Birth control pills: No more period

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(This article appeared in the April 2006 issue of Women’s Health magazine. I must say I was a bit baffled by the editors’ (there were many) directions: sound like a wise older sister, but also like a friendly gynecologist who will take you by the hand and explain everything. It was not exactly my bag, but I found (and still do find) the topic fascinating.)

The latest trend in birth control pills is to do away with menstruation altogether. Convenient, definitely. But is it safe?

Jasmine Bhatia hates getting her period, which brings cramps so severe that they extend down her legs, making it hard to walk. “To say it gets bad is an understatement,” says Bhatia, 25, a copy editor in New York City. Bhatia’s gynecologist prescribed painkillers and birth control pills, offering her the option of taking the Pill back-to-back — no dummy pills, no period — every other month. For Bhatia it’s a reprieve, like being sentenced to home confinement instead of prison. “Even having to deal with periods half as often has made a big difference in my life,” she says.

Okay, so not everyone’s period is more torturous than an episode of Breaking Bonaduce. Still, you’ve likely fantasized about how great it would be to dispense with those days of the month when your jeans fit like cellophane, you’re capable of restraining-order-worthy rants, and it takes a small Samsonite to tote around your tampons.

That fantasy is becoming a reality, albeit slowly. Birth control makers are increasingly cranking out products that aim to hit the pause button on your period for months, even years. You’ve seen the ads for Seasonale, a pack of 84 tablets introduced in 2003 by Barr Laboratories that makes periods a quarterly affair, like estimated taxes. Two other forms of birth control — Depo-Provera (the injectable drug that debuted in 1992) and Mirena (a kind of IUD that became available in 2000) — may completely eliminate periods (many women stop menstruating on them, though that’s not a given). For years there’s been the route Bhatia took — simply chucking the fourth week of the pill pack. And now Wyeth Laboratories has invented a pill called Lybrel that would do away with periods altogether; the FDA is likely to approve it by this summer.

But a period-free life, like a guy who keeps his apartment spotless, may not be as good as it sounds. For starters, the term “period-free” is approximate at best — Barr Labs has been rebuked by the FDA for making the claim on TV, when spotting and breakthrough bleeding are common side effects of Seasonale that can persist for up to a year. “It was really inconvenient, which kind of defeats the purpose,” grumbles Pierrette Lo, 27, of Houston, who tried Seasonale last year but gave up after a few months.

Most women are open to less frequent periods, according to surveys, but some balk at the idea of eliminating them completely. “The idea of never having a period would be kind of weird,” Lo says.

But scientists say it’s the monthly bleed that’s weird. Since the days when instant messaging meant exchanging grunts around the campfire, women have spent most of their reproductive years pregnant or breastfeeding — i.e., period-free. Until birth control became widely available a century or so ago, women had about 100 periods in a lifetime. We modern gals can expect about 450. The shift may not be a bad thing — still, from a biological point of view, experts say, skipping periods is as natural to women as the maternal instinct. “The notion that you have to bleed to be healthy is incorrect,” says David Grimes, M.D., of Family Health International, a nonprofit consulting and research group. “Indeed, there is no medical need to bleed.”

But hold on, you say. Turning your body into a baby factory may be natural, but forcing the issue by swallowing estrogen and progestin is not. And it’s true that oral contraceptives pose risks. Because estrogen promotes clotting, doctors don’t recommend the Pill for women with a history of heart attacks or strokes, or for smokers. And some women say birth control pills dampen their sex drive, saddle them with dreaded pounds, and can turn even a sunny personality into a Joan Crawford impersonator. But the Pill has some health benefits, too: It reduces the risk of endometrial and ovarian cancer.

You’d expect period-skipping pills to be radical, but ingredient-wise they’re relatively mild. Seasonale’s hormone hit is equivalent to that of popular low-dose pills like Alesse and Ortho Tri-Cyclen Lo: 30 micrograms of estrogen and 150 micrograms of progestin. If approved, Lybrel would be the lowest-dose combination pill out there, with 20 micrograms of estrogen and 90 of progestin.

How could lower amounts of hormones send Aunt Flo packing? It turns out we’d be period-free even on standard birth control pills if it weren’t for a 40-year-old marketing ploy as crafty as the money-back rebate. The Pill’s inventors worried that women would shun this newfangled and vaguely scandalous product if, on top of liberating them from unwanted pregnancies, it took away their monthly cycle. So they dreamed up the placebo week. The sudden hormone-level drop causes a bleed — but one that serves no biological or health-promoting purpose. So if you already pop the Pill, you’re most of the way toward suppressing your period as it is.

Breakthrough bleeding is more common when a low-dose pill is taken continuously — possibly because with low hormone levels the padding of the uterine lining is thinner and more fragile, hence more susceptible to wear and tear. In one trial, 28 percent of women still had irregular bleeding after 6 months of continuous Pill use; after a year, 10 percent of women did.

Not the best hassle-to-convenience ratio. But if you have a problem like cramping, endometriosis, or recurring ovarian cysts, skipping periods may be worthwhile. In studies, continuous birth-control use soothed symptoms more than the traditional Pill. “It might not be a good option for everyone,” Bhatia says. “But for me it could really be great.”

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