Menstrual hygiene while on cycle inhibitors?

[brungerbulb]

Hi! I’ve been taking birth control pills for a few months due to my PMDD. While the bleeding itself is a very large annoyance, I personally find I don’t really mind it as long as I’m not in a particularly stressful situation (ie, over Spring Break I have zero qualms with dealing with my periods), and as well acquiring a Diva cup has done leaps and bounds for my downstairs health overall. Despite all this, though, PMDD has made maintaining a natural hormonal cycle absolutely untenable for my mental health, thus I’ve switched to the pill.

It’s worked out very well for the most part, except for one minor hitch. A single day in late May, my mom was unable to refill my prescription until a day late. I usually take the medication daily as to avoid bleeding altogether, but that month I missed a single pill. Not that much of an issue, since I was still able to avoid my PMDD. However…

For around two weeks I found brown breakaway bleeding in my underwear. It was never enough to bleed through to my actual pants, so I never bothered to put my cup in, but it was enough that basically every pair of underwear I owned was left soiled. After a wash, they were fine, but the ghost of blood is still slightly visible there if you’re in the right light. The next two weeks, I didn’t necessarily have “flow”, but I was reliably finding snot-like brown globs in my front hole basically every time I checked. It was honestly worse to just know there was like, stuff sitting up there taking up space rather than being voided.

This did make me realize why birth control pills are designed to be taken before and after the period, and not as a way to cease it. I suppose the “build-up” is a lot greater if your body is never given the time to clean any of it out. I am planning on switching to Depo shots to prevent a similar situation, but the experience does have me wondering; how the hell am I supposed to keep my uterus clean if I’m purposefully avoiding ever letting it bleed?

Like, seriously. The first time I ever went to a birth control consultation, I asked the doctor a question: I was aware that on testosterone, menses usually stopped, but the patient remained fertile, meaning that at least some amount of uterine tissue was created over a month’s course and was simply never dumped. My question was, how would a person deal with this build-up of tissue if they never bled? The doctor answered very ominously, “A doctor will get it out of you.”

What? What the hell!? How is that for an answer? With what tools? Some sort of cocktail of uterine agitator and cervical relaxant? Or do they straight-up go in there with a tooth-pick and start scraping?

This answer has vexed and haunted me for over a year. I probably wouldn’t even be wondering about my menstrual hygiene if it wasn’t for this doctor. But, anyway, my question is: how can I keep my insides clean if I’m planning to never bleed?

(P.S. I am looking to get a full hysterectomy as soon as possible, and what with the current medical climate in America, that’s seeming like maybe three decades from now. Basically I’m planning to ditch this whole mess, but I understand it’s important to remain healthy in the meantime. I’d rather get it removed for benign reasons than, well, an actual medical emergency.)

[Sam W]

Hi brungerbulb,

I want to start by giving you big kudos for being so proactive about your healthcare and researching your options for what to do when a method you're using isn't working for you!

One thing I want to note is that on the pill, you do shed your uterine lining and mucus still get shed on the pill during the withdrawal bleed. If someone uses the pill continuously without taking that break for their withdrawal bleed, of if they're on something like the IUD which tends to stop periods entirely for a lot of people, that stops the uterine lining from building up in the first place, meaning there's nothing to be shed. That's why people with IUDs don't have to go to get "buildup" removed; because nothing really builds up in the first place.

Honestly, I'm not sure what that healthcare provider was getting at with that comment. I know a LOT of folks on T and try to keep up to date on trans healthcare and nowhere have I heard or seen discussions of people on T needing to go get buildup removed from the uterus. Part of that is because Testosterone can also cause the uterine lining to grow much thinner, meaning there's less that needs to be shed in the first place. That's why folks on T notice less and less monthly bleeding. Does all that help clarify things?

[brungerbulb]

Thanks! I realize now that the doctor I spoke to probably wasn’t all that knowledgable about bleeding on testosterone (I don’t live in the most trans populated area) and most likely just said what sounded like a rational response.

I also wasn’t aware that IUDs stalled menses. I was under the impression that they only killed sperm, as I was taught in my singular two-hour sex ed lesson, and I also wasn’t shown IUDs as an option when I was looking for solutions myself. Maybe they didn’t tell me about it because I guess it would be a hassle to remove if I randomly decided I wanted to menstruate again? But, ah, whatever, my insufficient sex education isn’t really the topic at hand. Thanks for the insight, now I can finally stop worrying about that.

[Jacob]

hey brungerbulp,

It's always interesting to hear people's sex ed experience! It sounds like your sex ed session only had time to cover the very briefest headline, but not the particulars.

My understanding is that IUDs do inhibit sperm - hormonal IUDs primarily by thickening the cervical mucus, like a glue-trap for sperm, and copper iuds primarily by acting as an actual spermicide. But, that's not the only thing they do, they both alter the chemistry of your uterus just by being there. It's believed that contraceptive affect of "omg there's something here" does part of the work, and the hormonal element of hormonal IUD has further local effects beyond the cervical mucus thickening, that influence menstruation, sometimes ovulation, the further inhospitability of the uterus to sperm, and the thickness of the cervical lining.

Basically IUDs do a bunch of things, there's always research going into finding out more, even though we know their primary modes of action, i.e. "they kill sperm" might have been a good enough summary of that for the situation!