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MEDICINE
SEPTEMBER 18, 2000 VOL. 156 NO. 12

Who Needs a Period?
More and more women are taking control of their monthly cycles. What are the risks and benefits?
BY CHRISTINE GORMAN

Anne Jorgensen, 22, a law student at Washington and Lee University in Lexington, Va., who uses birth-control pills, has a secret she doesn't want her doctor to know. To make it easier to attend her winter formal, a wedding and a few other special events, she tricked her body into skipping its monthly menstrual cycle several times in the past year. How? Instead of taking the last seven pills in her contraceptive case, which contain the placebos, or dummy pills, that allow her uterine lining to slough off each month, she immediately started her next month's batch of active medication. Result: instead of the usual 13 periods a year, she had nine.

Jorgensen is not alone. Practically since the Pill was introduced in 1960, women have used it to manipulate the timing of their periods--something the contraceptive was not designed to do. But what has been an off-label practice may soon become mainstream. Researchers at Eastern Virginia Medical School in Norfolk are testing a new contraceptive formula, called Seasonale, which can reduce the number of periods a woman experiences to as few as four a year.

"Not every woman will be able to do this initially," says Dr. Freedolph Anderson, who is leading the study. Some women, for instance, may at first experience breakthrough bleeding, something that often happens when women skip periods using standard birth-control pills. But with some fine tuning, women can learn to turn their cycles off and on to suit their busy schedules. And if all goes well--and if the Food and Drug Administration approves--Seasonale, the first pill produced for that purpose, could reach the shelves of U.S. pharmacies by 2003.

Like ordinary contraceptive pills, Seasonale contains two different hormones: progestin, which inhibits the release of eggs from the ovaries; and estrogen, which holds the uterine lining together. The idea is to take Seasonale every day for 12 weeks. Taking daily placebo pills for the following week creates a short interruption in hormone levels that allows an immature egg to be discarded with only a little bleeding.

Having just four menstrual cycles a year may not be as unnatural as it sounds. Studies of ancestral societies in Africa and Australia suggest that historically women have spent most of their fertile years either pregnant or nursing. As a result, they averaged about 150 periods between puberty and menopause, compared with 400 in developed countries today. Indeed, the risk of such modern medical ills as endometriosis is believed to increase with the number of menstrual cycles a woman goes through.

But there are risks in using the Pill to fool with Mother Nature. Seasonale would necessarily expose a woman to nine extra weeks of estrogen a year, and doctors have long known that taking estrogen increases a woman's risk of suffering a blood clot or stroke--particularly if she smokes or has high blood pressure. Estrogen may also boost a woman's risk of developing breast cancer, although the evidence for that is less clear.

Anderson contends that the risk should be minimal because Seasonale contains less estrogen than conventional birth-control pills. Other doctors are not so sure. "Any time we're dealing with hormone manipulation, we should act with caution," says Dr. LaMar McGinnis Jr., a senior medical consultant for the American Cancer Society. "There's such a complex relationship that gets played out over a long period of time."

There is another way to avoid monthly menstrual cycles besides getting pregnant or nursing. You can get shots of Depo-Provera, which contains only progestin (and not estrogen), every three months; the majority of women who use this contraceptive eventually lose their periods. Of course, they do have the added inconvenience of having to go to a doctor's office four times a year.

Meanwhile, new and better ways to avoid monthly bleeding are being explored. Researchers at Balance Pharmaceuticals in Santa Monica, Calif., are developing a contraceptive that reduces the level of reproductive hormones circulating in the body. The goal is to lower the risk of hormone-dependent cancers and minimize cramping, bloating and the other discomforts associated with menstruation. At McGill University in Montreal, scientists are trying to design a "career pill" that would put women's ovaries on hold for decades, allowing them to start having children later in life. It's still unclear, however, whether the women's eggs would survive in good enough shape to give rise to healthy babies.

In the meantime, it doesn't hurt to consult your doctor first if you decide to shift the timing of your period. You may discover your physician to be surprisingly sympathetic to your plight. And there are so many different formulations of birth-control pills that you may need help in figuring out which pills to skip. For example, some brands require you to skip to the middle of the pack, rather than to the beginning, to prevent breakthrough bleeding. Besides, it often helps to have two people watching for any untoward side effects. Menstrual cycles may be on their way out, but they're not yet obsolete.

--REPORTED BY JULIE RAWE/NEW YORK



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