UW study examines putting end to periods

More than 40 years after the birth-control pill transformed the lives of women by giving them power over when and whether to have children, some doctors say women can take the revolution a step further: They can use the pill to rid themselves of the hassles of monthly menstruation.

While the practice is often one of convenience or used to address problems related to menstruation, experts are studying whether it is medically risky — or beneficial — for women to have fewer periods.

A University of Washington professor will publish a study in March on women who used the pill to skip their periods for a year.

And by this fall, pending Food and Drug Administration approval, women will be able to slash the menstrual experience from 13 times a year to four with currently available pills packaged to allow three months between periods.

"Birth control led to a fundamental social, cultural and psychological change," said Susan Jeffords, a professor of women's studies at the University of Washington. "This is an amendment to that."

Women for years have used the pill to manipulate the timing of menstruation. They skip the placebos in their packs of birth-control pills and start new, "active" packs to keep their periods from coinciding with weddings and special events.

Doctors also have been prescribing continuous use of birth-control pills for women who have difficult and sometimes painful periods, or who suffer from conditions such as menstrual migraines or endometriosis, which is the growth of uterine tissue outside the uterus.

But some women are tossing their tampons and pads simply to make their lives easier.

"It's not something totally magical," said Dr. Leslie Miller, the UW obstetrics and gynecology assistant professor who is heading the project here. "It's just logical that you don't have to have bleeding during the period week."

Diane Royal, 49, of Seattle, has been skipping her periods for almost six years.

"I don't have mood swings. I don't have the mess. I don't have cramps," she said. "It's just more convenient in my life not to have a period."

When she reached her 40s, Royal began having painful periods that were so heavy she was hesitant to leave home. She heard about skipping periods from a friend and talked to her doctor.

"At first he was really skeptical," she recalled. "Then he started doing some research ... and said, 'Let's go ahead and try this.' "

For Royal, an artist and mother of three, continuous birth-control use has given her new options, even allowing her to home-school her youngest child.

"It's great," said Royal. "It doesn't change my sexuality or my womanness. I'm still as feminine as I've always been."

The science of birth control

The menstrual cycle helps allow pregnancy. The ovary releases an egg, usually monthly. Blood and tissue build up in the uterus to host a fertilized egg.

If pregnancy doesn't occur, the lining of the uterus is flushed out. The process repeats itself each time an egg is released.

Birth-control pills, first approved by the FDA in 1960, contain the hormones estrogen and progestin. They prevent pregnancy by thwarting the ovaries from releasing eggs and thickening mucus in the cervix to prevent sperm from entering the uterus. And they keep the uterine lining thin so even if an egg is fertilized, it won't implant.

The pill was designed to mimic an average menstrual cycle of about once a month, although individual women's cycles actually range from 22 to 35 days, according to the American College of Obstetricians and Gynecologists.

"On their own, most women won't have a 28-day cycle," said Wayne Shields, president of the Association of Reproductive Health Professionals, a nonprofit educational organization. "The whole premise of the 28-day cycle is something that was made up in the early '50s by a bunch of white guys." Most women take 21 days of pills and then stop or take sugar placebos for seven days. The drop in hormones causes the uterine lining to weaken and bleed lightly, a process called "withdrawal bleeding."

But because the uterine lining never thickens, there's no actual need for it to be shed, she said.

Miller herself threw out a box of tampons a few years ago because it had collected so much dust in her bathroom.

"First you skip a period because it's convenient. And then you start skipping them because you can," she said. "I experimented on myself. ... I did it and it worked and I thought, 'Oh, well, everyone should do this.' "

When she couldn't find any studies to support, or contradict, the practice, Miller decided to do some research.

In 2001, she published a paper on 40 women who were taking pills to skip their periods every other month. They reported less fatigue and fewer side effects of menstruation than 40 women who took the pill as usual.

But, Miller said, there can be drawbacks to constant pill use.

"The first six months, it's very common to have irregular bleeding," she said.

And women would need more birth-control pills. A traditional pack costs about $30.

Unknown risks and benefits

Dr. Hilda Hutcherson, an assistant professor of obstetrics and gynecology at Columbia University, cautions against the practice until long-term studies prove it's safe.

It's unknown whether long-term menstrual suppression could increase risks linked to the pill, such as blood clots, heart attacks and strokes, she said.

"Is it really worth the unknown risks of serious harm for a little convenience? I don't think so," she said.

The American College of Obstetricians and Gynecologists also highlights the lack of research.

"There is no evidence of any adverse health ramifications," said Dr. Jimmy Moore, who chairs the organization's committee on gynecologic practice. "But there's not enough data for our committee to come together with an opinion."

The interest in using the pill to suppress menstruation comes just as women in menopause are being cautioned against prolonged use of hormone-replacement therapy, or HRT. Many birth-control pills and HRTs contain virtually the same hormones but in different proportions.

The lack of research comparing the two could add confusion to the hormone debate.

Some doctors believe there may be health benefits to decreasing the number of a woman's periods.

A century ago, most women had about 50 periods during the course of their lives because they were pregnant more often, breast fed for up to two years (which stops bleeding) and died younger, Miller said.

Today, most women have more than 450.

"Nature did not mean for you to have that many periods," Miller said.

Studies have shown that women who have fewer pregnancies and breast feed less are at a higher risk of ovarian, uterine and breast cancers as well as endometriosis and uterine fibroid tumors, she said.

"This is not to say that continuous pills are going to prevent fibroids or endometriosis, but women who do use pills (the traditional way) decrease their chances of ovarian and uterine cancers," said Miller.

A woman's ability to get pregnant shouldn't be affected, she said.

"Within seven days, the pill hormones are out of your body. And within a few months, most women ovulate," she said. "But you'll only be as fertile as you were before you got on the pill."

Women should talk to their doctors about the best pill to use for an extended regimen. Miller recommends pills with low doses of estrogen that don't fluctuate in dose each week.

Four periods a year

New York-based Barr Labs is awaiting FDA approval to market Seasonale, a package of 84 birth-control pills and seven placebos that would cut periods to four times a year, said company spokeswoman Carol Cox.

The company has to prove the drug does what it is marketed for, which is to prevent pregnancies. Having fewer periods would be a side benefit, she said.

Studying 500 women, doctors found that women with four periods a year got similar protection from pregnancy as those taking the pill as usual, said Dr. William Gibbons, chairman of the obstetrics and gynecology department at Eastern Virginia Medical School, which studied the pill for Barr Labs.

"These days, women lead busy lives. Menstruation is something they can do without if they want to," said Dr. Hope Ricciotti, an obstetrician/gynecologist at Beth Israel Deaconess Medical Center in Boston and an assistant professor at Harvard Medical School.

And because one in four women reported canceling a professional or social appointment due to period-related problems, according to a survey last year by the Association of Reproductive Health Professionals, interest in the ability to suppress menstruation is sure to be high.

"There are a lot of women who will choose to take advantage of this just because it's going to be easier," said Jeffords, the UW women's studies professor. "Just the availability will send a powerful message to women, giving them more opportunity to control their day-to-day lives."

Gina Kim: 206-464-2761 or gkim@seattletimes.com