Wednesday, June 15, 2016

Diabetes and your period: Is skipping periods a good idea?

There was an article recently on NPR about whether women need periods.  The article was largely about how there is no point to having a period if you're not trying to get pregnant, and discussing different birth controls that suppress periods.

At the bottom of the article, however, was one lone dissenter:

As with all forms of hormonal contraception, there are risks and side effects with these devices, such as an increased risk of blood clots. And some doctors think there isn't enough known about the long-term effects of menstruation suppression, especially with teenagers.

"Important studies, like what are the effects on the breast? What are the effects on bone — haven't been done," says Jerilynn Prior, an endocrinologist at the University of British Columbia.

She says women should think carefully before trying to suppress their cycle. Having a period does serve a purpose, she says: It tells you your reproductive system is working well and that you're not pregnant. It isn't a "disease" that needs to be treated away, she says.

"I think there is value in understanding and appreciating our own intrinsic hormonal cycles," Prior says. "It's our identity."

I was disappointed that there wasn't anything more about the potential dangers of suppressing periods.  Of course I know a lot of women hate the inconvenience of having a period, but it seems to me that we've learned time and again that tinkering with the body for convenience, rather than medical necessity, is a bad idea.

(Notice I said medical necessity.  Yes, I realize that there are many women out there who don't want to or can't have periods for genuine and sometimes very serious medical reasons.  Please know that I am in no way talking about those cases.  Disliking cramps or wanting to avoid the inconvenience is a very different issue, in my opinion.)

As a woman and a diabetic, the issue of periods is a pertinent one.  When I was first diagnosed, I was taking Depo-Provera, a quarterly birth control injection.  As I understand it, the Depo shot inhibits estrogen, which is why your your period eventually stops completely.  It also, because of the lack of estrogen in my system, made me gain weight in the gut like a guy, and as I found out after I was diagnosed, also removed estrogen's protective effects on cholesterol.

The benefits of being on the Depo shot and not cycling was that my insulin needs were very consistent.  My Lantus shot -- Lantus being a time-released insulin that you take once a day -- was the same every day.

I transitioned from the Depo shot back to the pill because my doctor was hoping it would have a positive effect on my cholesterol, which was slightly higher than he wanted to see.  (I've written all about the issues surrounding diabetes and cholesterol in other posts, if you want to catch up.  There was some minimal impact on my cholesterol, by the way, but not enough to keep the doc happy.)

I quickly found that the trade-off was that my Lantus needs varied much more throughout my cycle than they had before.  By much trial and error, I discovered that my Lantus shot during my period week (the week of blank pills) had to be about four units less than it was the rest of the month.  This is likely because the hormones interfere with the insulin, and more is needed to get complete coverage.

Despite this, over time I feel like my insulin needs have settled into a pattern, and overall I feel much healthier than I did when I was on the Depo.  This may be partly because I've started eating better over the years, but since that wasn't an immediate change, I rather doubt it tells the whole story.  I think the hormones in the pill are much better for my body than the high dose of progesterone in the Depo shot.

My only other experience with trying to stop my periods was when I took two pill packs back-to-back, instead of allowing for the week of blank pills in between, in order to avoid inconveniencing myself on a trip.  The result was a disaster.  I spotted for days, despite having started the new pill pack, and experienced tremendous cramping.  I'll never do that to my body again.

Periods may be "unnecessary," according to most of the experts in this article, but to me that sounds just like something a man would say.  There is obviously a place for medically necessary medicines, such as insulin and oral diabetic meds, and of course some women have conditions where avoiding periods is desirable and even necessary... but for the rest of us, I think it's healthier to just leave our periods alone.

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