Hormonal period surpression an option for many

Most women see the headaches, cramps and discomfort of menstruation as an unavoidable part of life. But women who take hormonal birth control may be able to safely skip their monthly period by taking birth control continuously, one UW professor says.

Women have traditionally taken 21 days of actual birth control pills, followed by seven days of placebo pills each month in order to have a period, said Dr. Leslie Miller, a professor of obstetrics and gynecology. However, she said, the decision to include the seven placebo pills was not based on scientific evidence that it was safer or necessary.

"The period you have on birth control is not a true period," Miller said. "The week off was supposed to help you know you weren't pregnant. Well, that week off is why women have often gotten pregnant."

According to Miller's Web site, NoPeriod.com, a woman 100 years ago would experience between 50 to 150 periods in her lifetime. Women underwent menarche later and spent much more of their reproductive years pregnant or breast-feeding. Now a woman might have 450 periods in her life.

"Nature did not mean for women to have 13 periods year after year," she said.

Miller is enrolling patients in the fall for a clinical trial to study continuous-use low-estrogen dose birth control, Loestrin and Alesse, for period suppression. The research aims to eliminate the irregular bleeding historically associated with continuous use birth control. If women just want to skip one month, they can do that with any type of birth control pill, said Miller.

"But if your goal is no bleeding, I think you should do it with the lowest possible dose of estrogen," she said.

Most birth control pills have some combination of estrogen and progestin. Progestin is needed to prevent pregnancy, but some hormonal contraceptives have no, or very low, doses of estrogen. High doses of estrogen increase the risk of blood clots.

"In the first birth control pill, estrogen dosage was 10 times higher, and women died. But progestins can be used by most women safely," Miller said. "Modern birth control pills are really well-tolerated. In large clinical trials they randomized patients to birth control pills or placebo, and the only side effects were breast tenderness and nausea."

Moreover, cyclic birth control pills have already been shown to reduce the risk of uterine and ovarian cancers by 80 percent, Miller said.

Kathy Slettebak, a family planning counselor at Hall Health, said continuous-use birth control pills have been prescribed at Hall Health for a number of years.

"Some of our patients already take birth control continuously. Sometimes there's a medical reason not to have a period," Slettebak said. "Women may have menstrual migraines associated with their period, and others have endometriosis. Others take continuous birth control pills to prevent ovarian cysts."

Slettebak said she feels comfortable mentioning the option to women, and they could then discuss the possibility with their physicians.

"I don't see it as a high risk to try it out for a couple of months," she said. "Obviously the clinician would weigh the risks and benefits of using it. The main risk is bleeding right after you switch to continuous use. We don't know if there are any long-term side effects."

One of Miller's patients, Anna, said she switched to continuous use low-dose birth control three months ago.

"I'm 25 years old, I have a career and I play a lot of sports," she said. "I don't think it's necessary for me to have a period."

Anna became curious about skipping her period when another gynecologist told her she could skip her period on her vacation.

"I did a lot of research on my own," she said. "The birth control pill I was on before was Ortho Tricyclin. It has three different types of pills. I felt really moody and I just felt like my body was unbalanced. Even with Ortho Tricyclin, I had heavy bleeding for three days and had bad cramps the first day of my period."

Anna said she had some light spotting the first few weeks after switching to Microgestin, but has not had a period since May.

"It makes my life easier," she said. "I feel more relaxed. My mood is comparable to when I wasn't taking the pill. It's such a small amount of estrogen, my body doesn't notice it as much -- it just feels more natural."

Anna said she really likes the way she feels on the continuous birth control pill.

"I don't miss my period at all," she said.