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Period: Full Stop?

"I had a vague notion in the back of my head that people did it occasionally with no detrimental effects," wrote Levy in an e-mail interview. "When I first started taking the pill, I would skip this period or that period because it was inconvenient -- [because of] a camping trip, Valentine's Day or just general stress I didn't want to deal with." She has since gotten married and has stopped taking hormonal contraception.

And as methods for decreasing the frequency of menstrual periods have grown, online communities have sprung up that allow women to discuss when, how and why to practice what is variously termed "menstrual suppression," "menstrual management" and "menstrual reduction."

One site -- a blog called "The Well-Timed Period" ( http://thewelltimedperiod.blogspot.com/ ) -- is written by Diana Kroi, a New York OB/GYN and the author of a book called "Take Control of Your Period" (Berkley Trade 2004, $12).

On the site, Kroi explains how to use specific types of birth control to skip periods and explains the difference between monophasic birth control pills -- which contain the same amount of hormones every day, aside from the placebo week -- and triphasic and biphasic pills, whose hormone content varies throughout the cycle. Monophasic pills seem to work best for continuous suppression of periods, say experts, but further study is needed.

Leslie Miller, an associate professor of obstetrics and gynecology at the University of Washington, runs a site, http://www.noperiod.com/ , which addresses such concerns as "I don't want to have my period during my honeymoon, help me!" and "What are the risks of suppressing my period?"

Contraceptive experts generally agree that "bleeding [during a menstrual period] is not a necessary part of contraception," Miller said in an interview. But altering a woman's cycle so that she menstruates only once every few months, for example, may introduce breakthrough bleeding, she said. Though studies have explored whether hormone levels can be adjusted to reduce or eliminate such bleeding, findings have been inconclusive.

One issue many women encounter, doctors say, is getting insurance companies to pay for more pills, patches or vaginal rings than the labeling says is necessary. Some doctors said they've had success by writing a letter to the insurer on the patient's behalf.

While extended use of contraceptive drugs spares women some personal hygiene worries and lets them avoid side effects such as bloating and cramping, there are also potential drawbacks. A key one is that a woman cannot be assured by having her monthly period that she is not pregnant.

Miller generally advises against teens' using contraceptives to suppress their periods because studies are typically done on women ages 18 and older. And because no long-term studies have proven the safety of these techniques, experts can only speculate on the risks of years of menstrual suppression.

"The longer-term question is: Does it increase the risk of cancers" such as breast cancer, or other known risks of birth control pills like blood clots, said Edelman.

Levy said she initially worried that if she skipped her period, she could be pregnant and not know it. But she said that fear subsided.

"Since I always used more than one form of birth control, I would convince myself that I wasn't pregnant the way I always did: that it wasn't possible. Or at least so highly improbable as to be virtually impossible," Levy e-mailed. "After about a week (the week I should have been bleeding), the feeling went away." ยท

Comments: paynej@washpost.com.


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