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Passing Up Your Period

Taking birth control pills for months at a time reduces headaches, cramping, study shows

FRIDAY, June 28, 2002 (HealthDayNews) -- Women whose periods come with headaches, cramps and heavy bleeding have found one way to ease their symptoms.

They simply stop having their period every month.

Nearly half of a group of 292 women with hormone-withdrawal symptoms connected with taking birth control pills opted to suppress their monthly menstruation by continuing to take the Pill for an average of three months before having a period, says a new study.

This is the first large study of women with this problem who have extended their use of birth control pills for as long as they wanted and been followed for an extended period of time, says study author Dr. Patricia J. Sulak, a gynecologist at Texas A&M University College of Medicine.

What it shows is how popular a method it is for women who suffer from severe menstrual problems.

"Of all the patients who tried to extend the length of time between their periods [to ease hormone-withdrawal symptoms], 46 percent of those who tried it were still doing it after five years," Sulak says.

The results of her study appear in the June issue of the American Journal of Obstetrics and Gynecology.

"A significant number of women are on the Pill and every month are having menstrual migraines or cramps on their weeks off, but a lot of doctors don't know this and don't ask about it," Sulak says. "By extending their oral contraceptive use, they have less monthly problems, reduce the incidence of gynecologic surgery, don't miss work -- it's a win/win situation."

"There is definitely a rationale for this use of the birth control pill for convenience and for reduction of menstrual symptoms," says Dr. John Buek, a gynecologist at the Georgetown University Hospital.

In analyzing the effectiveness of the relief of the symptoms, however, Buek says it would be important to know whether the symptoms relieved are due to the effects of the Pill or were present before the Pill was taken.

As for the health issues of interrupting the monthly menstrual cycle, Sulak says women are having far more periods than they ever have had before because menstruation is starting earlier and women are having fewer children, so that reducing the number of periods is probably more healthy than not.

"What is natural?" she says, adding that her mother had seven children, her first at age 19 and her last at age 40, so she had far few menstrual periods than does Sulak herself. "Now is unnatural."

"I have a lot of patients who ask questions about safety, and I don't feel there should be major concern," Buek adds.

Both he and Sulak point out they and many doctors already prescribe birth control pills to be taken for extended periods to treat endrometriosis and that there are other longer-term contraceptives in use.

The only caveat Buek tells patients is that although studies of birth control pills have found no increased risk of blood clots and no clear association with breast cancer, and although Pill use has also been shown to reduce the risk of ovarian and endrometrial cancers, "the data is based on those women who take the regular 21/7 regimen of birth control pill, and there is no data on extended time periods."

Sulak says not everyone would necessarily benefit from extending the time between their periods.

"If patients are taking the Pill the regular way and have no headaches, no PMS or major pain, I think they're fine. The problem is the number of women having problems on their weeks off the Pill," she says.

The women in the study were all patients of Sulak's who reported menstrual problems during the week they were off the Pill. They ranged in age from teenagers to women in their late 40s, with the average age 35. The most common complaints they reported were headaches (46 percent), cramping (41 percent), heavy bleeding (30 percent) and premenstrual symptoms (22 percent).

After counseling, 25 women chose not to try to extend the length of time between their periods. Of the remaining 267 women who started to extend their birth control pill use, 57 chose to stop taking birth control pills completely, either because of worsening symptoms, desire for pregnancy or because of surgery, menopause or cost.

Of the 210 patients who started the extended birth control pill regimen, 38 returned to the standard 21/7 day cycle, mostly commonly because of breakthrough bleeding or spotting.

The remaining 172 women stayed on the extended menstrual cycle for an average of three months before stopping the Pill for an average of five days. Sulak followed the patients over a seven-year period, with an average follow-up of 25 months per patient.

Sulak has done other studies on the results of extending birth control pill use and found that "the rate of gynecological surgery plummets and there are less monthly menstrual problems."

What To Do

For a basic description of menstruation, you can visit Medem. The National Cancer Institute has an informative summary of studies of birth control pills and any associations with cancer.

SOURCES: Patricia J. Sulak, M.D., professor, obstetrics and gynecology, Texas A&M College of Medicine, Temple, Texas; John Buek, M.D., assistant professor, gynecology, Georgetown University Hospital, Washington, D.C.; June 2002 American Journal of Obstetrics and Gynecology.
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