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.
"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." ·