A Stanford Medical School professor is putting up a billboard in Elk Grove to let Sacramento-area girls and women know that they can consider menstrual periods an optional part of life unless they are trying to conceive a child.
Dr. Sophia Yen, who founded a company that delivers birth control directly to customers, said: “The research has shown that we really don’t need to have this many periods. The natural state of the female used to be more pregnancies and breastfeeding. How many periods do you have when you’re pregnant? Zero. Now we’re incessantly menstruating because we’re not pregnant.”
She points to the women in the Dogon tribe of Mali who have fewer periods than American women because they start menstruating at age 16 and they have more children and routinely breastfeed them. They have about 100 periods over their lives, while in the United States, women have 350 to 400 menstrual cycles.
Women in the United States have periods “from age 12 to 26 – or 12 to 35 for those who had more school or just took a while to find our significant other – and we pop out two kids, and we keep doing it until we hit menopause,” Yen said. “This increases our risk of ovarian cancer, endometrial cancer, colorectal cancer… . And, it also adds waste to landfills. On average, women use 10,000 to 13,000 menstrual products in their life.”
Simple method to suppress cycle
There’s a simple way for women to suppress their menstrual cycles, according to Yen and medical organizations such as the Mayo Clinic: Take only the first 21 days of their birth control pills, and then rather than taking the last seven days of sugar pills, immediately begin taking the next month’s pills.
Most women will at some point have episodes of breakthrough bleeding, Yen said, and when they do, they should stop taking the pills for five days.
On day six, she said, whether still bleeding or not, women should restart their birth control pills and that will turn off their periods. Women will find they can gradually go longer and longer without any breakthrough bleeding.
“The birth control pill has been out since the 1960s, so we have 59 years worth of data, and if you ask any physician, they’ll agree that the birth control pill, patch, IUD (intrauterine device) or ring would not affect fertility,” Yen said. “If you come off it, you’re fertile within the next two weeks.”
Yen has been quoted in women’s magazines on the science behind why it’s safe to skip menstrual cycles and has led discussions on it in forums such as TEDx. She also co-founded a Sunnyvale-based company, Pandia Health, that delivers birth control directly to consumers.
When women and researchers were first introduced to the idea of a long-acting birth control pill, the idea of suppressing menstruation was met with some ambivalence and debate. However, doctors say all current prescription birth control methods are considered very safe, even for long-term use. And, many women physicians in the United States personally use an intrauterine device with hormones that makes periods lighter for many women or reduces the number of periods for some.
Because all medications can cause side effects in some people, Yen said, Pandia’s physicians ask questions such as whether you smoke, whether you have migraines with aura, or whether you have uncontrolled hypertension in order to identify any behaviors or medical conditions that pose health risks.
How birth control works
Dr. Nimi Mastey, an obstetrician and gynecologist at UC Davis Health, said birth control works by preventing ovulation and preventing the tissue that lines the uterus from thickening.
If the lining in the uterus doesn’t thicken, Mastey said, there’s nothing to shed each month. The monthly bleeding that occurs when a woman takes birth control pills is not a regular period, according to the Mayo Clinic – instead, it’s “withdrawal bleeding,” the body’s reaction to stopping hormones during the seven-day placebo cycle.
If women aren’t taking birth control and, for some reason, are not having regular periods, then that lining grows and grows, Mastey said, and over a life span, someone with that condition will have an increased risk of endometrial cancer. Also, because some birth control methods prevent ovulation, Mastey said, they can protect against ovarian cancer.
Mastey agreed that current methods of birth control — a number of different brands of pills, vaginal rings, intrauterine devices that release hormones, and contraceptive skin patches that look like square Band-Aids — do not appear to be associated with a loss of fertility.
“There was once evidence of infertility related to an older, more notorious IUD known as the Dalkon Shield,” Mastey said. “It had a string that increased women’s risk of pelvic inflammatory disease, and the type of strings that modern IUDs have are called monofilament. That is not associated with increased risk of pelvic inflammatory disease. The stigma of this older IUD and increased risk of infections in the pelvis, that’s why I think people still hold in their minds that birth control, especially IUDs, can affect fertility.”
Mastey said that, although her patients have the option of not ever having periods, some choose to do so.
“Some people think it’s natural and healthy,” Mastey said. “We can always counsel and say you don’t need it to be healthy. Some people think it’s a biological part of your body, and they don’t mind having a period. The other thing I hear is that people like having a period every month because it confirms that they are not pregnant.”
Chicks in Crisis joins billboard effort
Yen’s company is teaming up with local nonprofit Chicks in Crisis to deliver the periods-optional message via the billboard now up at 9455 East Stockton Blvd. in Elk Grove, just off Highway 99. Inez Whitlow, the founder of Chicks in Crisis, said her nonprofit works with women and teens who struggle to supply basic needs to their children.
“We get a lot of young girls who, when they have their periods, they won’t go to school or go to work because they don’t have enough money to buy tampons or Kotex,” Whitlow said. “I’m hoping this will increase awareness that there’s options in the community. We want people to succeed, especially women....We’re here to help these girls and women succeed and just take care of their families.”
All around the world, menstruation activists have been asking women to speak up on the challenges that menstruation poses in terms of acceptance and affordability. In 2014 in Portland, Ore., teenage activist Nadya Okamoto launched what is now the largest youth-run nonprofit called PERIOD.org to ensure poverty didn’t limit girls’ or women’s access to period products. Okamoto discovered how difficult it was to afford the products when her own family was struggling with homelessness.
By making periods optional, Whitlow said, Pandia Health ensures that girls and women in Chicks in Crisis can avoid the high cost of feminine hygiene products, but there’s another benefit as well. Pandia allows women to get a prescription for birth control through a telemedicine consultation, she said, and that’s helpful because the girls and women in her program don’t regularly see doctors.
In many countries, Yen said, women can buy birth control over the counter, so she feels comfortable that Pandia’s questionnaire and consultation allow doctors to effectively assess the health of women they’re serving. Through Pandia, women see whether they qualify for a prescription, get advice on which method would work best, and have it shipped to them through Pandia’s partner pharmacy.
Nonprofit fund helps with costs
Under the Affordable Care Act, Yen said, insurers must cover all forms of federally approved birth control with no co-pay and no deductible, but if patients have no insurance, they can apply to have their consultation fee or birth control costs covered by a nonprofit fund that Yen set up. Women who have the means donate at pandiahealth.com/socialgood/ to help other women who can’t afford it, she said.
“You set it and forget it, and let Pandia worry so you don’t have to,” Yen said.
Yen said she founded Pandia Health for a couple of reasons: For one, women were often so busy that they would forget to go by a pharmacy to pick up their birth control prescriptions. Her other reason, she said, is more personal. She recalled being a premed student in middle of a biochemistry final when one of her periods started. She looked to her right and then to her left, and there were men on either side of her. At that moment, she said, she wished she had their biological advantage.
“For me, I have two daughters,” Yen said. “I want my daughters to go out and crush the guys and show them that they are as equal as them. I don’t want them randomly hit with blood in the middle of finals, in the middle of boards (state licensing exams), in the middle of a presentation. Women today can choose how many, how often and when they want to have a period.”