April 6, 2023 – When Shazia Chowdhury was 12 years old, her period started, and it wouldn’t stop.
She would bleed for weeks on end, leaving her weak and dizzy. Nearly a year later, she finally visited her primary care doctor, who diagnosed her with a bleeding disorder and recommended birth control to suppress menstruation.
“I only went 3 or 4 days out of the month without bleeding,” said Chowdhury, who's now 18 and a student in New York City. “I can now sit comfortably instead of feeling my own blood every time I sit down.”
“I’m glad I went on the pill because the bleeding was so overwhelming,” she said. “My quality of life wouldn’t have been great.”
Adolescents have been able to safely suppress their period with birth control for decades. Hormonal birth control can make the blood that flows during menstruation less frequent and less intense, and it can sometimes stop periods completely. But not every menstruating teenager is made aware of that option.
“As an adolescent medicine physician, I can say with confidence that there are certainly providers who are reluctant to prescribe birth control to teens,” said Krishna Upadhya, MD, vice president of quality care and health equity at Planned Parenthood Federation of America.
Some primary care doctors working with young people don't include contraception as a routine part of their practice, and instead refer these patients to OB/GYNs, she said.
“For some youth, that’s not a big deal,” Upadhya said. “But referring them out can add barriers to care like finding a new provider, additional medical appointments, and building rapport with someone new who may or may not be receptive to adolescent contraceptive needs.”
Charles Thompson, MD, director of the obstetrics and gynecology residency program at Texas Tech University Health Sciences Center in Lubbock, said some health professionals may be reluctant to prescribe birth control to teens if a parent or guardian doesn’t support the idea. These caregivers and doctors may be uncomfortable with the idea of a teen being on birth control, even for period management instead of the prevention of pregnancy.
“Whether you like it or not, birth control pills are tied to sexual activity,” Thompson said.
But teens do not need their parents' permission to be prescribed birth control, thanks to a 1977 decision by the U.S. Supreme Court that gave minors the right to access contraceptives.
“I always recommend that if a parent or guardian is willing to engage in the conversation, it's good for the patient, but they don't have to,” said Julia Cron, MD, chief of the Department of Obstetrics and Gynecology at NewYork-Presbyterian Lower Manhattan Hospital in New York City.
Making Life More Comfortable
Teenagers may ask to suppress their periods if they have painful or heavy periods, especially when their period leads to missing school or work. Patients with gender dysphoria may also want to suppress their period as a first step for gender-affirming care, said Sloane Berger-Chen, MD, a gynecologist specializing in pediatric and adolescent reproductive health at the University of California, San Francisco.
“We try to say that menstrual cycles are a normal part of life; however, your period should not hold you back,” she said.
Such was the case for 45-year-old Sarah Bramblette, who started her period at age 13.
“My bleeding was so heavy that I had to go to the emergency room to get things checked,” said Bramblette, who is the board chair of the Lymphedema Advocacy Group and co-chair of the Obesity Action Coalition’s Access to Care Committee in Miami.
She didn’t seek management of her period until she ended up in the emergency department with heavy bleeding at age 18. She had a dilation and curettage procedure, in which tissue was removed from the uterus to reduce blood flow. She was connected to an OB/GYN, who provided her birth control to suppress her period.
“It was pretty life-changing,” Bramblette said. Birth control “completely stopped my periods.”
Bramblette has lymphedema, a chronic disease marked by the buildup of fluid in the arms or legs. She wears tight compression garments to help excess fluid circulate through swollen limbs. Changing sanitary products in public restrooms feels near impossible for Bramblette because the garments are hard to remove, especially in cramped spaces. Suppressing her period with birth control helps her avoid hygiene issues while trying to manage both conditions.
Her doctor was concerned that hormonal birth control might weaken her bones over time, so she monitors her skeletal health annually to lessen the chance of fractures.
How Period Suppression Works
Birth control methods work in different ways, and some lead to period suppression better than others. The “pill” – usually a combination of progesterone and estrogen – thins the lining of the uterus, reducing the volume of blood to be shed. Patients who take a 28-day pack of birth control pills take 3 weeks of hormonal pills and 1 week of placebos. The non-hormonal pills, which usually consist of sugar or iron, are meant to help people stay on track with the regimen until the cycle starts again.
The absence of progesterone signals the body to start bleeding. Taking the placebo pills for a week allows the body to go through progesterone withdrawal. Patients who do not take the placebo pills can suppress their period because they never get the signal to have a period.
Although intrauterine devices (IUDs) can cause some period suppression, bleeding frequency is not as predictable as it is with the pill, Berger-Chen said.
Patients wonder if it is safe to skip the placebo week, but the withdrawal bleeding that people have while taking placebo pills is not medically necessary, Cron said. Skipping the non-hormonal pills does not present any long-term damage.
She added that young people, their parents, and some doctors may believe that treating younger people with birth control may somehow impair fertility, height, or their health in some other way.
But most adolescents are 95% of their total adult height by the time they reach their first menstrual cycle, Berger-Chen said. Most girls will only grow 2 to 3 more inches after they have their first period.
Birth control pills may slightly increase the risk of breast cancer, but after a patient stops taking the prescription, the risk goes back to baseline. Starting the pill at a young age will not change their lifelong risk.
Another misconception linking birth control and infertility is that many women take birth control for years. When they stop in their 30s or 40s, fertility is already naturally on the decline. These patients may believe fertility issues are the result of their years on birth control.
“The concern is that being on the pill for a long time is what is potentially causing fertility issues, but it's more likely a person's age than the duration of the pill,” Cron says.
Berger-Chen says the benefits outweigh the risks for many patients. Chronic suppression of ovulation with birth control can decrease your overall lifetime risk for ovarian and colon cancers and has been found to ease the fluctuation in estrogen that can cause migraines in menstruating patients before or during their period.
Teens need “to receive non-judgmental sexual and reproductive health care [from] providers who are able to listen to their concerns and help them get the resources they need to live healthy lives,” Upadhya said.
