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No Periods, No Pain?

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Aug. 22, 2001 -- It was not cramping, Melanie says. It was constant pain -- the pain of endometriosis. With every monthly cycle, hormonal changes made it worse. "It got to be every day the pain was there," she tells WebMD. "I was so fatigued all the time. "

But Melanie has relief at last, thanks to surgery and a little improvisation with her monthly cycle. She's now takes birth control pills every day for nearly three months at a time, bypassing the usual week of placebo pills that trigger what doctors call "hormone withdrawal" and the monthly period of bleeding.

By suppressing her periods for months at a time, her hormone levels remain steady and she keeps endometriosis, where tissue from the inner layer of the uterus grows on the ovaries and other areas, at bay. "I'm getting ready to have my first period in three months," says Melanie, an Atlanta-area customer-service representative who spoke to WebMD on condition that her full name not be used.

An estimated 25% of women take birth control pills for their non-contraceptive benefits, says Melanie's gynecologist, Michael Randell, MD, of Atlanta's Northside Hospital. "They decrease symptoms of PMS, ovarian cysts, endometriosis," he tells WebMD. More and more pills are being formulated to help women take advantage of these benefits, with the bonus that those who take them have shorter menstrual periods each month -- or periods only a few times a year.

Migraine headaches, bloating, irritability, and other less-than-charming attributes of PMS are all caused by hormone withdrawal, Randell explains. "You delay the period and you delay the occurrence of those events."

It's something that gynecologists have figured out in the 40 years since oral contraceptives hit the market. And marketers have gotten the message. Today, some 50 brands of oral contraceptives are available as pharmacologists adjust the basic estrogen-progestin formula to target various market niches. Estrogen levels range dramatically among the different brands of pills, with some now at all-time lows.

All these pills meet the FDA's standards of 99% contraceptive effectiveness. And allowing women to buy these pills without a prescription has many proponents and has been considered by the FDA -- with no official decision yet. So what are the pill shopper's choices?

One new pill contains a diuretic or a medication that increases urination. Another has a fine-tuned estrogen dosage regimen, offering low- and ultra-low doses during the cycle, with just two days of placebo [dummy] pills. The result: fewer PMS symptoms -- along with the reassurance of a brief monthly period.

"I think we're going to see more pills coming down the pike with a decreased pill-free interval," Robert Hatcher, MD, MPH, a professor of obstetrics and gynecology at Emory University School of Medicine in Atlanta, tells WebMD.

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