April 6, 2023 – When Shazia Chowdhury was 12 years old, her period began and he or she wouldn't stop.
She bled for weeks and felt weak and dizzy. Almost a 12 months later, she finally visited her GP, who diagnosed her with a bleeding disorder and beneficial contraception to suppress her menstruation.
“I only had three or four days a month without bleeding,” said Chowdhury, now 18 and studying in New York City. “I can now sit comfortably instead of feeling my own blood every time I sit down.”
“I'm glad I took the pill because the bleeding was so overwhelming,” she said. “My quality of life would not have been as good.”
For many years, teens have been capable of safely suppress their periods with contraception. Hormonal contraception could make bleeding during menstruation less frequent and fewer intense, and sometimes can stop periods altogether. But not every menstruating teen is aware of this selection.
“As an adolescent health professional, I can say with certainty that there are certainly physicians who are hesitant to prescribe contraceptives to teenagers,” said Krishna Upadhya, MD, vp of quality care and health equity at Planned Parenthood Federation of America.
Some general practitioners who work with young people don’t routinely provide contraception of their practice and as a substitute refer patients to gynecologists.
“For some teens, this isn't a big deal,” Upadhya said. “But a referral can create additional hurdles to treatment, such as finding a new provider, additional doctor's appointments, and building a relationship with a new person who may or may not be receptive to teens' contraceptive needs.”
Charles Thompson, MD, director of the obstetrics and gynecology training program at Texas Tech University Health Sciences Center in Lubbock, said some health professionals could also be hesitant to prescribe contraceptives to teens if a parent or guardian doesn't support the thought. These caregivers and doctors could also be uncomfortable with the thought of teens taking contraceptives, even when the goal is period control and never pregnancy prevention.
“Whether you like it or not, taking birth control pills is tied to sexual activity,” Thompson said.
But teenagers don’t need their parents’ permission to get contraceptives prescribed, due to a Decision of 1977 by the US Supreme Court, which granted minors the proper to access contraceptives.
“I always recommend that it's good for the patient if a parent or guardian is willing to participate in the conversation, but it's not required,” says Dr. Julia Cron, chief of the department of obstetrics and gynecology at NewYork-Presbyterian Lower Manhattan Hospital in New York City.
Making life more nice
Teens may ask to suppress their periods in the event that they have painful or heavy periods, especially if their period causes them to miss school or work. Patients with gender dysphoria might also wish to suppress their periods as a primary step toward gender reassignment treatment, says Dr. Sloane Berger-Chen, an ob-gyn specializing in child and adolescent health on the University of California, San Francisco.
“What we're trying to say is that the menstrual cycle is a normal part of life; however, your period should not hinder you,” she said.
This was the case with 45-year-old Sarah Bramblette, who began her period at age 13.
“My bleeding was so severe that I had to go to the emergency room to get everything checked out,” said Bramblette, board chair of the Lymphedema Advocacy Group and co-chair of the Access to Care Committee of the Obesity Action Coalition in Miami.
She first tried to manage her period when she ended up within the emergency room with heavy bleeding on the age of 18. She had a Dilatation and curettagewhich involved removing tissue from the uterus to scale back blood flow. She was referred to a gynecologist who gave her contraception to suppress her period.
“It changed my life completely,” said Bramblette. Thanks to contraception, “my periods stopped completely.”
Blackberry brooch has lymphedemaa chronic disease characterised by fluid buildup within the arms or legs. She wears tight compression garments to permit excess fluid to flow into through the swollen limbs. Changing sanitary items in public restrooms is almost not possible for Bramblette because the clothes are difficult to remove, especially in cramped spaces. Suppressing her period with contraception helps her avoid hygiene problems while attempting to keep each conditions under control.
Her doctor was concerned that hormonal contraception might weaken her bones over time, so she has her skeletal health checked annually to scale back the chance of fractures.
This is how period suppression works
Contraceptives work in alternative ways, and a few are higher at suppressing periods than others. The “pill” – normally a mixture of progesterone and estrogen – thins the liner of the uterus, reducing the quantity of blood passed. Patients taking a 28-day pack of contraception pills take hormonal pills for 3 weeks and placebos for 1 week. The non-hormonal pills, which normally contain sugar or iron, are designed to assist patients proceed taking them until the subsequent cycle.
The lack of progesterone signals the body that bleeding is about to start. Taking the placebo pills for every week allows the body to undergo progesterone withdrawal. Patients who don’t take the placebo pills can have their periods suppressed because they never get the signal for a period.
Although Intrauterine devices (IUDs) can provide some period suppression, however the frequency of bleeding shouldn’t be as predictable as with the pill, Berger-Chen said.
Patients wonder if it's secure to skip the placebo week, however the withdrawal bleeding people experience when taking placebo pills isn't medically mandatory, Cron said. Skipping the non-hormonal pills doesn't cause long-term harm.
She added that young people, their parents and a few doctors may consider that treating younger individuals with contraceptives could affect their fertility, body size or their health in other ways.
But most adolescents have reached 95% of their total height by the point they reach their first menstrual cycle, Berger-Chen said. Most girls only grow 2 to 3 inches more after that they had their first period.
Birth control pills can increase slightly the chance of breast cancer, but when a patient stops taking the prescription pill, the chance returns to baseline. If she starts taking the pill at a young age, the lifetime risk doesn’t change.
Another misconception linking contraception and infertility is that many ladies take contraception for years, and by the point they stop of their 30s or 40s, fertility is already naturally declining. These patients may consider that fertility problems are the results of their years of taking contraception.
“The concern is that long-term use of the pill may cause fertility problems, but it is more likely to be due to the person's age than the length of time the pill has been taken,” says Cron.
Berger-Chen says that for a lot of patients, the advantages outweigh the risks. Chronic suppression of ovulation through contraception can increase your overall lifetime risk of Ovarian and colon cancer and was found, alleviates estrogen fluctuations which may trigger migraines in menstruating patients before or during their period.
Young people need “non-judgmental care in the area of sexual and reproductive health [from] Providers who can listen to their concerns and help them get the resources they need to live healthy lives,” Upadhya said.