Lifting the 'Curse' - Should monthly periods be Optional?

The Menstrual Cycle

By Julia Sommerfeld, as written for MSNBC April 18, 2001

Do you sometimes dream about a world without menstrual periods?

No more cramps or bloating.

PMS jokes abolished.

Thanks to the simple birth control pill, the “curse” was lifted a long time ago — but somebody forgot to tell us.

Do you think stopping monthly menstruation is safe?

If you could stop having your period with no health risks, would you?

Do you think stopping monthly menstruation is safe?

* 12737 responses
Yes 19%
No 44%
Uncertain 37%

If you could stop having your period with no health risks, would you?

* 13241 responses

Yes 71%
No 12%
Uncertain 9%
Not applicable 8%
(views and are not scientifically valid surveys).


DOCTORS HAVE known for years that women could eliminate their monthly periods with the pill. But they are just now letting the general public in on what some experts call one of medicine’s best kept secrets.
In a recent essay in the international medical journal The Lancet, Charlotte Ellertson, a reproductive health researcher at the Population Council, argues, “Health professionals and women ought to view menstruation as they would any other naturally occurring but frequently undesirable condition. This means providing those women who want it with safe and effective means to eliminate their menstrual cycles.”
Continuous use of oral contraceptives — tossing out the seven inactive pills typically packaged with 21 active pills and taking the active tablets for months on end — keeps hormone levels constant and eliminates monthly menstruation.
While gynecologists sometimes let select patients in on this trick — such as those wanting to avoid their periods on their honeymoons — they have generally not given women the option to suppress menstruation for long periods of time. Some doctors don’t feel comfortable prescribing a relatively untested therapy and worry it could increase the pill’s risks.
But some gynecologists, endocrinologists and contraceptive researchers are trying to spread the word about menstruation suppression.
“For many women there is a menstruation-associated health problem month after month and there is no reason they have to put up with it,” said Dr. Sheldon Segal, an endocrinologist at the Population Council and co-author, with Dr. Elsimar Coutinho, of the recently published book “Is Menstruation Obsolete?”

HEALTH BENEFITS
According to the American College of Obstetricians and Gynecologists, 50 percent to 75 percent of women suffer some physical or emotional discomfort during or right before their periods. Up to 85 percent suffer from PMS and over 50 percent experience painful cramping.
No periods mean no PMS and no cramps — and less monthly discomfort.
Women with endometriosis, which is caused by and made progressively worse by menstruation, may also benefit from skipping periods.
The birth control pill has been shown to reduce the risk of endometrial cancer by 50 percent and ovarian cancer 40 percent.
Segal advises the continuous use of oral contraceptives containing constant, low doses of both estrogen and progestin.

New pill promises fewer periods

While there is no currently available oral contraceptive marketed for the purpose of suppressing menstruation, Barr Laboratories has a patent on a four-periods-a-year pill, called Seasonale, which will likely begin clinical trials later this year and is expected to be on the market by about 2003.

CULTURAL BARRIERS AND MISCONCEPTIONS
Ellertson says common misconceptions about menstruation need to be debunked before women widely accept period suppression.


Today’s menstrual pattern is far from natural, she says. Women living in industrialized countries begin menstruating at an earlier age, have fewer children, breast-feed for shorter periods of time and experience menopause later than their foremothers. Hundreds of years ago, the average woman had about 160 periods in her lifetime, while modern women have about 450.
And women on the traditional pill schedule who think the bleeding they experience each month is natural menstruation are being “duped,” Ellertson says. The bleeding is artifically induced by the drop in hormones from going off the active pills. There is no ovulation and hardly any build-up of the uterine lining so a period is not necessary, she says.
The placebo phase was built into the birth control pill regimen by its developers to make it seem more natural to women — and in a failed attempt to make it more acceptable to the Catholic Church, she says.

WHY DIDN’T ANYONE TELL ME?
Dr. Edward Levy, a gynecologist in private practice in St. Louis, tells some of his patients about this option — and about a dozen have taken him up on it — but he says most doctors aren’t informing their patients.
“General gynecologists get lots of complaints about being on the pill — skin being a different texture, being headachy, weight gain — so they don’t want to accentuate the side effects so aren’t likely to tell women to take more,” said Dr. Michael Soules, a reproductive endocrinologist and professor of obstetrics and gynecology at the University of Washington in Seattle.
The menstrual cycle -- Feminine rhythms explained

Soules also says that for some women there can be a downside to taking the pill continuously — it can result in small amounts of breakthrough bleeding. Spotting is already a side effect for half of women on the traditional pill regimen. This poses no danger, but some women find its unpredictable nature a nuisance.
Some doctors also have concerns about the safety of using the pill for extended periods of time since it is not labeled for that purpose.
“Birth control pills ... were designed to be used as cyclical agents. That’s how they work and have been tested,” said Dr. Gerson Weiss, chairman of the department of obstetrics and gynecology at New Jersey Medical School in Hackensack, N.J.

While studies have found the birth control pill safe for most women — with exceptions such as those who are over 35 and smoke or who have certain medical conditions such as heart disease, blood clots or breast cancer — they have suggested that pill users have a slightly higher chance of developing blood clots in the veins and lungs, stroke and heart attack.
“If you take it continuously, that’s effectively increasing the amount of hormones someone gets by 25 percent. That will probably up the risks by that percentage,” Weiss said. “A potential increase in [blood clots] is probably the major [concern].”

Segal says the potential risks of continuous use of the pill are the same as with the three-weeks on one-week-off regimen. “Women who take the presently available oral contraceptive today are taking a much lower dose than in the past. The dose has been reduced dramatically. Even if you take it continuously, it’s still less than the older products,” he said.
The issue will come to a head this summer when Dr. Elsimar Coutinho, a gynecology professor at Federal University of Bahia in Brazil, takes on an as-of-yet-undecided naysayer in a debate named after his book “Is Menstruation Obsolete?” at the annual meeting of the Association of Reproductive Health Professionals.

A PERIOD-FREE FUTURE?
Coutinho predicts that in five years women will only be having periods when they want to have them — such as when they want to get pregnant.
Ellerston also envisions a period-free future: “Pills are more frequently being used for reasons other than contraception, for instance to control acne, and menstruation suppression might grow to be just another use for pills,” she said.
But Segal warns continuous pill use is not OK for all women and women should not attempt to hormonally suppress menstruation without first consulting with their doctor.