People with vaginas have a wide range of experiences when it comes to their menstrual cycles. For some, the cycle is predictable, for others, it’s impossible to know what to expect. A period can be a way to be in tune with your body, or it can be a monthly appointment with gender dysphoria if you do not identify with your assigned female gender.
For some, a period is merely a nuisance, for others, it’s cramping that feels like a sharp-clawed rodent is trying to tear its way out of your uterus. For many, it’s more than just a “bad period.” There exist a plethora of reasons — from endometriosis and PCOS to fibroids and anemia — why a person might want to make their menstrual cycle more tolerable, or get rid of it altogether.
There are several methods that can potentially reduce the frequency and intensity of bleeding patterns, or completely stop bleeding and/or your menstrual cycle. This is known as menstrual suppression.
Is there anything that can be done once bleeding has started for the month?
Unfortunately, once bleeding has begun for the month, flow length and intensity can’t really be controlled for that period. We’ll get into the methods to prevent menstruation later on, but first, there are some general things to consider to mitigate the pain and discomfort if your flow is already here:
1. Ibuprofen: If you’re in pain, you can take an over-the-counter pain reliever. Talk to your healthcare provider about the best dose to take for your pain level.
2. Heat therapy: Use heating pads or hot water bottles to soothe menstrual cramps, or soak in a warm bath.
3. Avoid caffeine: The American College of Obstetricians and Gynecologists (ACOG) recommends that people with vulvas who experience premenstrual syndrome (PMS) avoid consuming caffeine. However, this doesn’t apply to all, so please consult with your doctor (and pay attention to how your body reacts to caffeine when you’re on your period).
Temporary, ongoing menstrual suppression
Note that these options aren’t one-size-fits-all. What works for one person with painful, heavy periods, may not help the next person. It’s crucial that you and your healthcare provider work together to discuss and explore options, as well as to be aware of the possible side effects and long-term health effects of any methods being considered.
Combined Oral Contraceptive Pill
Combined oral contraceptive pills (COGs), using a combination of progestin and estrogen, are designed to keep the uterine lining thin and suppress hormone production and follicle growth — the development of the ovum. Normally, three weeks of active pills are taken, followed by a week of placebo (inactive) pills, when most would get what is referred to as “withdrawal bleeding” as a result of no longer receiving pills with active hormones. However one can safely suppress the menstrual 'withdrawal bleeding' by skipping the last week of placebo pills and instead starting a new pack, and continually taking the 21 pills that contain hormones.
This method is successful about 74 percent of the time in suppressing the menstrual cycle, as well as reducing dysmenorrhea, menstrual cramping in the belly, pelvis, hips and low back, often associated with an upset stomach and vomiting, a common experience for folks with periods, ranging in severity.
There are also a few contraceptive pill options that are specifically designed to delay the frequency of the menstrual cycle. Ask your healthcare provider for more information.
Hormonal Intrauterine Device (IUD)
There are a couple types of IUD that one can choose from as a method of birth control, one being the copper IUD, the other being the hormonal IUD. The hormonal IUDs containing progesterone, such as the Mirena, Skyla, and Liletta, are an option to consider if one desires to reduce their monthly bleeding, or at least lessen it. These small T-shaped devices that are implanted in the uterus have been shown to reduce heavy menstrual bleeding and symptoms of dysmenorrhea by up to 90 percent and nearly half of IUD users on the highest dose of IUD report amenorrhea by six months of having it inserted. Lower doses of IUD don’t work as well to prevent menstruation. Most others will have lighter or less frequent bleeding.
However, Nathan Riley, MD, and host of the Obgyno Wino Podcast, notes, “there is the possibility that this method can create irregularity in bleeding leading to spotting throughout the month that many people may find undesirable."
An advantage, though, is that the IUD only needs to be inserted once and can be used for as long as three to five years — no need to worry about a daily pill.
The Depo-Provera (depot medroxyprogesterone acetate) shot is another method to consider. These shots, administered every 90 days, act by working on your pituitary gland, which causes the ovaries to stop releasing eggs, rendering one unable to get pregnant. Additionally, it alters the ecosystem of the uterus, by changing the cervical lining and cervical mucus, which makes it more difficult for any sperm to travel.
Prolonged use of the Depo-Provera shot reduces the frequency of menstruation as well as symptoms related to menstruation. Within a year, about 50 percent of users have successful menstrual suppression, that number increasing to 90 percent after two years of use.
Long-term solutions to consider
For people suffering from very heavy menstrual bleeding, or chronic reproductive health concerns, there are a few safe and fairly common non-surgical and surgical procedures that one may consider.
Endometrial ablation involves the removal of the functional endometrium. This non-invasive procedure involves removing the thin layer of uterine lining without making any incisions. The result is the prevention of the regeneration of this endometrial lining, effectively suppressing the menstrual cycle and inducing amenorrhea.
Satisfaction rates from endometrial ablation range from 77 percent to 96 percent, reporting a significantly lighter, less frequent flow, less dysmenorrhea, and improved quality of life, with complete amenorrhea occurring in 14 to 70 percent.
Folks with vulvas who experience conditions that cause the menstrual cycle to be an atypically painful experience, such as endometriosis, chronic pelvic pain, or abnormal or extreme uterine bleeding, who desire a more permanent option may consider a full or partial hysterectomy.
A hysterectomy is a surgical procedure in which the uterus is removed — with or without the cervix, fallopian tubes, and/or ovaries, depending on the person’s specific situation.
When it comes to heavy bleeding, hysterectomies have similar satisfaction and amenorrhea rates to endometrial ablation but have longer recovery time and higher rates of post-surgical complications.
Understand the potential side effects of menstrual suppression
It’s important to note the side effects of any method you choose to suppress or lighten your menstrual cycle.
Dr. Riley tells O.school, “When a person is taking birth control, their ovaries are effectively in hibernation — they’re not cycling, the eggs aren’t maturing — and what you’re doing is saying to the body “hey, let’s pretend like we’re in menopause.”
With the ovaries shut down during this period of time, Riley explains that “one might notice increased dryness, less lubrication, lower libido, and changes in mood.”
Data consistently supports the suggestion that dyspareunia (painful penetration), vaginal atrophy (thinning and fragility of the vaginal canal), and vaginal dryness are associated with hormonal contraceptive pills, hormonal IUD, and hysterectomies.
As with any reproductive healthcare decision, you deserve to know all the options and potential side effects. That way you can make the best decision based on your body, your life and your priorities. These options should be discussed at length with your healthcare provider, so you can work together to determine the best road to relief for you.