There's any number of reasons why I might be feeling off right now: Stressed about a deadline. Somebody hurt my feelings. The chemical imbalance in my brain. All of the above?!
Or maybe it's PMS. As a human, who is alive and therefore regularly experiences ups and downs, getting my period was a consistent way to keep tabs on my emotional state. Since I began menstruating at age 12, I was always very regular: 28 days between cycles, with roughly 3-5 days of bleeding. After an unexpected outburst of tears or spike in dread, I could look at the calendar and think, Oh right, it’s because I’m getting my period soon. When the blood started a few days later, I’d relax, knowing the PMS had run its course and I was on my way to better vibes. It gave me a sense of comfort and control, surrendering to this hormonal scapegoat.
Think of it as mindfulness of menstruation. A horoscope, but for the body.
But since getting the Mirena IUD a few years ago, I no longer get a physical period. I’m not an outlier: according to Bedsider.org, one in five women using a hormonal IUD (specifically the Mirena and Liletta, which release roughly the same amount of hormones) stop getting their period a year after IUD insertion.
Although I no longer bleed, (a condition known as amenorrhea), I still experience PMS. Or at least, I think I do? On certain days throughout the month, I’ll feel crampy or bloated, irritable or blue-classic PMS symptoms-but without the blood to confirm my condition, I can never be sure if that’s what’s going on. I think of these murky symptoms as my “ghost period,” and frankly, sometimes I miss the real version.
If my reproductive system is going to turn into a haunted house every month anyway, I’d at least like the chance to exorcise the demons!
That the Mirena stops your period, or at least makes it more low maintenance, is one of its major selling points: gynecologists often recommend it to women who have painful cramps or difficult period symptoms. It’s touted as the chillest birth control option: set it and forget it, ditch your period, and lose the mood swings, too! But nobody warned me that, despite the drop in blood, PMS symptoms can still rage on-and without being able to peg them to a physical period, it can be disorienting.
Jaime Eisen, 27, who also has the Mirena, agrees that PMS sans monthly bleeding “feels arbitrary.”
“I used to have this very physical hormonal barometer, and now my moods get erratic and it feels foreign,” she says. “I wouldn’t say I miss bleeding, but I do miss understanding why my body and mood shifted so clearly each month.”
Hormonal IUDs like the Mirena prevent pregnancy by thickening cervical mucus in the uterus so that sperm can’t get through. Because the hormones act locally on the uterus-versus hanging out in your bloodstream, like with the pill-they also thin the uterine lining. In some women (like me), the uterine lining is so thinned by the IUD that nothing comes out, AKA no period.
Gynecologist Dr. Jen Gunter, MD, says that PMS doesn’t actually have anything to do with the physical bleeding aspect of your period, but rather, the hormonal changes caused by ovulation. I very badly want to say that I already knew this, but I did not.
“After you ovulate, progesterone levels start to rise,” Gunter says. “We believe it’s this change in levels that triggers PMS.” And because IUDs, unlike birth control pills or the NuvaRing, don’t suppress ovulation, you could still experience those hormonal changes and all the PMS symptoms that come with them.
But it’s much harder to follow your cycle when you don’t get a period. “Since I’m not bleeding, I don’t automatically relate PMS to my period,” says Sara Bosworth, 23. “Pre-IUD, at least I could be like, ‘Oh, I’m menstruating.’ Now it’s just like, ‘Oh, I feel shitty and gross and oily.’ I think that leaves me feeling a little out of touch with my body.”
There must be another way for all of us non-bleeders to get a handle on our insides. Gunter suggests using a period tracker app-though she cautions being careful about which one you use, as some don’t protect your data-or just a regular calendar, and recording your symptoms for at least three months to see if there’s a regular pattern.
PMS lasts about six days per month, Gunter says, and can occur anytime during the luteal phase of the menstrual cycle, which is the two weeks after ovulation. So that’s a pretty big window of time. It’s been more than three years since I last got my period regularly, so it’s hard to remember, but now I’m wondering: did I ever know for certain when I had PMS, or was the timeline always sort of fuzzy?
For the most part, I’m happy with my IUD. And don’t get me wrong: not bleeding is great. I save hundreds of dollars on tampons and laundry every year, I can have sex whenever I want without worrying about getting knocked up, and I suppose I could wear white pants without a care, if that were a thing I ever felt like doing.
But sometimes I miss the monthly scapegoat, the relief in the messy release. Maybe I’ll finally download Co-Star and have it yell at me every day about how I really feel.
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