With the 2019 news that women don’t need pill bleeds came the assurance that “women don’t need periods.” But is that accurate?
It’s true that women don’t need monthly pill withdrawal bleeds because they’re not periods, but women do need (or at least benefit from) monthly natural menstrual cycles because that’s how women make the hormones estradiol and progesterone.
Both estradiol (our main estrogen) and progesterone are beneficial for general health and not just for making a baby. Together, they promote the long-term health of the brain, bones, and cardiovascular system.
In the words of Canadian endocrinology professor Jerilynn Prior, “ovulatory cycles across a woman’s long reproductive life span are needed to prevent osteoporosis and fracture, heart attacks, and breast and endometrial cancers during women’s older years.“
💡Tip: The contraceptive medications in birth control are not estradiol and progesterone and do not have the same benefits.
Just as testosterone benefits men’s general health, so do estrogen and progesterone benefit women’s.
To say that women don’t need ovulation except to make a baby would be like saying that men don’t need testosterone except to make a baby.
It’s the cycle and hormones that are beneficial, not the bleed. The bleed is only an inevitable outcome of an ovulatory cycle because, in general, it’s not possible to ovulate but then not go on to have a bleed—except in the case of pregnancy, hysterectomy, uterine ablation, or the hormonal IUD.
Natural cycles are possible with the hormonal IUD
The hormonal IUD (Mirena) is unique in that, unlike all other types of hormonal birth control, it does not suppress ovulation.
In other words, the hormonal IUD permits ovulatory cycling and the production of estrogen and progesterone; it only suppresses the bleed. This is in stark contrast to the combined estrogen methods (e.g., the pill and Nuvaring), which suppress ovulatory cycling but induce a withdrawal bleed.
With the pill, women bleed but don’t cycle.
With the hormonal IUD, women can cycle but not bleed.
Do women need periods?
In summary, women don’t need a period if it’s defined as a bleed. And women certainly don’t need a pill-bleed because it’s not a menstrual cycle.
Women do, however, need a period if it’s defined as a menstrual cycle because a regular ovulatory menstrual cycle is how women make hormones.
