Period peace

Louisville KentuckySouthern Indiana


Birth-control pills for stopping menstruation promise

freedom, but do they deliver?


By Darla Carter 

March 20, 2008

Ladies, don’t go to your doctor asking for Annuale. The period-stopping contraceptive pill that was recently spoofed on “Saturday Night Live” doesn’t exist. But the concept of putting the call of Mother Nature on hold using birth-control pills is a real option for women.

The concept is called “menstrual suppression” or “cycle stopping,” and it’s the selling point for certain brands of birth-control pills that have been packaged and marketed in recent years not only to prevent pregnancy but to make monthly periods a distant memory.

The assortment includes Lybrel, the first continuous-use birth-control pill, which can eliminate scheduled periods entirely. It was approved by the U.S. Food and Drug Administration last year.

Seasonale and its cousin Seasonique, which are a few years older, can limit periods to four a year.

Freedom is a theme found in some marketing for the pills. On Lybrel’s Web site, a woman stands barefoot in the grass with wind blowing in her hair as she stretches out her arms behind her, holding fabric in her hands that reminds one of wings.

But after hearing the pros and cons of using such pills, the realities may not be as wonderful as the marketing makes it sound, said Dr. Tina Simpson, an obstetrician/gynecologist with Women’s Health Care. “Except for treatment of specific medical indications — people that truly have heavy and painful periods — really, the only other pro in my opinion is the patient’s convenience.”

A recent episode of “SNL” featured a satirical commercial that opened with the line, “What if you could have your period just once a year?” Interested women in the skit replied, “I’d like that” and “That’s all I have time for.” But what sounded like a good idea turned out to be a nightmare — at least for bystanders — as the users of the fictional pill Annuale turned into raving banshees when their periods finally arrived.

Though the depiction was comically over-the-top, it serves as a reminder that pharmaceuticals that sound great in a drug ad might have some drawbacks to consider, and extended-cycle birth-control pills are no exception.

Some women experience what Simpson refers to as “poor cycle control.”

That means some women find “that instead of having a monthly flow, you have episodes of light spotting erratically throughout the duration of the pills,” Simpson said.

Susan Essing-Spiller abandoned Seasonique after a few months of use.

“I tried it, and it caused a lot of breakthrough bleeding, and I decided it wasn’t worth the effort,” said Essing-Spiller, an exercise physiologist and nurse who works for CardioVascular Associates in Louisville. But she did not experience the emotional instability implied by the “SNL” skit, which showed, among other things, a hatchet-wielding Tina Fey wreaking havoc in an office.


The emotional portrayal was “absolutely false,” said Dr. Steven Nakajima, a reproductive endocrinologist who’s also an associate professor and a division chief at the University of Louisville.

Dispelling myths

Women should not fear that, nor should they expect to have a massive flow if they only have a period a few times a year, he said.

“One of the biggest myths that people have is that if they don’t stop their birth-control pill after 21 or 24 days, that the blood is going to well up inside them and all of a sudden they’re going to explode and then have this big awful period; that’s absolutely false,” he said.

“The hormones in your birth-control pill are gradually thinning out the lining (of your uterus), and they’re holding it in place,” he said. “The minute you stop taking your birth-control pills, there’s no support to the lining; therefore, you bleed. The blood isn’t inherently welling up inside you before that,” nor are toxins.

He said extended-cycle birth-control pills represent an advancement in that they give women more flexibility in controlling their cycles.

Extended-cycle pills also are effective at preventing pregnancy and have been proved safe, at least in the short-term.

“There’s not a better or worse safety profile with the continuous pills versus the regular monthly ones,” Simpson said.

And birth-control pills in general reduce the risk of ovarian cancer and endometrial cancer in addition to preventing unintended pregnancies, Nakajima said.

But what effects, if any, might extended-cycle birth-control pills have decades down the line?

There’s reassuring data that in the first couple of years there aren’t the kind of changes that one would look for if you were looking for cancer of the uterus, said Christine Hitchcock, a board member of The Society for Menstrual Cycle Research, a nonprofit, interdisciplinary research group. But “we still don’t know if someone takes this for 10 years what those effects are going to be.”

Women are not just stopping their periods. They’re exposing themselves to more hormones than they would with standard regimens of birth-control pills. With Lybrel, there are 13 additional weeks of hormones.

The Society for Menstrual Cycle Research issued a statement last year saying that “menstruation is not a disease, and that future research on the potential health risks and long-term safety of cycle-stopping contraception is still needed,” including how it might impact parts of the body beyond the uterus, such as the breasts, bones and cardiovascular system.

Weighing benefits, risks

In the meantime, “a woman should ask herself what she expects to get (from these pills) and what risks, both known and unknown, she’s prepared to take,” said Hitchcock, a research associate with the Centre for Menstrual Cycle and Ovulation Research in Canada.

Right now, the risks are thought to be similar to traditional birth-control pills, which carry such risks as stroke and blood clots but have been used safely by many women for decades.

Simpson supports the use of extended-cycle pills as a way to treat medical problems like endometriosis, a painful condition that often is worse around the time of a woman’s period.

But she’s not a fan of using them for year-round convenience.

“I think you should question the value of putting a synthetic product in your body that might increase your long-term risk for another illness.”

Traditional birth-control pills are taken for three weeks, followed by a week off during which users have their period. Women usually take placebos (inactive pills) or no pills during that time.

But with Lybrel there is no off week. Women take the pill continuously, eliminating their period all together.

Cutting down the number of periods in a given year also can be achieved with regular birth-control pills by working with one’s doctor to customize how they are taken, said Nakajima of University OB/GYN Associates. This has been done for women in the military or who don’t want a period while competing in athletic events, he said.

Also, Simpson said, “we have used traditional birth-control pills in a continuous fashion for both control of medical illnesses and for short-term convenience,” such as to change a bride’s cycle so she won’t be on her period during her honeymoon, or to accommodate other specific events.

But it is only in recent years that certain brands have been introduced and marketed expressly for the routine convenience of few to no periods.

These pills have “made it more convenient and user-friendly” to do this because there are more active pills in a package, Nakajima said. Before, women had to buy extra packs if they wanted to go without a period for an extended amount of time.

Unplanned bleeding

Essing-Spiller, 48, was interested in using extended-cycle pills for the convenience of having fewer periods. She leads a busy life that includes being a mother of five and teaching Jazzercise.

“I wanted to lessen the amount of periods that I had, and it went completely the opposite. I maybe had one week where I didn’t have a period and three weeks when I did,” she said.

“It didn’t work out for me, but somebody else, it may work out for,” she said.

Upon announcing its approval of the drug Lybrel last year, the FDA cautioned that “the convenience of having no scheduled menstruation should be weighed against the inconvenience of unscheduled bleeding or spotting.”

The unplanned bleeding lessens after the woman has used Lybrel for about a year. “In the primary clinical study, 59 percent of women who took Lybrel for one year had no bleeding or spotting during the last month of the study,” according to the FDA.

But the problem makes some women stop taking the extended-cycle pills, fearing that they don’t work, said Debby Herbenick, a sex educator for the Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University.

“Spotting can happen on any type of birth-control pill,” she said. “It’s more common with the extended-use ones, but it doesn’t mean that it’s not working.”

Another challenge is detecting pregnancy since there’s no monthly arrival of a period. Drug companies tell users of extended-cycle pills to be alert to pregnancy symptoms, such as nausea, vomiting and unusual tenderness of the breasts, and to take a pregnancy test and see a doctor if pregnancy is suspected.



Author: Leslie Carol Botha

Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.