Many Young Women Wary of a Life Without Periods

Experts say eliminating the monthly flow is safe, but not all consumers agree

WEDNESDAY, May 31, 2006 (HealthDay News) -- Jennifer Burch has seen the ads for Seasonale, Barr Pharmaceutical's new packaging of the standard birth control pill that promises users just four periods a year.

But, she said, she's not buying it.

"Let the body do what it does naturally," said Burch, a 32-year-old yoga instructor who said she was in the midst of her monthly period at the time, with its usual bothersome mood swings.

"If we weren't meant to have periods -- if for some evolutionary reason that made the most sense and was the healthiest -- then we wouldn't have them," Burch said from her home in New York City. "I say, let the energy flow."

Susan Greenhalgh, a 40-year-old chemicals broker from Amityville, N.Y., has also put up with the physical and emotional hassles that come with periods. But, she said, she has her suspicions, too.

"As much as I would love to not be bothered by a monthly period, I can't believe that manipulating hormones and your body's natural cycle to that degree could be healthy," Greenhalgh said.

And yet gynecologic experts say putting an end to the period is safe, and that the growing popularity of interventions such as Seasonale -- whose sales jumped 62 percent last year to over $110 million -- shows there are a lot of American women willing to take that step.

"I believe that most women would really like to get rid of their period," said Dr. Camelia Davtyan, an expert in women's health and assistant professor of medicine at the University of California, Los Angeles, Medical Center. She pointed out that any woman who is on the Pill ceased having a real period long ago, anyway.

"When women are on the Pill and have a period, it's not a natural period -- there was no actual maturation or transformation of the lining of the uterus," Davtyan said. Instead, gynecologists call it "withdrawal bleeding." This bleeding only occurs because the uterine lining experiences a sudden drop in progestin during the placebo week, Davtyan explained.

And the Pill's 7-day placebo "break" was arbitrary in the first place, she added.

"There's an anecdote that's floating around the gynecologic world that when the Pill was first introduced 40-something years ago, it was made by a bunch of guy gynecologists," Davtyan said. "They just thought women would be much happier to have something closer to their natural period, rather than to have no periods at all."

Dr. Shari Brasner, an obstetrician/gynecologist affiliated with Mount Sinai Hospital, in New York City, said she's used the conventional Pill continuously -- without the 7-day break -- for years. She said opting for a life without periods has left her with no regrets.

"I have an incredibly busy day, and I was never the kind of woman who, quite frankly, had a rigid enough schedule that I could remember to go into the bathroom and deal with issues involving periods," Brasner said. "I did it on the basis of understanding what the pills were and believing that they were safe."

Indeed, gynecologists have been prescribing "continuous" birth control pill regimens for decades to help women struggling with problems such as endometriosis. And, Brasner said, new products like Seasonale simply stretch the number of days women take the active pill.

In Seasonale's case, women take the hormonal medication for 12 weeks at a time with a one-week placebo break 4 times per year, when the user experiences "withdrawal bleeding."

"And that placebo week, quite frankly, was only added to just be more acceptable to the user," Brasner said. "The concept of going from 12 or 13 periods per year down to none was a huge [mental] leap, so they've tried to soften that by still giving women that occasional withdrawal bleeding. It doesn't serve any true medical purpose, though," she added.

Seasonale is just the first of many period-suppressing products to hit the market. Drug maker Wyeth is hoping to receive U.S. Food and Drug Administration approval next month for its continuous low-dose contraceptive pill, Lybrel; Berlex Inc. has its own version poised for launch; and Organon USA is hoping to receive an FDA heads-up within the next few weeks for Implanon, a single-rod, three-year contraceptive implanted in the upper arm that's been used by European women for more than a decade.

Just last week, the FDA announced its approval of Barr's successor product to Seasonale, a long-term contraceptive called Seasonique. The company said the new hormonal regimen should be available by prescription in July.

Other long-term contraceptive devices currently available in the United States include NuvaRing, a three-week vaginal contraceptive ring, the Ortho-Evra patch, and Pfizer's injectable three-month contraceptive Depo-Provera.

While long-term use of Depo-Provera can cause thinning bones, Davtyan said other hormone-based contraceptives do not pose bone risks. "Remember, estrogen is actually good for bones," she said.

"As for low-dose pills, the main side effect is blood clots," she said. "But whether a woman decides to take the Pill for 21 days or continuously for 28, most likely she will have a similar blood-clot risk." The absolute risk for any healthy, nonsmoking woman for a Pill-linked blood clot remains extremely low, experts say.

According to Brasner, the take-home message for women is that these new hormonal contraceptive regimens contain "nothing new. We have had traditional birth-control for 40-some-odd years, and, overall, I think their safety has been proved."

But, if that's true, why are women like Burch and Greenhalgh resistant to the idea of a life without periods?

"I guess there is something about femininity and periods that kind of goes together psychologically," Davtyan said.

Brasner agreed. "That's definitely been the biggest barrier to getting women to accept this," she said. "Even once I tell them that I firmly believe in its safety, and that I have used this myself, many of my patients will say, 'Yes, I hear you, I believe you -- but it's not really what I want.' "

And both experts said that's totally fine with them.

"The bottom line is that [period suppression] is a safe thing to do, but it should be optional," Davtyan said. "Women should simply be given the option of having a monthly period, or a period once every three months, or not at all. Then they can decide."

More information

Get more information on various forms of birth control at the U.S. Food and Drug Administration.

SOURCES: Jennifer Burch, New York City; Susan Greenhalgh, Amityville, N.Y., Camelia Davtyan, M.D., assistant professor, medicine, University of California, Los Angeles; Shari Brasner, M.D., obstetrician/gynecologist, private practice, affiliated with Mount Sinai Hospital, New York City
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