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Mood swings, cramps, body aches and bloating… Many women would like to put an end to “those days”. “In theory, everyone can go without menstruating”, says Tathiana Parmigiano. Elsimar Coutinho, a gynecologist from Salvador, defender of the interruption of menstruation since the 1960s and author of the book Menstruation: Useless Bleeding, goes on to say: “Women can and should stop menstruating. She gains more disposition and does not develop anemia and sterilizing diseases, such as pelvic infections and endometriosis”. The relationship between menstruation and endometriosis, inflammation of the endometrium, a disease that affects thousands of Brazilians, is straightforward: during the menstrual cycle, part of the blood flow is drained from the fallopian tubes into the abdomen, causing inflammation.
“Our grandmothers menstruated about 40 to 50 times in their lives, as they got pregnant early and had many children. Today, women menstruate an average of 350 times and are subject to some diseases related to excess estrogenic hormone typical of the female cycle: endometriosis and fibroids, for example. By suppressing menstruation, she, in theory, would be more protected and would not suffer so much discomfort with the excessive number of menses”, reinforces gynecologist Silvia Morandi El Faro, from São Paulo.
Options for not menstruating
Continuous use contraceptive pill, also called combined pill because it contains two components – one derived from estrogen and the other from progesterone, both synthetic. The hormone dose is practically the same as for regular pills. The difference is that the common ones are presented in packs of 21 pills, while those for continuous use are in packs of 28 pills. Quarterly injection of progesterone derivative. Subcutaneous implant that delivers minimal daily doses of a progesterone derivative. Intrauterine device (IUD) that delivers minimal daily doses of a progesterone derivative.
The choice, which must be made with medical guidance, will depend on how each organism reacts. “Depending on the purpose of menstruation suppression, some may be more suitable than others. They reduce the likelihood of menstruation, but we cannot guarantee that every woman will stop menstruating”, warns gynecologist Luciano Pompei, from São Paulo, professor at the Faculdade de Medicina do ABC.
more advantages
Women with conditions such as fibroids, endometriosis and cysts can especially benefit from menstrual suppression. “Endometriosis appeared as one of the first indications for the continuous use of the contraceptive pill”, says physician Luciano Pompei. “Not menstruating, the woman with endometriosis avoids the flow that can maintain the evil evolution of the disease”, completes Tathiana Parmigiano.
As for myoma, it is important to say that menstrual suppression does not act in the sense of reducing it or making it disappear. “But the method can reduce the volume of blood lost associated with fibroids, helping to reverse anemia that has arisen due to heavy menstruation”, says Luciano Pompei. And as ovarian cysts can be caused by ovulatory cycles, by inducing ovulation blockage through some of the hormonal contraceptives, they would have their activity inhibited.
Combating PMS
“It is worth remembering that there are also other forms of combat, such as drugs from the serotonin reuptake inhibitor family (antidepressants)”, completes physician Luciano Pompei. And, of course, natural alternatives: healthy eating (with reduced sodium and sugar, greater intake of water and complex carbohydrates, such as oats, cereals, breads and brown rice); exercises (mainly aerobic activities, which release endorphins, a hormone linked to the feeling of pleasure); and relaxation techniques (such as massage and yoga).
It is also important to note that not menstruating does not necessarily mean not ovulating. “Some women are bothered by menstrual flow, but they don’t have PMS. Others have PMS and are not bothered by the flow itself. Everything has to be well discussed and explained when choosing the suppression method so that false promises are not made”, warns Tathiana. Contraceptives can be combined (with estrogen and progesterone hormones) or not (with progesterone only). “Using the combination, the woman interrupts the cycle, stops bleeding and does not ovulate, which is indicated for the treatment of PMS”, explains the doctor.
The uncombined also acts to inhibit ovulation – but this may not happen. About 50% of the time, a woman ovulates. Even so, its contraceptive action is high, as it thickens the vaginal mucus, which makes it considerably difficult for sperm to pass through, in addition to thinning the endometrial layer. As this tissue becomes very thin, if by chance there is reocundation, the embryo cannot attach itself to the uterus. Exactly because it is thinner, it does not flake off and, therefore, there is no bleeding in most women. Some, however, may have irregular bleeding. Therefore, the non-combined contraceptive is recommended for those who do not suffer from PMS and just want to stop the flow.
Fertility, libido, weight
Could going without menstruation cause problems for women’s health? “The use of hormonal contraceptives, like any medicine, is associated with risks and benefits and the doctor must balance the pros and cons before prescribing”, says Luciano Pompei. And it is essential that the woman is without menstruation because she has programmed herself for this. “Menorrhea (absence of menstruation) not associated with this strategy can mean a problem. She should see her gynecologist to investigate”, warns Tathiana.
Fertility is also not compromised by stopping menstruation. “Studies show that the continuous use of birth control pills for the purpose of not menstruating or other hormonal methods (injections, implants, IUDs) do not decrease fertility. Specifically in the case of the quarterly injection of a progesterone derivative, there may be a delay in the return of fertility after discontinuing its use, but no permanent damage occurs. With the other hormonal methods, such a delay is not observed”, clarifies Luciano Pompei. Regarding a possible drop in libido caused by hormones, Elsimar Coutinho reassures: “More willing, without worrying about flow, women can have more desire”.
The doubt of 10 out of 10 women is whether the continuous use of hormones could lead to weight gain. “Some of them do, mainly the quarterly injectables of progesterone derivatives”, responds Tathiana. “Methods are increasingly modern and use low doses of hormones, causing the least possible inconvenience in terms of weight. But they are medications and all of them can cause one or another adverse effect in some women”, says gynecologist Silvia El Faro.
In defense of the cycle
Physician Eliezer Berenstein, from São Paulo, author of the book The Hormonal Intelligence of Women, considers menstrual suppression with hormones to be unnatural. “The menstrual cycle is a woman’s number 1 ally, proof that the female organism is in tune with nature and is fundamental for her physical and psychological balance. By interrupting menstruation for years and years, the harmony of the hormonal cycle will be compromised.” He says he understands the woman who occasionally gets upset with the flow and looks for a way to stop the blood but not the cycle.
“An anti-menstruation crusade has been created and they are making indiscriminate use of hormones in healthy women. These interventions bring what you want, but what you don’t want comes with it. High hormone doses and inadequate choice for the woman’s type can be harmful, causing, for example, thromboembolism (formation of clots in the veins, which block blood flow and can cause serious damage to the body) and neoplasms (abnormal growth of cells and tissues ). Any measure in this sense has to be very well thought out.”
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