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Ask
a bunch of women if they enjoy getting monthly periods and
a significant majority (at least according to our own water-cooler
survey) will answer “No!” Still, a woman’s
cycle has long been seen as a healthy and inevitable part
of reproductive life. That could soon change with a new
version of the birth-control pill that dramatically reduces
the number of periods a woman has every year, from 13 to
4. Now even menstruation turns out to be a lifestyle choice.
Doctors have been prescribing “menstrual suppression”
off-label for years to treat endometriosis (an overgrowth
of uterine tissue), menstrual migraines and PMS. And plenty
of women have altered the pill’s regimen to enjoy
period-free vacations. Now, in addition to the new version
of the pill, which manufacturer Barr Laboratories has submitted
for FDA approval, makers of the birth-control patch and
vaginal ring are also testing their products for continuous
use. If the pill, called Seasonale, passes muster,
women could reprogram their monthly cycles by the end of
the year with government approval.
Seasonale contains the same ingredients as conventional
birth-control pills, but will be packaged and prescribed
differently: 84 active pills taken in a row, followed by
seven placebos, as opposed to the traditional 21/7 regimen.
Women do seem to want it. In a Dutch survey, two thirds
of women between 15 and 49 said they’d prefer fewer
periods. And when 318 women with painful periods were counseled
on continuous oral contraception in a study led by Dr. Patricia
Sulak at Texas A&M Medical School, 91 percent jumped
at the chance to try it.
Many doctors believe cutting back on menstruation could
be healthy. Researchers estimate that women now have three
times as many periods (450 over a lifetime) as our hunter-gatherer
ancestors, who started menstruating later and spent many
more years pregnant or nursing. Menstruation can promote
fibroids and endometriosis. And taking oral contraceptives
cuts the risk of uterine and ovarian cancer. As it is, the
pill shuts down ovulation, so bleeding is a reaction to
the shift in hormones, not true menstruation. Why, then,
have monthly periods? asks Dr. Leslie Miller of the University
of Washington: “There’s really no benefit.”
The pill has some negative side effects like breast tenderness,
and, in very rare cases, blood clots. A recent study found
no increased risk of breast cancer, but it’s not known
whether that’s true for continuous use. So far, the
biggest problem has been breakthrough bleeding. In the Seasonale
trial, 7.5 percent of the women dropped out because of it,
compared with 1.8 percent taking the pill conventionally.
The problem tends to dissipate after the first few months
and may be less of an issue among women already on the pill,
says Dr. Alison Edelman, who is studying breakthrough bleeding
at Oregon Health & Science University. Still, other
problems could show up later. “One of the things that
the HRT debacle showed us is we just can’t assume
safety,” says Dr. Susan Love of the Susan Love MD
Breast Cancer Research Foundation. As a result, Miller,
who is studying menstrual suppression, believes the lowest-dose
birth control available (20mcg) should be used.
So far, there’s no official stance. The American College
of Obstetricians and Gynecologists may issue an opinion
this spring, says ACOG’s Dr. Jimmy Moore. Until then,
it’s up to women and their doctors to decide. Many
women depend on their periods as proof that they’re
not pregnant and think fiddling with nature’s rhythms
is “freakish.” But for others, cutting back
on periods (and cramps and chocolate cravings) would be
a fantasy come true. “We’re giving women a choice,”
says Dr. William Gibbons of Eastern Virginia Medical School,
a test site for Seasonale: to go with the flow or to control
their bodies in a whole new way.
© 2003 Newsweek, Inc., Feb.
3, 2003
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Contraception