Not all periods are real periods. Here's why...
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If you’re like me, and most menstruating humans, you were taught that periods are periods - that there are not different types of periods or periods that are more real than others. If you’re bleeding from your vagina, it’s a period. That’s that.
Well the truth is that that’s not that. The conversation around periods is so much more complex than just to bleed or not to bleed.
Just because you’re having what looks like a period, does not mean you’re having a real menstrual period. Here’s why…
Real menstrual periods happen because you ovulated in that cycle. Biologically speaking, that’s the only reason that menstrual periods happen.
However in today’s modern world with rampant hormonal imbalances and widespread hormonal birth control use people are now getting periods without ovulating. Those periods are not real, menstrual periods.
In today’s world we suddenly have three main types of periods - ovulatory periods (aka menstrual periods), anovulatory bleeds, and withdrawal bleeds (also known as pill bleeds).
Let’s take a look at what happens with each type of bleed and why it’s important for our health to understand the difference.
Ovulatory Periods / Menstrual Periods
Ovulatory periods are menstrual bleeds that happen because you ovulated in that month’s menstrual cycle. Biologically, if we don’t ovulate, we don’t bleed. The goal of the menstrual cycle is to achieve ovulation, not to get a period. However, the result of ovulation without pregnancy is to get a period. So, ovulation = period or ovulation = pregnancy. That’s biology.
Generally speaking, healthy ovulatory periods occur about every 26 to 35 days and take place on a regular, predictable basis. When the cycle is healthy and well-supported ovulatory periods should arrive with little to no symptoms, pain, or discomfort.
Ovulatory periods are what our bodies want to do. From puberty to menopause, ovulatory periods are our natural state of being.
In fact, ovulatory periods - well more accurately ovulatory cycles - are good for us. They’re healthy. Ovulation is how we make our hormones. It’s how we make estrogen and progesterone which are good for us. These hormones support brain health, bone health, muscle development, libido, mental health, mood, breast health, uterine health, fertility and more. When made in optimal balance estrogen and progesterone can even help with the prevention of ovarian cysts, uterine cancer, breast cancer, and more. (source)
Unfortunately, in our modern world with unprecedented hormonal birth control use we’ve been led to believe that the periods we get on hormonal contraceptives are real, ovulatory periods when in fact they are not. They are withdrawal, or pill bleeds, and happen for an entirely different reason.
Withdrawal Bleeds / Pill Bleeds
The periods that we get on most forms of hormonal birth control are not the result of ovulation, but rather the timing and/or influence of pharmaceutical drugs. Most conventional forms of hormonal birth control like the pill, ring, arm implant, and shot prevent pregnancy by suppressing ovulation. This means that they shut down the communication pathway between your brain and your ovaries that would allow the body to achieve ovulation. The hormonal IUD also does this in some cases, but not all and it can be difficult to know if the body is continuing to ovulate on the hormonal IUD.
So, how then are we getting “periods” without ovulating when we’re on hormonal birth control?
When you’re on the pill or the ring synthetic progestins masquerading as progesterone hold your uterine lining in place until your switch to the sugar pill week or take the ring out. This prevents you from ovulating and bleeding. This is why if you skip the sugar pills or take the ring out and immediately put a new one back in you won’t get a period at all. When you do, however, switch to the sugar pills or take a break between rings you’re taking a break from the synthetic progesterone which triggers a release of the uterine lining similar to the way declining progesterone levels at the end of an ovulatory menstrual cycle triggers the release of the uterine lining and the start of your period.
Withdrawal / pill bleeds tend to be lighter and shorter than ovulatory periods because you’re under the influence of the synthetic progesterone for 3+ weeks, whereas in an ovulatory cycle you’d only be under the influence of natural progesterone for 10 to 16 days. This prolonged exposure to synthetic progesterone prevents the uterine lining from achieving its more natural, thickened state.
With the arm implant and the shot you’re getting constant daily exposure to progestins. Again these methods of birth control suppress ovulation, so the bleeding that occurs on them is withdrawal or breakthrough bleeding and not a result of ovulation. The major downside? This bleeding is usually unpredictable because these forms of birth control don’t have an obvious “take it out and bleed” week. The implant, especially, is known for causing frequent spotting and/or bleeding even though ovulation is not occurring.
Most doctors continue to refer to bleeds that we get on hormonal birth control as “periods” without ever discussing with their patients that those “periods” are not true, ovulatory periods. They are synthetic chemically-induced bleeds. This lack of period transparency is not only misleading, it’s dangerous - scroll down to find out why!
Anovulatory bleeds are bleeds that happen in natural menstrual cycles, that is in the cycles of folks who are not on hormonal birth control, but do not happen as a result of ovulation. Anovulatory bleeds are a type of natural withdrawal or breakthrough bleed that occurs when it has taken the body longer than usual to achieve ovulation and the uterine lining is heavy and needs to release itself which, without the presence of progesterone (which is made after ovulation) will inevitably happen in long menstrual cycles.
This can be confusing because if you’re not cycle tracking cervical fluid and temperature to confirm ovulation in each cycle you will likely think that this period is in fact your “real” period when in reality it is a mid-cycle bleed on the longer than usual road to ovulation.
Anovulatory bleeds are common in folks with irregular cycles, PCOS, eating disorders, chronic stress, intense illness, postpartum, and during perimenopause - essentially anytime that healthy ovulation is impaired.
Why it is important for our health that we understand the difference between ovulatory, withdrawal, and anovulatory bleeds.
It’s important to know the difference between these types of bleeds so that…
> You know the truth about what’s going on in your body.
You deserve to know the truth about what goes on in your body. Knowledge is power. It puts us back in control of our bodies and our decisions. We deserve to be trusted with the accurate information about how our bodies work and the choices that come with that wisdom.
> You are able to make an informed decision when choosing your method of birth control.
Encouraging women to go on hormonal birth control without informing them that most of these methods will suppress ovulation and replace their ovulatory, menstrual bleeds with chemical withdrawal bleeds is misleading. When we are encouraged to take a pill daily or have a medical device inserted into our bodies for years on end, we deserve to know the truth about what they do to our bodies. We need to acknowledge that choosing to rewire our neural and ovarian pathways in an effort to prevent pregnancy is a HUGE decision and one that should not be made lightly or without adequate education on the methods in question. You deserve to make informed birth control decisions, and you cannot do that without access to the truth about how these methods work and impact our bodies.
> You understand the potential repercussions of suppressing ovulation and not ovulating regularly.
It’s often assumed, and sometimes outright taught, that ovulation doesn’t matter unless we want to get pregnant. However, ovulation is important. It very much matters. From puberty to menopause, monthly ovulation is our body’s natural state. A healthy body in its reproductive years ovulates regularly. If it doesn’t, we’re pregnant or something is likely wrong.
As you read above ovulation has many incredible health benefits, nearly all of which we are never taught about in school or the doctor’s office. To suppress ovulation for years, sometimes decades, has potential health repercussions we’re only now beginning to understand and acknowledge. From certain types of cancer to autoimmune diseases, from early onset osteoporosis to sex drive struggles, many researchers are now beginning to ask and study - “What role has early and prolonged hormonal contraceptive use had on modern women and girls?”
Anytime I share information like this I always like to clarify that I will always support your right to access hormonal contraceptives because it is your body, your choice. You are the master of your domain (Seinfeld fans anyone!).
As someone who has extensively studied natural and hormonal birth control, personally, I don’t like hormonal birth control nor most pharmaceutical methods of contraception available today. BUT, that doesn’t mean I don’t support your right to love them and choose them for yourself.
What I am very not okay with is the lack of informed consent and accurate education that is provided by trusted individuals in the medical and health fields to people contemplating hormonal contraceptive use. Having open, honest, transparent conversations is to me a non-negotiable when discussing birth control options.
So, I write this post not to hate on hormonal contraceptives, but to provide you with a safe space to access the information about your body and your birth control that you should’ve been given access to a long time ago.
If you’re interested in unlocking the menstrual cycle and birth control education that you DESERVE to have, I want to invite you to check out my Cycle Wisdom Mentorships and schedule a one-on-one consult call with me today!
Disclaimer: Brandy Oswald, Sauvage Wellness LLC, and her employees are not doctors, nurses, physicians, psychotherapists, or in anyway licensed medical practitioners and information presented here is to serve as an educational resource and not to be interpreted as: (1) medical advice; (2) a 100% effective birth control or pregnancy achievement options or (3) nutrition or health guidelines. By reading this you acknowledge that you understand that as a specialized form of consulting, fertility awareness education is not the same as professional or licensed therapy or medical advice and intervention; and recognize that it is your responsibility to seek such services from a licensed professional. Brandy Oswald is not a medical provider and cannot give medical advice. All information provided by Sauvage Wellness LLC and Brandy Oswald is of a general nature and is intended only for educational purposes to help with your personal health improvement goals and should not be relied on as medical advice. Always consult a physician with any health concerns and prior to changing your diet, lifestyle, supplements, birth control, fitness, or prescription medicine routine. Should you choose to use the information provided by Brandy Oswald it is of your own volition and you recognize that neither Brandy nor Sauvage Wellness LLC is not held liable for any intended or unintended outcomes.
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