Should Women Put an End to Periods?

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For many women, their period is a combination of a monthly menace and a cause for relief. Cramps and bleeding are never fun, but women have dealt with the monthly cycle for thousands of years. Besides, it is a nice reminder that everything is working as it should.

But, if you could skip your period entirely, would you?

A new birth control pill, Lybrel, is being developed to both protect women against pregnancy and also end menstrual periods for as long as the drug is taken. The FDA has not yet approved Lybrel, but other forms of the birth control pill, such as Seasonale or Seasonique, which have been approved for use, stretch the menstrual cycle to allow women to only have periods four times a year.

It may sound like a great combination: pregnancy protection without the worry and pain of a monthly period. But the one thing that connects women throughout history is this monthly rite of womanhood. Is it safe to just skip it entirely?

Birth Control Blues
When the birth control pill was first approved for use in 1960, it looked pretty much the same as modern forms of monthly birth control. The dosage packs contained 21 "active" pills, which contained a hormone to prevent the release of an egg from the ovary, and seven "inactive," or placebo pills, which were placeholders that did not contain any drug.

When taken as prescribed, these seven placebo pills allow the body to go without the hormones for a few days, causing the uterus to shed its lining and make the woman have a monthly period.

"The thinking was that women would find this more acceptable, that they would feel like they were having their normal [period]," says Dr. Susan Ernst, chief of gynecology services for the University Health Service at the University of Michigan.

But many doctors point out that this monthly bleed is a result of controlling the menstrual cycle, not as natural as many women believe.

"When a woman chooses to use hormonal contraceptives, she's [suppressing] her own hormonal fluctuations," says Ernst. "So she's always controlling her cycle by taking those hormonal contraceptives and can further control her cycle by eliminating the placebo pills."

For decades, women have occasionally skipped the week of placebo pills to avoid getting their period on an important event or vacation. In a survey completed by the Association of Reproductive Health, 22 percent of women claimed to have used the birth control pill at one point to either delay or stop their period for a given amount of time.

Lybrel, if approved, would take this idea of skipping the inactive week a step further, giving women only active pills to take. In several studies completed by the drug's manufacturer, Wyeth Pharmaceuticals, Lybrel seems to be just as safe as the standard birth control pill. The most common side effect of this drug seems to be breakthrough bleeding, a side effect also experienced by women who skip placebo pills with normal hormonal birth control.

The Period Problem
When offered the option of delaying their period, some women are understandably worried that it will somehow harm their reproductive cycle and even prevent them from getting pregnant when they want to.

"When considering a non-cyclic oral contraceptive option, women want to know, once they stop use, when they will begin to menstruate again," says Dr. Ginger Constantive, vice president from Wyeth Pharmaceuticals.

In one study of Lybrel, 99 percent of the 187 participants who took the pill for a year either became pregnant or starting having their period again within 90 days of stopping the drug.

However, approximately 60 percent of women say they rely on their period to let them know that they are pregnant, whether they take birth control or not. So, reluctance to suppress the menstrual cycle for months or years at a time may stem from the tangible reminder that a period brings.

However, Dr. Peggy Stubbs from the Society for Menstrual Cycle Research believes that too many young women without a real need for it are too quick to begin menstrual suppression and are using it for the wrong reasons.

"I think young people are confused," she says, pointing out advertisements for Seasonale which "feature women dancing in pristine white dresses playing to [women's] insecurities about their bodily functions."

Stubbs agrees that menstrual suppression is important for women with overly painful or heavy periods, but too many take it just because they view their periods as a nuisance. "Taking a pill is a very easy way to deal with it," she says, but then calls up reminders of other hormonal therapies, such as hormonal replacement therapy (HRT) to treat menopause symptoms; it was used for years until it was found to significantly increase the risk of breast cancer.

"[Older women] seem to be more likely to view menstrual suppression as a new and problematic technology," she says.

The Masses Speak
Menstrual suppression is nothing new and it's not something doctors shy away from either. For years, hormonal birth control has been prescribed to help women with painful, heavy or irregular periods, says Ernst. It is also used to treat women with endometriosis, a condition in which the tissue that is normally found on the inside of the uterus extends to the outside, making periods especially heavy and painful.

But do experts agree that even healthy women can go without their period?

In the survey, over 70 percent of health care providers have prescribed hormonal birth control to delay or stop a patient's period for a given amount of time and 76 percent strongly disagree with the belief that it is physically necessary to have a period every month. In contrast, 50 percent of women think a period is necessary every month.

"There appears to be a disconnect between what health care provides know and do about menstrual suppression, and the general public," says Dr. Linda Andrist, lead study author from the Association of Reproductive Health.

A 2003 Gallup survey, conducted for The American College of Obstetricians and Gynecologists found that 69 percent of female Ob/Gyns believe that long-term suppression of a woman's period is safe, with an additional 30 percent believing it is safe if suppressed occasionally.

More research will have to be done before a conclusive answer can be given about the safety of menstrual suppression. Until then, if you are considering delaying or stopping your monthly period, experts warn that there are always risks related to taking hormonal contraception, even as prescribed. These risks include blood clots, hypertension, stoke and heart attack and are greater for smokers. Long-term use of certain forms of hormonal birth control, such are progesterone injections, have been shown to cause a decrease in bone density, increasing a woman's risk for osteoporosis.

"A woman has to take these risks into account when thinking about using hormonal contraception for menstrual suppression," says Ernst.

As always, speak with your doctor and fully consider all risks before deciding to begin any form of hormonal birth control, especially if you are considering skipping your monthly cycle.

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