March 12, 2003 -- Whether you call it Aunt Flo, the crimson curse, code red, or your monthly visitor, menstrual periods leave many of us feeling bloated and blue. And frankly, surveys suggest, we'd rather not be bothered with them.
The fact is, menstruation, as we know it, could be obsolete. At the very least we may only get a period once a season, several leading women's health experts said Tuesday.
With traditional birth control pill regimens, a woman takes hormones on days one through 21, and she takes a placebo on days 22 through 28. During this time, withdrawal bleeding occurs in a timely fashion, like monthly periods. But taking birth control pills back-to-back with no placebo eliminates a monthly period. These predictable cycles are desired by many women for many reasons including social, recreational, and sexual activities.
"The continuous method provides excellent contraceptive protection -- maybe better than traditional," says Carolyn Westhoff, MD, professor of obstetrics and gynecology and public health at Columbia University in New York. Westhoff spoke at a briefing sponsored by the Coalition for Cycle Freedom of Barr Laboratories, Inc. What's more, the continuous method has been shown to lower risk of breast and gynecological cancers, she says.
For years, some doctors have been prescribing "continuous" birth control pills to treat conditions such as endometriosis, migraine, and iron-deficiency anemia. But once there is an FDA-approved long-interval pill regimen, more women will have the option to control their periods, experts say. One such pill, Seasonale, is being tested by Barr Laboratories. With Seasonale, women take the product for up to 84 consecutive days, followed by seven days of placebo. The regimen is designed to reduce the number of withdrawal periods from 13 to four per year.
It's what women want, Westhoff says.
"Across all age groups in three surveys, women said they would like shorter, lighter, and less painful periods," says. In one survey, three-quarters of women said they would want their periods less frequently -- or never at all, she says.
What's more, more than 90% of women already taking birth control pills say they chose to take them longer then the traditional 21 days to limit the number of times they experienced periods and 94% said their quality of their life improved by doing this.
Estrogen and progestin are the main hormones in birth control pills. Estrogen causes the uterine lining to grow and thicken; progestin inhibits ovulation and changes the secretions in the vagina that makes sperm less likely to enter to uterus. When women stop taking active pills, the uterine lining begins to shed, resulting in bleeding -- a period. Oral contraceptives were originally developed to include a monthly menstrual periods so that they would seem more "natural," but there is no real reason for it, Westhoff explains.
While not getting monthly periods may seem unnatural, experts say that throughout the centuries, most women did not menstruate as regularly as we do today. In the past, women had an average of six pregnancies and breastfed for one to two years after each pregnancy. Today women average two or three pregnancies and breastfeed for a few months, if at all. In addition, puberty began at age 16 in the past and now the average age is just over 12. Many women in the past had their first birth at age 19, but today it is closer to 25. Menopause, too, occurs later.
Fewer periods are healthy, says Ann Davis, MD, an assistant professor of obstetrics and gynecology at Harvard University School of Medicine in Boston.
"It is not not-ovulating that is dangerous, but why you are not ovulating," Davis says. "If you are not using hormonal contraceptives to alter your menstrual cycle and you are not getting your periods regularly, that is unhealthy," she says. Underlying diseases including eating disorders could be too blame, she adds.
Misperceptions about menstruation abound, says Hester M. Sonder, MD, clinical instructor of medicine at Temple University in Philadelphia. Hippocrates, the father of medicine, believed that menstruation was designed to purge women of their bad moods; ancient Roman physicians believed that contact with menstrual blood could turn wine to vinegar; and some myths persist in the 21st century.
But, she tells WebMD, the purpose of ovulatory, "natural" menstrual cycle is to establish a pregnancy. Menstruation follows an unsuccessful cycle. "When pregnancy doesn't occur, menstruation does," she says.
But some ob-gyns are not sold on the idea of continuous hormones.
"My concern about continuous oral contraceptives is that we don't have long-term data supporting this type of use," Brian Levitt, MD, of Atlanta tells WebMD. For example, "until last summer, women were told that taking hormone replacement therapy (HRT) long-term after menopause could lower their risk for diseases, but now we know that it may actually increase risk for some of the same diseases it was thought to prevent." Levitt did not participate in the briefing.