Freed From Pesky Periods
Consider the pros and cons of the new birth control pill
Now that the birth control pill Lybrel has been approved, women can view their monthly period as another lifestyle choice. Several contraceptives already tinker with menstruation; Lybrel, which got the nod last week and will arrive in pharmacies in July, would stop them altogether.
Gynecologists, by and large, are in favor of the new option; many for years have been telling women with painful periods or excessive bleeding to skip the seven placebo pills in the regular 28-day pack that allow a period and just go on to the next pack. "Women don't need menstrual periods," says Paul Blumenthal, a contraception researcher and professor of obstetrics and gynecology at Stanford University School of Medicine. "In fact, historically they've had few of them because they spent most of their time either pregnant or nursing."
The catch. But taking contraceptives continuously has a downside: Instead of predictably bleeding every month, women often experience spotting at random times. Of the women in a clinical trial who took Lybrel for a full year, about 20 percent still had intermittent spotting and 20 percent had periodlike bleeding. "Women may be under the impression that this pill will take care of the nuisance of having periods, and that isn't the case," says Jerilynn Prior, a professor of endocrinology at the University of British Columbia who directs the Center for Menstrual Cycle and Ovulation Research. Unpredictable bleeding is a problem as well with Seasonique and Seasonale and the progesterone-only shot Depo-Provera, all of which also cut back or stop periods.
The solution may lie in experimenting with different drugs to see which dose of estrogen and progestin causes the fewest bleeding problems. All women don't metabolize these hormones the same, explains Leslie Miller, a clinical associate professor of obstetrics and gynecology at the University of Washington-Seattle who has conducted studies on menstruation cessation using generic birth control pills. A certain combination may affect two women entirely differently.
The long-term effects of taking oral contraceptives continuously for years are unknown. Studies indicate that birth control pills protect against endometrial and ovarian cancer, while they might slightly increase the risk of breast cancer. No one knows how breast tissue will respond to constant exposure to hormones, Prior points out. And she says using the pill without a break could have a detrimental effect on bone density, especially in women under 25 who are still building bone.
It is evident, however, that there's demand. According to Amy Marren, director of clinical affairs at Lybrel-maker Wyeth, the company's market surveys show that 60 percent of women like the idea of putting their periods completely on hold.
This story appears in the June 4, 2007 print edition of U.S. News & World Report.
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