i don't think i understand birth control!

[glortw.livejournal.com]

I know this may make me sound kind of stupid, but I was trying to explain to my boyfriend about the placebo part of the birth control pills..and how I've been stacking..and he was just like "Well that can't be good for you..you need to have a period." And I was like "Well it's not a real period..it's a withdrawal bleed..it's just to simulate a period.." and he was like "That doesn't make sense, why would you want to simulate a period? There has to be some other reason they give you the placebos to bleed once a month." And I didn't know! What is the point of them? Why can't there just be all hormones, no placebos, all year long? I mean even those Seasonique or whatever, you still get blood a few times a year, right? Why is that? Why do we have to bleed if it isn't a real period? Someone please explain exactly how this works? Thanks.

Comments

[jadeserenity.livejournal.com]

There can. It just took us longer to figure that out. I'm sure they figured it was a good idea to simulate a woman's natural cycle when the Pill was developed. But the more recent research indicates that yes, indeed, it's not necessary.

There might be more to it than that, that's just my conclusion.

[skyladagaz.livejournal.com]

um who said it wasn't a "real" period, I believe it is. Isn't the purpose of placebo to just keep you in track of taking a pill each day? aren't they sugar or something? The reason there are placebo is to allow the hormones to die down to allow your period to come right?

I've never heard of a simulated period lol. It IS real.

I'm on the ring though, i dont know much about pills.

[tenna.livejournal.com]

No, it's not 'real' period or menstrual bleed, it's a withdrawal bleed. It's your withdrawal symptoms from coming off of the hormones.

And it's the same with the ring.

[skyladagaz.livejournal.com]

how is it not real & withdrawal? Is there an article i can read that talks about this more in depth? I've never even thought about this or heard of it being fake.

[tenna.livejournal.com]

http://thewelltimedperiod.blogspot.com/2004/08/menstrual-suppression-vs.html The part about withdrawal bleeding is around halfway down.

[skyladagaz.livejournal.com]

thanks =]

[ends-and-means.livejournal.com]

This (http://thewelltimedperiod.blogspot.com/2007/04/i-offer-marketing-advice-to-wyeth-via.html) explains it fairly well:

"Again, the difference between regular pills and extended/continuous use ones is not the presence or absence of a monthly menstrual period. All pills are designed to eliminate periods for as long as a woman takes them. [Keep this in mind the next time you hear or read that Seasonale enables women to have only four periods per year.] The difference is that Seasonale, Seasonique, and Lybrel, on top of eliminating the period, also mostly/altogether do away with the monthly withdrawal bleed.

The monthly menstrual period and the monthly withdrawal bleed are not one and the same thing. They are distinct, unrelated events.

The monthly period is the body-directed shedding of a thickened uterine lining, under the influence of fluctuating endogenous hormone levels, at set intervals (~21 days). The monthly withdrawal bleed is the user-directed artificial destabilization of a thin uterine lining, as a result of deliberately manipulating the dosage of exogenous hormones in the Pill, at arbitrarily set intervals (21 days, 49 days, 84 days, 168 days, or 336 days).

A monthly menstrual period has a [single] biological purpose: to prepare the uterine lining for pregnancy. A monthly withdrawal bleed has no physiological or biological purpose. It's a designer trick, intended mostly to appease politicians and Popes. It's a historical artifact, not a biological requirement."

[skyladagaz.livejournal.com]

do you think this has anything to do with why my cramps have been lessened since being on birth control? & why it's lighter/shorter as well?

oh thanks for the info also!

[jenn-possible.livejournal.com]

Yep, the cramps decreasing is related to having less lining and less of a bleed.

[skyladagaz.livejournal.com]

it all makes sense now lol

[http://users.livejournal.com/__justlikeyou/]

Oh, d'oh. No wonder I'm not using Super tampons constantly anymore! (I've been on the Ring since February and I went through my entire period with Lights last time, and Lights/Regulars this time. The dots hadn't connected! Hahah)

[ends-and-means.livejournal.com]

Yeah, that's why birth control is advertised as helping PMS/period issues.

[tenna.livejournal.com]

I think there are a few reasons for it.

1. It's to make women feel more 'normal'. A lot of women find it comforting to have a period or something LIKE a period on a regular basis.
2. It gives your body a week "off" of hormones, so that they can get flushed out of your system and not build up.
3. Also, many women will begin spotting and having breakthrough bleeding if they do not have a regular withdrawal bleed.

[queensugar.livejournal.com]

As far as #2 goes, I don't actually think that is the case, though I'd be curious to see sources for that statement. I'm certainly not a pharmacist and may be reading it wrong, but from reading the product monographs of most oral contraceptives, from what I can tell most of them reach a steady blood level of hormones about mid-pack (with dips and spikes between pills), so they don't "build up" really.

At any rate, it isn't necessary -- with Yaz, for instance, the four-day interval is not enough time for the hormones to be thoroughly eliminated from the body (I believe their prescribing information states it takes 10 days for all traces to be eliminated from the body), and that's deemed safe.

[tenna.livejournal.com]

It's just something I've read in here from various people's comments. But I guess they (and I) could be mistaken.

[queensugar.livejournal.com]

Yeah, I'd hope someone who actually has training in reading prescribing monographs could confirm.

[queensugar.livejournal.com]

I realize I'm just chiming in with others, but so I will. :)

The pill was designed to give women monthly withdrawal bleeds, or "periods," for a few reasons: one, it was thought that women would want the familiarity of a monthly bleed in order to feel comfortable with the pill.

Two, the monthly withdrawal bleed serves as handy evidence that a pregnancy has not occured. And three, it was not known at the time (or, to my knowledge, tested) to see if long-term suppression of bleeding was safe.

The other thing, of course, is that it doesn't necessarily work for all users. Though HBC certainly prevents much of the uterine lining buildup, in some users there is still buildup that eventually has to come out -- that's why not all HBC users can skip even a single "period," let alone a full year's worth, without having spotting or even a full bleed.

Why can't there just be all hormones, no placebos, all year long?

There is a pill specifically marketed for this purpose, called Lybrel. It is packaged to be taken 365 days a year, with no hormone-free or placebo week.

The reason this wasn't done before was because differing directions required specific approval from whatever a country's drug authority is (in the US, the FDA, in Canada, Health Canada): pills couldn't market themselves for continuous use without A) proving that this was safe and B) requesting to be able to change their usage instructions to indicate that this was possible and recommended. None bothered to do this, until recently.

This doesn't mean that it didn't happen: for many, many years, women with conditions like endometriosis or other reproductive conditions have been prescribed continuous HBC with no placebo weeks using any monophasic pill. But that was considered an off-label usage prescribed by the doctor.

And also for many, many years, women have simply chosen to take their HBC pills continuously to prevent bleeding for months or years at a time. There's nothing really new about this -- only the marketing angle is new.

[jenn-possible.livejournal.com]

Just to add to this: the withdrawal bleed also made the pill easier to accept for people with *traditional* views about women who believe that it's just wrong to NOT have a period once a month. Being able to prevent pregnancy and not have a period was just too much, so the withdrawal bleed was added in part to prevent people's heads from exploding ;)

[chiyo-no-saru.livejournal.com]

Pretty much, yeah! There's no super giant buildup of lining that NEVER GETS RELEASED UNTIL EXPLOSION--it lessens the lining which is why it doesn't, well, shed. w00t BC.

[lokiismykitten.livejournal.com]

Especially you have to remember when the pill was created, during the 50s & the 60s the whole women wanting to have sex in the first place was a novel concept now ad to it no consequence of babies. Mind blowing, also Dr's didn't have the ability or some say the want to test it thoroughly enough. Women in cuba died b/c of the massive amounts of hormones that where in the first pills. Though really nothing much has changed except messing with the doses. I had a nurse complain about Seasonal b/c it wasn't a new pill just an old one in a new package. Personally I never took the placebo pills because I could remember without them and a week off was nice.

[sickofyourbs.livejournal.com]

Agreed. I have no problems remembering the pills after a week off. I think I've trained myself not to care about the placebos. I have about 3 empty packs around here with the full 4th week still in them.

[slobbergal.livejournal.com]

I think the main reason (which I have learned by stacking now for about two years straight) is to avoid spotting. I started spotting about 2 months ago and haven't stopped since. My dr put me on progesterone to stop it so that my cycle gets regulated again.

[sickofyourbs.livejournal.com]

I agree with all of the above posts. But I've always kind of wondered, too...
If this is a withdrawal bleed, and not true menstruation, would that mean that HBC would make it possible for a woman who was unknowingly pregnant to "have a period"?
Pretty curious.

[fleurlur.livejournal.com]

No because if she had a period or withdrawal bleed the uterine lining would be shed and the embryo would have no where to implant itself.

[sickofyourbs.livejournal.com]

That makes sense. Thanks :-)

[gunsforchildren.livejournal.com]

I'm on Lybrel and don't ever have a withdrawl bleed.
No other girls I know are willing to go on it though, they need the piece of mind seeing blood to know they're not pregnant.
I'm pretty trusting of my pill taking skills, so I don't need to bleed and be miserable and get migranes to feel safe. (:

[gunsforchildren.livejournal.com]

and- i haven't had spotting problems since being on Lybrel, except for after one night when I got sick & puked up/"missed" the pill for that day.
I spotted CONSTANTLY while on OTC-Lo, even with the placebo week and withdrawl bleed, so i'm not quite sure placebo weeks are there to help avoid spotting.