How Natural Is Monthly Menstruation? Use of the Pill Opens Debate
For years, gynecologists have been quietly telling their patients who take birth control pills that they can avoid menstruating while on their honeymoon or on vacation simply by skipping the seven placebo pills and starting right in on the next packet.
Now, however, some women are going far beyond this onetime, “special occasion” skipping of a period and opting to have just three or four periods a year. Still others are stopping menstruation altogether.
Although the Food and Drug Administration has not approved hormones for this purpose, doctors are prescribing them to reduce or eliminate periods for women suffering from heavy bleeding, severe PMS, debilitating cramps or other menstruation-related maladies. Still others may be helping their patients avoid the hassle of monthly menstruation.
Debate over this practice, and interest in it, heated up with the publication earlier this year of Brazilian gynecologist Elsimar M. Coutinho’s provocatively titled book, “Is Menstruation Obsolete?” Coutinho notes in the book that “the attitude that menstruation is a ‘natural event,’ and therefore beneficial to women in some way, has no basis in scientific fact.”
Women today, Coutinho says, have three times as many periods in their lifetime as their female hunter-gatherer ancestors did, due to first menstruation at a younger age and giving birth to and breast-feeding far fewer children. He says this can help explain the higher rates of endometrial and ovarian cancer compared with those of a few generations ago.
Although critics say it’s not normal for a woman to skip her periods, a woman is fooling herself if she thinks she’s having “normal” periods while taking birth control pills, some experts say.
Even when a woman takes such pills the old-fashioned way, she’s really having “artificial periods,” says Dr. Anita Nelson, professor of obstetrics and gynecology at UCLA School of Medicine. Birth control pills stop a woman from ovulating and shut down her ovaries, so going off them every 28 days, just to cause hormone levels to drop and the uterine lining to slough off, “is an artificial exercise and a waste of metabolic energy,” Nelson says.
For some women, a good case can be made for stopping menstruation altogether, Nelson says. “It comes down to a quality-of-life issue. The No. 1 cause of lost work days for women under age 25 is painful periods,” she says, adding that for one in five female migraine sufferers, the pain worsens during menstruation.
There is evidence too that stopping menstruation or reducing the number of periods can have some preventive health benefits, Nelson says, noting that controlling a woman’s cycle this way might help block the formation of cysts and may help protect against some cancers.
Other experts contend that the idea of eliminating, or even suppressing, a woman’s period is fooling too much with Mother Nature.
“It’s just stupid,” says Dr. Susan Love, an adjunct professor of surgery at UCLA and medical director of the Santa Barbara Breast Cancer Institute. Love, who recently wrote a book on women’s hormones, says some doctors and researchers are too quick to encourage women to take such a dramatic step and are “playing fast and loose” with women’s health.
The contention that our foremothers had far fewer periods in their lifetimes than we do, and therefore we should eliminate many or all of our own periods “is a specious argument,” says Love.
“Women didn’t live long enough then to get breast cancer,” she adds. “And we’ve evolved since then. We’re not living in primitive times.”
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Some women do suffer a lot with their periods, Love acknowledges, adding that for a few women, eliminating menstruation may be an appropriate option. But for most, the monthly period isn’t so awful that menstruation should be stopped or the number of periods reduced, especially given the limited amount of research on the subject, she contends.
Experts note that birth control pills have a 1% to 2% failure rate with “perfect use,” with about a 5% failure rate in the general population, rising to 8% for teenagers, Nelson says.
So a woman who decides to give up her periods this way should consider taking a home pregnancy test every other month, advises Dr. Donna Shoupe, a professor of gynecology at the Keck School of Medicine at USC. And because doctors disagree on possible effects of these hormones on a fetus, a woman should see her doctor immediately if she thinks she may be pregnant.
Menstruation cessation is certainly not a one-size-fits-all solution, she says. For example, a doctor will need to find the correct balance between estrogen and progestin for each woman, to avoid breakthrough bleeding or unnecessary buildup of the endometrial lining.
Most women probably won’t be interested in completely stopping their periods--at least until more is known about possible side effects or long-term problems--but many may want to work out a schedule with their doctor that would reduce their monthly periods to three or four a year.
FDA approval of a pill specifically designed for such a cycle may not be far off. Within about three years, doctors may be able to prescribe a pill that will limit a woman’s menstrual periods to four a year.
Early next year, Eastern Virginia Medical School in Norfolk, Va., working with Barr Laboratories in Pomona, N.Y., will begin a 1,350-woman, 12-month clinical trial for a new birth control pill called Seasonale.
Seasonale contains a combination of two hormones, estrogen and progestin, that already are available in oral contraceptives. To reduce her periods from 13 (birth control pills usually create 28-day cycles) to four a year, a woman would take the pill for 84 consecutive days and then skip a week.
Although it won’t apply to great numbers of women, perhaps one of the best reasons to eliminate--or reduce--the number of periods could be to avoid more-drastic surgical options, such as hysterectomy, for women with excessive monthly blood loss or problems such as fibroids, Shoupe says. “The more options we have, the better,” she adds.
Of course, a woman should talk to her doctor if she is thinking about reducing her number of periods or stopping them altogether.
As always, there are some women who should not take birth control pills at all. Women older than 35 who smoke and women with liver disease, high blood pressure or problems with blood clots are generally advised to avoid them. And some doctors advise against birth control pills for women with a strong family history of breast cancer.
In any event, women on birth control pills should have regular checkups, whether or not they’re also having periods.
