symptom of extreme undernourishment.

In that case, your body might focus its hormonal resources on you rather than a potential pregnancy.

And because hormones maintain pretty much everything in the body, that shift could lead to more broken bones than usual, or even heart problems.

So that kind of natural period suppression isn't really something to strive for.

But artificially stopping your period using contraceptives is a different matter.

If you have any number of conditions like endometriosis, fibroids, or heavy bleeding, it can be medically beneficial.

There are several contraceptives that can significantly reduce the pain from those conditions, according to a recent clinical trial.

But a lot of professionals who suppress their periods do so because of the impracticalities of bleeding.

Astronauts and military personnel, for example, don't always have convenient times and locations to deal with their flow.

So they often just don't menstruate.

And you don't need to be an astronaut to do this, either.

Period suppression can be gender-affirming.

That's not to say that it's going to end your gender dysphoria or depression if you're dealing with that.

But it's just treating one trigger.

But that's better than treating none of them.

So for any number of reasons, a person might choose to take birth control to stop getting periods.

In fact, back in 1957, the first birth control pill, an Ovid, was approved by the FDA as a menstruation regulator.

Before it was ever approved as a contraceptive, the pill was used for this purpose.

Today, similar drugs are still the most common method of menstrual suppression.

Here is how that works.

Instead of cycling through ups and downs in your hormones each month, you stay in the same stage of the cycle every day.

So when you take a birth control pill, you don't release an egg, and you don't get pregnant.

On the Inovid pill, there was no medical need to have a period at all.

But people who used it kind of still did because of how it was administered.

The idea here was to reassure users that they weren't pregnant.

A person would take a regular hormonal regulator pill for 21 days, and then get a 7-day break.

During that break, they would experience something called withdrawal bleeding, which is the body's response to withdrawing from the hormonal pills.

So technically, the bleeding that a person might have on birth control isn't even a period.

But for all intents and purposes, it's still a whole lot like one.

Many people who take the pill today follow a similar schedule of skipping a week for that bleeding to occur, even though it's unnecessary to prevent pregnancy.

Now, you might have been told that you need to shed your thick uterine lining.

And that is actually true if you are normally cycling.

When you're on some forms of birth control, this is less of a problem.

For example, if you take contraception that introduces multiple hormones into your body, such as estrogen and progestins, your lining doesn't thicken in the first place, so you don't need to shed it.

Which means you can choose to not have a period.

And since the FDA approved that first method in Ovid, we've done a lot of iterating.

Today, there are dozens of different hormonal birth control methods that accomplish this.

They all alter the amount of hormones, like estrogen and progesterone, throughout your cycle.

The main difference are which hormones they target and at what dose.

And from the FDA's perspective, they are safe.

Menstrual suppression is a known effect of many approved birth control pills.

It's just that, also, there's more to the story.

From pretty much the beginning, some research has suggested that birth control pills can increase the risk of blood clots, especially in the legs and lungs.

And even today, doctors aren't sure what's driving this.

It may be that estrogen increases the pro-clotting factors in your plasma.

A study that began in 1968 found that people who took birth control pills were four times more likely to develop a certain kind of blood clot than people who didn't.

This calculation probably depended on what dose people were taking and which hormones the contraception messed with.

But those specifics are a little murkier.

And a 2018 meta-analysis found that some newer pills, like desagestrel, put you at an even higher risk of developing blood clots than others that have the same amount of estrogen.

Depending on which pill you take, the risk of blood clots may be as much as six times higher for people on the pill than those who aren't.

Even so, the risk is still fairly low, at only 12 in every 10,000 people developing this side effect.

The FDA has always stood by the pill because the number of people who would die from a blood clot complication on the pill is still actually smaller than the number of people who would die from pregnancy complications off it.

And that's a huge point that I will keep coming back to here.

When you're not using contraceptives, some of the most common of which are hormonal pills, you are way more likely to get pregnant.

And universally, pregnancy is one of the most life-threatening things we do.

In 2020, someone died from pregnancy-related complications almost every two minutes in the world, totaling just under 800 deaths every day.

Now, of course, this varies drastically depending on where in the world you live and the kind of access to healthcare you have.

So for low-income countries, birth-related complications account for the number 9 and number 5 leading causes of death, while they do not make it on the top 10 for upper-middle-income countries.

But on a global scale, the World Health Organization says that the best way to prevent these deaths is to use contraception to prevent unintended pregnancies.

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So birth control pills can increase your risk for blood clots.

They also reduce your risk of pregnancy-related death, and that's by a much larger margin.

With all that in mind, the World Health Organization has noted that your personal and family history of blood clots should be taken into consideration when starting a new contraceptive.

The thing is, blood clots aren't the only potential risk of using the pill to suppress periods.

Another concern is that it weakens your bones.

See, the amount of growth hormone and other stuff you use to grow bones increases and decreases throughout your hormonal cycle.

In fact, growth hormone peaks in the middle of the cycle along with estrogen.

So when you pause that cycle, it's going to mess with all those molecules.

And when they're low, you form less bone.

A study published in the journal Obstetrics and Gynecology found that how much that happens varies depending on your method of contraception.

They measured participants' bone mineral densities, and found that hormonal contraception is worse for your bones than non-hormonal options, like some intrauterine devices.

But they cautioned that they didn't investigate all of the many kinds of birth control pills, so you might get different results based on the one you use.

And they also found that age plays a role in this bone effect.

Bone mineral density is typically increasing in young people under the age of 18, but that growth sometimes pauses in young people taking hormonal contraception.

In the next age bracket, from 19 to 24, they start losing bone mineral density after contraceptive injections.

And by the 25 to 33 range, they might still lose bone mineral density, but not as much as when they were younger.

Now, fortunately, these effects seem to be reversible when you stop taking it or switch to non-hormonal contraception.

And while this is nothing to ignore, even at the peak of your bone mineral density loss, you're not losing as much as you will when you go through menopause.

This means that, again, the negative effects of hormonal contraception are not nearly as extreme as those same effects when they occur naturally.

The bone mineral density loss observed in one study during the first year of menopause was almost six times greater than what was observed in this contraception experiment.

And you gotta bring this back to balancing weak bones over an unintended pregnancy and or death.

Neither of those outcomes are guaranteed if you take hormonal contraception or don't, but you get the calculation here.

So if bone health isn't the be-all end-all consideration, what about your immune system?

Because yeah, hormonal birth control can really kick your immune system into overdrive.

And that sounds like a good thing if you happen to have a cold at the moment.

But if you're not sick and your immune system is overreacting, you can end up with autoimmune disorders.

See, inflammation is regulated by your hormones.

And when you introduce new hormones into your system from external sources, like contraceptives, you often end up with more signs of chronic inflammation.

A study published in 2024 compared people using hormonal contraception to those who aren't, and found that people on birth control have more of a protein associated with lupus, Crohn's disease, and other autoimmune disorders.

The authors of that study said that more research is needed before they can say exactly how this all increases your immune system's response to things that aren't necessarily posing a huge risk to you, like your own body.

But they think that birth control users might have exaggerated responses to the immune challenges they face.

And that is definitely a bad side effect.

But being at a higher risk for developing something doesn't mean that you are destined to develop it.

They haven't yet found that people are more likely to be diagnosed with autoimmune disorders when they are on the pill.

So the general guidance from doctors seems to be that if you already have certain autoimmune disorders, maybe try something other than a hormonal contraceptive.

The authors of that immune study also suggested that their results could help explain another risk of hormonal contraception—depression.

A lot of studies have tried to figure out how contraceptives are related to this mood disorder.

Some of them conclude that people who use hormonal birth control are more likely to also use antidepressants.

Others find no association.

And still others conclude that people who use it tend to be in better moods.

So the results here are mixed, to say the least.

To get to the bottom of these conflicting results, a 2016 study from Denmark compared more than 1 million people using different types of hormonal birth control.

It showed that when taking hormonal contraceptives, people become more likely to get their first prescription of antidepressants than people who have never used hormonal contraceptives.

And this effect peaks six months after use.

Now, depending on which contraception you use, the effect may be larger or smaller.

First-time antidepressant use was three times greater among those using non-oral contraception products, while birth control pill users were twice as likely to seek antidepressants.

One reason for that variation may be that some birth control methods are more progestin-heavy.

And that synthetic hormone can degrade serotonin, a chemical associated with your mood.

So while there is some conflicting information out there about depression in the pill, it is a potential side effect to take seriously.

But remember, the Denmark study had data on over a million people, and only about 23,000 of them got their first diagnosis of depression by the follow-up assessment.

So of course, this side effect is a big deal for the people it affects, but it isn't something that's, like, happening to everyone who uses hormonal contraceptives.

Ultimately, periods suck.

And they can come with some very real health consequences.

But so do the hormonal contraceptives used to suppress them.

Which means that whether or not it's safe to just not have periods anymore depends on how your body responds to that intervention.

In high-income countries, we have come a long way in preventing pregnancy-related death, and also pregnancy-related disability, by using contraceptives.

And you can see how life-saving they can be when you compare the data against other parts of the world with less access to this stuff.

But that doesn't mean that they come without a cost.

If you're not using them to prevent pregnancy, then the pros and cons might look a little different to you.

So thank you to that doctor who inspired me and the SciShow team to learn about all of this.

If you're thinking about menstrual suppression, talk to your doctor and decide what's right for you.

[♪ OUTRO ♪)]