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Part Five // To bleed or not to bleed

Perceptions of Birth Control: A collection of stories and themes that emerged from interviews with undergraduates using birth control at the University of Vermont

This series of blog posts is excerpts (at times edited so its not so academic) of writing from my undergrad research in 2021

Something that came up in nearly every interview was women talking about their periods. That was something that I was not expecting at all (though looking back to my own experience with birth control perhaps I should have expected it).  It was a very interesting phenomena because it was not something that I asked any questions about specifically. Every time someone mentioned their periods (or lack thereof) it came up spontaneously. This was really interesting to me and highlighted how even though periods can seem like such a taboo topic, they are something that people have a lot of thoughts about and experiences with. 

On the topic of not getting a period, people were indifferent to being a little weirded out, but found not getting a period to be a good tradeoff for not getting pregnant or having to deal with their own blood. Leah described how appreciative of her IUD she is because it gives her confidence in not getting pregnant. With that appreciation for not getting pregnant comes the tradeoff of not getting her


“Um, I'm really glad that I can almost definitely not get pregnant. That makes me super excited. Um, I'm like, I was really proud of myself for going through the insertion process and how hard that was, but, um, I think probably the biggest thing is the disconnect that I feel not getting my period. Like, it's, it just, it's always been a little bit weird, but then I also have a friend who switched from the hormonal IUD to a copper IUD, which gives you your period back. And she, like, had a very light period before and hates it now. She was like, if I could go back and switch, I would like, it makes it so much worse. So I don't know.”

Gemma described a similar experience of enjoying her chosen method at first, but also feeling at odds about not getting a period.  

“I went on the Nexplanon implant and did that for like two and a half years, I think. And I loved it. I didn't get a period, like, at all on it. So I kind of, I liked that. And then part of me also felt a little bit weird about that, but, um, I was in a relationship then and so it was just like made it really convenient.”

What is interesting to me about both Gemma and Leah’s experiences is that they started off by saying how much they loved or were happy with their devices, but then almost as an afterthought described their conflicted feelings about not getting periods. In both situations the lack of a period was normalized or made ok by other factors that outweighed their experience of feeling that disconnect. River had a different perspective. River uses the pill, but even on days when she takes the sugar pills, she reported not ever getting a period. For her not getting a period took away her confidence that she was not pregnant. 

“I'm definitely neutral about the not having a period thing and, like, kind of felt weird for a while. And when it first stopped, I, like, took a pregnancy test and I was fine, but, um, it was definitely freaky and it has been like freaky for a little bit. So I have been relying on taking pregnancy tests just for my own, like peace of mind, I guess. Um, so that is kind of a downside in that it took away an assurance in that way.”

River, Gemma, and Leah all used the word ‘weird’ to describe aspects of how they felt not getting a period. This word can be interpreted in so many ways, but I think it is a word that people sometimes turn to when they do not know other words to describe their experience. Separate from this idea of not getting a period as weird, Josie and Amanda shared the perspective of periods being really bad. 

This perspective I believe is rooted in some ways around the cultural perceptions that label periods as gross and something to be hidden. One of the very first memories I have of getting my period is learning how to conceal pads and tampons in my shirt sleeve. It was never something to be celebrated. With that type of cultural context it makes sense that people would not like them, but what if we lived in a world where periods were celebrated? I wonder if getting a period was socially acceptable if any of these perspectives would change. Josie shared aspects of her period anxiety with me.

“Yeah, I think for me specifically, having my period can cause a lot of anxiety with just having to go to classes and think about what points in the day you have to like, deal with it, like go to the bathroom, change your tampon. Like there's so. And having to time that out throughout the day can cause a lot of anxiety.”

Josie is one of the participants who uses an IUD and after she shared this perspective, she added that with her IUD,

“The one thing that's odd is I just don't bleed, but you still sort of get a period. You get the symptoms, but I never know it for me. It's mainly just like one big cramp and I'm like, oh my gosh, that must be my period, I must be on my period. But that's all I know about being on my period. So I don't really track it. So yeah, I do feel a lot better with it and it is a big luxury, not having to think about it or like I have to buy menstruation products. That's so nice.” 

For Josie not getting a period relieved a lot of stress and is something she overall enjoys. However, in reading this quote, it is more likely that those cramps are associated with ovulation. If this person has a progestin only IUD (which all hormonal IUDs on the US market are) there is a possibility that ovulation is still occuring, but the then lining of the uterus has gotten too thin to sustain a pregnancy and ever have a withdrawal bleed.

Amanda, Franchesca, and Parker all had unexplainably long periods caused by their birth control. They experienced extremely debilitating periods that lasted far longer than what is considered healthy by most doctors. And yet, in each case, interviewees shared that their doctors did not offer much support or know what was happening.  With these more negative experiences I must ask why do women tolerate this? I think in part because we are told that our periods are supposed to hurt and they are to be hidden. Parker shared that she reached out to her doctor for support, but beyond knowing it was the birth control, they were unable to know what was happening. Parker said, 

“I had, um, a period of two weeks where I just bled continuously, which was unpleasant. Um, and that was a bit of a mystery why? But my doctor said it was definitely because of the birth control, but didn't know why. So yeah, there were quite a few things that, um, I feel like didn't work great for me.”

Franchesca described a similar experience of unexpected bleeding, 

“Three months in [to using the kilena IUD] I started getting like 40 to 50 day periods. So it's like, it's like the hormones are not okay. They're not happy. They're not, they're not good. So obviously I'm not good. So I'm still trying to heal myself so then, so then…school ends, caps ends, therapy ends so I'm like, okay, I'm going to take the summer to heal. But it was quite the opposite. Cause I'm still like having 50 day periods and like fricken mess.”

Francesca's story with birth control is deeply interwoven with her mental health and the healing process from the trauma that birth control has caused her. While Parker and Franchesca both described long periods with unknown causes beyond generally their birth control, Amanda described her experience with noticing the bleeding and then choosing an alternative method.

“When I was on the pill, I actually had a period twice a month for like four days and it was really heavy. So I guess that's why I switched. Yeah. Um, sort of blocked that out of my memory, but yeah, I think a pill was inconvenient and the IUD is intrusive. Um, but either way. I’d rather have that than nothing.” 

Amanda further reported that now with her IUD she does not experience regular periods, but will sometimes bleed if she is stressed. There are so many things that impact hormones within the body and in order to fully understand Amanda's experience I would need more medical information that I was comfortable gathering. What she did highlight, however, is that her bleeding pattern caused by the pill was not something she liked, so she switched to a method that she felt worked better. Everyone should have the autonomy to choose what works best for them. Even if that means not using a hormonal contraceptive. Franchesca has decided never to use birth control again for the myriad of ways it has destroyed her physical and mental health and Parker is taking an indefinite break.

Both Franchesca and Parker were interviewees who experienced the negative mental health aspects of hormonal contraceptives and also had poor experiences with their periods. I wonder if there is a link between bleeding and mental health while using hormonal contraceptives.

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