So I was talking to a doctor the  other day.

I’m fine. Don’t worry.

We’re not talking about me. We  somehow got on the subject of periods. She mentioned that she, and  most of the doctors she knows, do not suffer through periods anymore.

They are too inconvenient, too  unpleasant, and, apparently, not physiologically necessary. Now, this probably won’t come as a  surprise, but … I don’t get periods. Still, I found the conversation fascinating!

So I hope you don’t mind  me, a non-period-having guy, covering menstruation and contraception. Also, I should say I did not write this episode. I pitched it and then other people  on the SciShow team took it on.

But the reason I did that is I started  to wonder if menstrual suppression is okay for the human body. Like, doing that must have  other effects on you, right? And answering those questions  is what SciShow is for!

So let’s look at the research. Is  ending your period really safe? [♪ INTRO] Menstruation is essential to humanity. If we don’t do it, we can’t make more humans.

And our species has been doubling  down on menstruation lately. We’re having way more periods than we used to. Like, 2.8 times more than we  had in pre-historic times.

That increase is probably  due to the fact that people spend less time in pregnancy and  breastfeeding than they used to. But today, we also have a lot  more ways to not get periods. And as I mentioned, I hear  periods are not pleasant!

So maybe it shouldn’t have been such  a revelation to learn that people are using birth control methods to  do more than just prevent pregnancy. Complete period suppression is a thing! What I’m talking about here is  intentionally pausing your menstrual cycle and not having to deal with it every  month through the power of birth control.

Now, this can actually happen naturally. Some people end up skipping  periods and going into a state called amenorrhea without  the help of contraceptives. But when your body naturally does  this, it’s not always a good thing.

Amenorrhea can be a symptom  of extreme undernourishment. In that case, your body might  focus its hormonal resources on you rather than a potential pregnancy. And because hormones maintain  pretty much everything, that shift could lead to more broken  bones than usual or even heart problems.

So that kind of natural period suppression  isn’t really something to strive for. But artificially stopping your period  using contraceptives is a different matter. If you have any number of conditions  like endometriosis, fibroids, or heavy bleeding, it can be medically beneficial.

There are several contraceptives  that can significantly reduce the pain from those conditions,  according to a recent clinical trial. But a lot of professionals who  suppress their periods do so because of the impracticalities of bleeding. Astronauts and military personnel, for  example, don’t always have convenient times and locations to deal with their flow.

So they often just don’t menstruate. And you don’t need to be an  astronaut to do this either. Period suppression can be gender affirming.

That’s not to say it’s gonna end  your gender dysphoria or depression if you’re dealing with that. But it’s just treating one trigger. But that’s better than treating none of them.

So for any number of reasons, a person might choose to take birth control  to stop getting periods. In fact, back in 1957, the first  birth control pill, Enovid, was approved by the FDA as  a menstruation regulator. Before it was ever approved as a contraceptive,  the pill was used for this purpose.

Today, similar drugs are still the most  common method of menstrual suppression. Here’s how it works: Instead of cycling through ups and  downs in your hormones each month, you stay in the same stage of the cycle every day. So when you take a birth control pill, you don’t release an egg  and you don’t get pregnant.

On the Enovid pill, there was no  medical need to have a period at all. But people who used it kind of still  did because of how it was administered. The idea was to reassure users  that they weren’t pregnant.

A person would take a hormonal  regulator pill for 21 days, and then get a 7 day break. During that break, they would experience  something called “withdrawal bleeding” which is the body’s response to  withdrawing the hormonal pills. So technically, the bleeding that a person might have on birth control isn’t even a period.

But for all intents and purposes,  it’s still a whole lot like one. Many people who take the pill today follow  a similar schedule of skipping a week for that bleeding to occur, even though  it’s unnecessary to prevent pregnancy. Now, you might have been told that you  need to shed your thick uterine lining.

And that is actually true …  if you are normally cycling. When you’re on some forms of birth  control, this is less of a problem. For example, if you take contraception  that introduces multiple hormones into your body such as estrogen and progestins, your lining doesn’t thicken in the first place.

So you don’t need to shed it. Which means you can choose to not have a period. And since the FDA approved  that first method, Enovid, we’ve done a lot of iterating.

Today, there are dozens of different hormonal birth control methods that accomplish this. They all alter the amount of hormones, like estrogen and progesterone,  throughout your cycle. The main differences are which  hormones they target and at what dose.

And from the FDA’s perspective, they are safe. Menstrual suppression is a known effect  of many approved birth control pills. It’s just that, also, there’s more to the story.

From pretty much the beginning,  some research has suggested that birth control pills can increase  the risk of blood clots, especially in the legs and lungs. And even today, doctors aren’t  sure what’s driving this. It may be that estrogen increases the  pro-clotting factors in your plasma.

A study that began in 1968 found that  people who took birth control pills were four times more likely to develop a certain  kind of blood clot than people who didn't. This calculation probably depended  on what dose people were taking and which hormones the contraception messed with, but those specifics are a little murkier. And a 2018 meta-analysis found that  some newer pills, like desogestrel, put you at an even higher  risk of developing blood clots than others that have the same amount of estrogen.

Depending on which pill you take, the  risk of blood clots may be as much as 6 times higher for people on  the pill than those who aren’t. Even so, the risk is still fairly  low at only 12 in every 10,000 people developing this side effect. The FDA has always stood by the pill  because the number of people who would die from a blood clot complication  on the pill is still actually smaller than the number of people who would die  from pregnancy complications off it.

And that’s a huge point that I  will keep coming back to here. When you’re not using contraceptives,  some of the most common of which are hormonal pills, you’re way  more likely to get pregnant. And universally, pregnancy is one of  the most life-threatening things we do.

In 2020, someone died from  pregnancy-related complications almost every two minutes in the world, totalling  just under 800 deaths every day. Now, of course, this varies drastically  depending on where in the world you live and the kind of access to healthcare you have. So for low-income countries, birth-related  complications account for the number 9 and number 5 leading causes of death, while they do not make it on the top  10 for upper-middle income countries.

But on a global scale, the World Health  Organization says that the best way to prevent these deaths is to use contraception  to prevent unintended pregnancies. This SciShow video is supported by  Brilliant: an online learning platform that helps you build real knowledge through  lessons you’ll actually remember. We all want to know more stuff.

So  the dream is to learn effectively, remembering and understanding  information the first time you learn it. And that’s what Brilliant tries to make a reality. One way they do that is letting you get  involved with the concepts yourself.

You play with the concepts you’re learning  about through a mixture of problems, competition, and encouragement. That way you stay motivated and on track to learn. You can try it with the first 30  days free at Brilliant.org/SciShow, the QR code, or the link in the description.

That link gives you 20% off an annual  premium Brilliant subscription. So birth control pills can  increase your risk for blood clots. They also reduce your risk  of pregnancy-related death.

And that’s by a much larger margin. With all of that in mind, the World  Health Organization has noted that your personal and family  history of blood clots should be taken into consideration when  starting a new contraceptive. The thing is, blood clots  aren’t the only potential risk of using the pill to suppress periods.

Another concern is that it weakens your bones. See, the amount of growth hormone  and other stuff you use to grow bones increases and decreases  throughout your hormonal cycle. In fact, growth hormone peaks in the  middle of the cycle along with estrogen.

So when you pause that cycle, it’s going  to mess with all of those molecules. And when they’re low, you form less bone. A study published in the journal  “Obstetrics and Gynecology” found that how much that happens varies depending  on your method of contraception.

They measured participants’ bone  mineral densities and found that hormonal contraception is worse for  your bones than nonhormonal options, like some intrauterine devices. But they cautioned that they didn’t  investigate all of the many kinds of birth control pills, so you might get  different results based on the one you use. And they also found that age  plays a role in this bone effect.

Bone mineral density is typically increasing  in young people under the age of 18. But that growth sometimes pauses in young  people taking hormonal contraception. In the next age bracket, from 19-24,  they start losing bone mineral density after contraceptive injections.

And by the 25-33 range, they might  still lose bone mineral density, but not as much as when they were younger. Now fortunately, these  effects seem to be reversible when you stop taking it or switch  to nonhormonal contraception. And while this is nothing to  ignore, even at the peak of your bone mineral density loss,  you’re not losing as much as you will when you go through menopause.

This means that again, the negative  effects of hormonal contraception are not nearly as extreme as those  same effects when they occur naturally. The bone mineral density loss observed  in one study during the first year of menopause was almost six times greater than what was observed in  this contraception experiment. And you’ve got to bring this  back to balancing weak bones over an unintended pregnancy and/or death.

Neither of those outcomes  are guaranteed if you take hormonal contraception or don’t,  but you get the calculation here. So if bone health isn’t the  be-all-end-all consideration, what about your immune system? Cause yeah, hormonal birth control can really kick your immune system into overdrive.

And that sounds like a good thing if  happen to, like, have a cold at the moment. But if you’re not sick and your  immune system is overreacting, you can end up with autoimmune disorders. See, inflammation is regulated by your hormones.

And when you introduce new hormones  into your system from external sources like contraceptives, you often end up  with more signs of chronic inflammation. A study published in 2024 compared  people using hormonal contraception to those who aren’t and found that  people on birth control have more of a protein associated with lupus, Crohn’s  disease, and other autoimmune disorders. The authors of that study said  that more research is needed before they can say exactly how this all  increases your immune system’s response to things that aren’t necessarily  posing a huge risk to you … like your own body.

But they think that birth control users might have exaggerated responses to the  immune challenges they face. And that is definitely a bad side effect. But being at a higher risk for  developing something doesn’t mean that you’re destined to develop it.

They haven’t yet found that people  are more likely to be diagnosed with autoimmune disorders  when they’re on the pill. So the general guidance from doctors  seems to be that if you already have certain autoimmune disorders, maybe try something other than a hormonal contraceptive. The authors of that immune study  also suggested that their results could help explain another risk of  hormonal contraception: depression.

A lot of studies have tried to figure out how contraceptives relate to the mood disorder. Some of them conclude that people  who use hormonal birth control are more likely to also use antidepressants. Others find no association.

And still others conclude that people  who use it tend to be in better moods. So, results here are mixed, to say the least. To get to the bottom of these  conflicting results, a 2016 study from Denmark compared more than 1 million people using different types of hormonal birth control.

It showed that when taking  hormonal contraceptives, people become more likely to get their  first prescription of antidepressants than people who have never  used hormonal contraceptives. And this effect peaks 6 months after use. Now, depending on which contraception you use, the effect may be larger or smaller.

First time antidepressant use was  three times greater among those using non-oral contraception products, while birth control pill users were  twice as likely to seek antidepressants. One reason for that variation may  be that some birth control methods are more progestin heavy. And that synthetic hormone can degrade serotonin, a chemical associated with your mood.

So while there’s conflicting information  out there about depression and the pill, it is a potential side effect to take seriously. But remember, the Denmark study  had data on over 1 million people, and only about 23,000 of them got  their first diagnosis of depression by the follow-up assessment. So of course this side effect is a  big deal for the people it affects, but it isn’t something that’s like happening to everyone who uses hormonal contraceptives.

Ultimately, periods suck. And they can come with very  real health consequences. But so do the hormonal  contraceptives used to suppress them.

Which means that whether or not it’s  safe to just … not have periods anymore … depends on how your body  responds to that intervention. In high income countries, we have  come a long way in preventing pregnancy-related death (and also  pregnancy related disability) by using contraceptives. And you can see how life-saving  they can be when you compare the data against other parts of  the world with less access to this stuff.

But that doesn’t mean that  they come without a cost. If you’re not using them to prevent pregnancy, then the pros and cons might  look a little different to you. So thanks to that doctor who inspired me and the SciShow team to learn about all of this.

If you’re thinking about menstrual suppression, talk to your doctor and  decide what’s right for you. [♪ OUTRO]