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An End to Periods?

When birth control pills first hit the market in the 1960s, women generally took three weeks of active contraceptive// pills followed by one week of placebos or no pills.

“The thinking was that women would find this more acceptable, that they would feel like they were having their normal menses,” says Susan Ernst, M.D., chief of gynecology services for the University Health Service at the University of Michigan and clinical instructor in the Department of Obstetrics and Gynecology at the U-M Health System.

Now, many gynecologists believe that the week without contraception – during which a woman experiences a “withdrawal bleed” that mimics the normal menstrual cycle – isn’t necessary. And while some debate surrounds the issue, numerous women are opting to take hormonal contraceptive products continually as a way of stopping the cycle entirely or for several months at a time.

Some women use products such as Seasonale or Seasonique, birth control pills that result in four periods a year; others take birth control pills that have been around for years, but without the week of placebos or no pills. An implantable device was approved during the summer for use in the United States, and injections, patches and vaginal rings are other methods of suppressing menses.

Ernst points out that suppressing one’s menstrual cycle is not very different from taking the three-weeks-on, one-week-off cycle of birth control pills, which women have been doing for decades.

“When a woman chooses to use hormonal contraceptives, she’s giving her body estrogen and progesterone, and that suppresses her own hormonal fluctuations,” Ernst says. “So she’s already controlling her cycle by taking those hormonal contraceptives and can further control her cycle by eliminating the pill-free interval or placebo pills.”

She notes that the practice of physicians prescribing contraceptives to stop women’s menstrual cycles is not new. “Gyn ecologists have been doing this for years,” she says, “using hormonal contraception for treating women with painful, heavy or irregular periods, or painful premenstrual symptoms.”

Menstrual suppression also has been used among women with endometriosis, a painful condition in which tissue that normally lines the inside of the uterus grows outside of the uterus; patients with disabilities who cannot maintain menstrual hygiene; and women athletes who have a difficult time with their period when competing in games and meets.

One downside experienced by some women is “breakthrough bleeding,” or the unplanned days of spotting or bleeding that can occur when they are not having monthly menses. Shedding menses three to four months after beginning menstrual suppression can help to stop or prevent breakthrough bleeding, Ernst says. “If you shed the lining of the uterus at an every three- to four-month interval, there tends to be less breakthrough bleeding than if you try to go completely menses-free for a year,” she says.

Ernst also notes that there are risks related to hormonal contraception, including blood clots, hypertension, stroke and heart attack, especially among women who smoke. Additionally, long-term use of progesterone injections can lead to a decrease in bone density, and even osteoporosis.

“A woman has to take those risks into account when thinking about using hormonal contraception for menstrual suppression,” Ernst says. Women should discuss the risks and benefits with their doctors before deciding to suppress their menstrual cycles, she says.

Facts about menstrual suppression
? One of the main benefits of menstrual suppression is the elimination or reduction of periods among women who experience painful periods due to endometriosis, heavy bleeding or cramping. Many women also say the ability to suppress their menstrual cycles adds a level of convenience to their lives.

? Critics cont end that too much remains unknown about the effects of menstrual suppression. Some say it prevents women from ridding their bodies of excess iron; that it is unnatural to suppress one’s cycle; and that more needs to be known about the effects on women’s bone health, heart health and cancer risks.

? A recent survey by the Association of Reproductive Health Professionals found that 71 percent of women surveyed do not enjoy getting their period each month, and that just 36 percent of clinicians surveyed think the monthly period is something that women have to deal with.

? A 2003 Gallup Organization survey, conducted for The American College of Obstetricians and Gynecologists, found that 69 percent of women obstetrician-gynecologists believe long-term menstrual suppression is safe, and 30 percent who say it is safe if used occasionally. One percent said it is unsafe.
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