Period: Full Stop?

By January W. Payne
Washington Post Staff Writer
Tuesday, June 6, 2006

Encouraged by drug marketers, more women are opting to reduce the length or frequency of their menstrual periods, or skip them altogether -- and even trading tips online for how to do it.

For decades, women have used birth control pills to occasionally skip a period, but only recently has the practice become the focus of marketing by drug companies and the subject of Web sites and blogs. Basically, the practice involves skipping the week of placebo pills that women using standard oral contraceptives typically take after three weeks of estrogen/progestin pills. (The placebos allow a menstrual period to occur.) Instead, counter to the label directions, they immediately start using a new month's worth of the hormones. Skipping the recommended week off for the patch or vaginal ring achieves the same results.

Because the Food and Drug Administration (FDA) hasn't approved any continuous period-skipping method lasting longer than three months and the long-term safety of this tactic isn't known, experts advise women to consult with their doctors before trying it.

"More patients are interested in the idea of using whatever hormonal contraception -- whether it's a vaginal ring or a patch or birth control pills -- in a more or less continuous way," said Philip Darney, a contraception expert who is chief of obstetrics and gynecology at San Francisco General Hospital. "In the past, we've talked to patients who might not have thought of it themselves. We'd suggest they simply continue taking the pills" if a woman had particularly painful or bothersome menstrual periods, or before a honeymoon or other important event, he said.

Today, doctors report that many patients are bringing up the idea of skipping or shortening their periods, often after hearing about the option through drug company ads. A few pills approved in recent years are designed to shorten the duration of or to reduce the frequency of menstrual periods; pills that stop periods on a more permanent basis are under development.

In 2003, Seasonale, made by Barr Laboratories, became the first pill on the market designed specifically to reduce the frequency of women's periods -- in Seasonale's case, to four times a year. A newer version approved in May, called Seasonique, maintains that cycle, but replaces Seasonale's placebo pills with low-dose estrogen pills thought to reduce the likelihood of irregular, or breakthrough, bleeding.

And a birth control pill being heavily advertised on television now, Loestrin 24 Fe, made by Warner Chilcott, claims to shorten the average period from more than five days to less than three.

The pills are not the first contraceptives used to alter the menstrual cycle -- Depo Provera, a progestin-only injection introduced in 1992 and given every three months -- was found to have the same effect for about half of its users. But the drug is associated with bothersome side effects including weight gain, headaches and thinning bones. Some women also modify their use of the birth control patch called Ortho Evra or the NuvaRing vaginal ring to skip their periods.

No Love Lost

It's not surprising that women are interested in skipping their periods, said Alison Edelman, an assistant professor of obstetrics and gynecology at Oregon Health & Science University who has researched extended use of birth control.

"The seven-day period week that's in [most] birth control pills wasn't because of a scientific reason," Edelman said. "It was put there because the makers of the pills were trying to mimic the menstrual cycle. They felt like women would want to have a regular period."

But research shows that most women "say they want their period every three months, or less than that," Edelman said.

Regina Levy, 25, of Burbank, Calif., is one of those women. She skipped her menstrual periods on and off for about six years.

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