No More Periods
Eliminating periods with continuous birth control may sound like a woman’s dream, but is it safe?
What Do Doctors Say?
That first menstrual period may be cause for celebration at sixth-grade slumber parties. But for many women, the thrill fades fast when they're beset with monthly bouts of pain, discomfort, bloating, crankiness, and the blues. Some women are so debilitated that they miss work or school.
Menstrual suppression can often ease troublesome periods or conditions that worsen around that time of month, says Sharon Mass, MD, an ob-gyn in Morristown, N.J. She has suppressed her own periods and often helps patients to do the same. "Initially, it was for patients who had medical indications, for example, a history of endometriosis, menstrual migraines, symptomatic periods with bloating, breast tenderness -- things like that," she says.
The convenience factor is a newer concept, and women are slowly coming around, says Leslie Miller, MD, associate professor of obstetrics and gynecology at the University of Washington. Miller stopped her own periods for "convenience" during a grueling medical residency. Later, she began medical research on using oral contraceptives to help women skip periods. Patients have told her that they've wanted to skip periods for honeymoons, vacations, and sports.
Despite the hassles, many women view menstruation positively, she says. "When you say to a woman, 'Is the menstrual period healthy?' they're going to say 'yes.' It's a sign that you're young and capable of getting pregnant. There are lots of good things about being able to have periods."
But she explains that women on birth control pills aren't having normal menstrual periods. Because birth control pills block ovulation, women are only getting withdrawal bleeding when hormone levels drop during the week that they take placebo pills. As a result, the uterine lining breaks down and bleeding starts.
Hormones and Placebos
The makers of oral contraceptives purposely designed the 21-days-on hormones and the seven-days-on placebo pills to make women bleed to increase their comfort levels with the drugs. By replacing the placebo phase with active hormones, the newer continuous pills attempt to suppress this withdrawal bleeding.
Women can still choose to bleed if they want, for example, four times a year with Seasonale, Miller says. But there's no medical reason that they have to go through withdrawal bleeding at all, she adds.
It's really up to each woman to choose how often she has withdrawal bleeding, Mass says. "There's no magic number."
How safe are extended and continuous oral contraceptives? Advocates point to a generally good safety profile for standard oral contraceptives, which have been studied heavily since their introduction in 1960. In addition, oral contraceptives can cut the risk of endometrial and ovarian cancers and anemia, Mass says.
Still, Miller says that the long-term effects of the new regimens aren't fully known. "When you don't have the week off, you are going to get extra hormones." In particular, she's planning to study the effects of menstrual suppression on bone density. "If we drop the estrogen low enough so that you don't bleed, are the bones OK? I think it's going to be OK, but we don't have proof of that."
"Is continuous pill use an experiment? Sure," Mass adds. "Nobody knows what's ideal."