The No-Period Pills
The newest birth control pills suppress women's menstrual cycles. But is this wise?
Do We Need More Study?
Other doctors, however, urge caution. They say continuous birth control may increase the amount of estrogen and progesterone that some women take in their lifetimes. The health effects of this experiment in convenience may not be known for years. After all, millions of menopausal women took hormone replacement therapy (HRT) for decades before the risks became evident.
"If you look at the normal physiology of the menstrual cycle, things like the breasts and the liver need a break from continuous high estrogen, and there's a break during that time around the menstrual flow," says Jerilynn Prior, MD, a professor of endocrinology at the University of British Columbia. "People who are touting this method say, 'Well, women years ago didn't get their periods as much as we do now,' but it isn't the same thing." In the old days, women didn't get their period as often because they were pregnant or breastfeeding, thus their lifetime estrogen levels were lower than today.
Prior's colleague, Christine Hitchcock, PhD, researches menstrual cycles and ovulation. She worries that we also don't know if continuous birth control could affect fertility. "The use of extended birth control pills is suppressing a complex, intricate hormonal system," she says. "There are no long-term data to show whether changing the schedule of birth control affects how fast your periods come back when you go off, whether they come back, and your level of fertility."
Should Women Have the Right to Choose?
Westhoff says such concerns are not borne out by research. "There have been numerous studies, both in the trials for Seasonale and other kinds of continuous regimens, that do include how long it takes to cycle and get pregnant, and the answer is there's no noticeable delay," she says. "I have no crystal ball, but in all the data we have so far, the cycle returns to normal with continuous birth control just as it does with regular oral contraceptives."
In fact, the National Women's Health Network, a women's health advocacy group that was among the earliest critics of hormone replacement therapy, does not see significant concerns with Seasonale. "Of course, we have a lot more data on regular pills. Our concern is somewhat less, though, because it's the same synthetic hormones that women have been taking for many decades for oral contraception," says program and policy director Amy Allina.
The Network does urge the makers of Seasonale and similar regimens to take care how they promote the new pill. "We've heard some people saying things like it's unnatural to get your period so much, it's not good for you, and suppressing your period is better," says Allina. "We feel strongly that that's a bad message for women to get. Putting aside the small group of women who really do have medical problems around menstruation, this is a matter of preference and convenience. We're all for convenience for women who find menstrual suppression appealing, but they should get information that helps them choose on that basis."