March 9, 2000 (Washington) - Imagine a world without PMS, without tampons, without cramps. Aside from cutting into comedians' repertoire, this may strike many as a pleasant scenario, and it can easily be achieved by using birth control pills to suppress menstrual periods, a reproductive health researcher tells WebMD. But another expert cautions against trying to fool Mother Nature for too long.
"Having you period is not an immutable part of being a woman, and any woman whose [periods] are a problem should be given this option," Charlotte Ellertson, PhD, tells WebMD. Ellertson is the lead author of an essay on the topic in the March 11 issue of the British medical journal Lancet. She directs reproductive health work in Latin America and the Caribbean for the Population Council, a global organization, and is based in Mexico City.
Birth control pills are designed to prevent pregnancy by preventing release of the woman's egg through controlled doses of hormones, typically a combination of estrogen and progesterone. Most pills are taken for 21 days, followed by seven days of no pills or pills with no active ingredients. During those seven days the woman has a period.
Before their monthly periods, many women complain of bloating, weight gain, food cravings, and mood swings that can constitute premenstrual syndrome (PMS). Other woman suffer from painful cramping and heavy bleeding during their period, and many would just as soon stop their monthly bleeding altogether, Ellertson says.
"Health professionals and women ought to view menstruation as they would any other naturally occurring, but frequently undesirable, condition," write Ellertson and her co-author, Sarah L. Thomas. "This means providing those women who want it safe and effective means to eliminate their menstrual cycles, contributing to happier, less encumbered lives and helping women individually and society as a whole."
She believes there are no ill effects from doing this, and she contends it can work with all pills on the market today. Ellertson also criticizes doctors, whom she says have known for years known about this "option" to rid women of their periods, for failing to pass this information along to their patients.
Ellertson says there's no reason to assume that monthly periods are "natural" or "normal." She notes that women today have more periods than did their foremothers for various reasons.
As such, Ellertson maintains that the medical value of menstruation is largely unstudied and unproven. "It is unclear how many periods women need to have per year or per lifetime," she says. Ellertson disagrees with the belief that the monthly shedding of the uterine lining, which is what forms the menstrual discharge, is necessary in women who are already taking the hormones. She says that women who are on the pill are already having "artificial" periods induced by the hormones in their medication.
"There are some women who like the monthly reminder that they are not pregnant and that their pills are working," Ellertson says. "But with modern pills, the failure rates are so low that more women are inclined to trust these methods. Plus, women have access to cheap and effective pregnancy tests" for added reassurance.
While it is probably not unsafe to suppress one's period for a few months at a time, today's oral contraceptive pills weren't designed for this purpose, counters Donna Shoupe, MD, a professor of obstetrics and gynecology at the University of Southern California. Shoupe, who reviewed the Lancet article for WebMD, also disputes Ellertson's contention that monthly periods aren't medically necessary.
"It is a very delicate balance between having enough estrogen for the rest of the body and not stimulating the lining" of the uterus to thicken. "[If] it builds up and you don't slough it off, you can get cancer," she says.
Shoupe says modern birth control pills are extremely useful in solving many of the problems associated with menstrual cycles, including PMS symptoms, cramping, and heavy bleeding. In her practice, fully 50% of her patients are taking oral contraceptives for some goal other than contraception. For most women on the pill, getting their period "really isn't that bad," Shoupe says.
- An expert on reproductive health has written an essay questioning the role of menstruation in women's health and whether birth control should be used to stop it altogether.
- She offers up as evidence that there are no health benefits to having a monthly period and there are no reasons to assume this is "natural" or "normal."
- One critic argues that using contraception to prevent menstruation could stimulate the lining of the uterus to thicken and cause cancer, and she adds that for most women on birth control pills, monthly menstruation isn't all that bad.