For better or for worse, a monthly menstrual period may no longer be a fact of life for women.
Women have been doing it for years – taking birth control pills straight through their ‘placebo weeks’ in order to skip a period. Gynecologists have often instructed women who wish to skip a cycle to employ this method – where women keep taking their normal pills rather than the standard hormone-free placebo pills – to inhibit the period.
But the Food and Drug Administration’s September approval of Seasonale, the newest oral contraceptive, has further ignited the debate over the biological necessity of menstruation and the safety of suppressing it.
Seasonale reduces the frequency of periods from once a month to once every three months – a dream come true for many women. The drug arrived on pharmacy shelves late last month, and differs from conventional contraceptives – the ratio of active pills to placebo pills dispensed in each pack has changed.
Pharmaceutical companies package other oral contraceptives as 21 active pills followed by 7 placebo pills or a pill-free week, while Seasonale prescriptions dispense 84 active tablets followed by 7 placebo tablets.
Developers chose Seasonale’s regimen based on responses of women that had been surveyed. The results indicated four as the optimal number of yearly periods.
WHAT WOMEN WANT
Barr Laboratories, the manufacturer of Seasonale, plans to present this difference as an added ‘convenience’ of a pill primarily intended to prevent pregnancy, said Carol Cox, a Barr spokeswoman.
‘This is going to be hot,’ said Patricia Sulak, a doctor and professor of medicine at Texas A’M College of Medicine, in reference to Seasonale. ‘I think monthly periods are going to be out the door.’
Boston branches of Planned Parenthood are not offering Seasonale yet.
‘It’s still very new. We’re looking into it at this point. It doesn’t appear to carry any known additional risks compared to traditional contraceptives,’ said Planned Parenthood communications director Erin Rowland. ‘We do believe that it’s going to be a good option, especially for women who have difficult or painful periods, and it does seem to offer more convenience.’
In the laboratory, Barr compared Seasonale to Nordette-28, a pill taken in the conventional style, in a yearlong clinical trial and concluded that the new contraceptive is safe, effective and well-tolerated.
Most often, study participants in both the treatment and control groups reported only minor adverse effects. These included symptoms associated with sinus and respiratory tract infections, headaches and unexpected bleeding. The researchers defined the bleeding as an inconvenient but harmless side effect. The study also reported that women taking Seasonale wanted to continue doing so, Cox said.
MENSTRUAL SUPPRESSION AROUSES SUSPICION
Despite the positive reports from results from Barr, which concluded that Seasonale is not dangerous, other health professionals believe longer-term studies are necessary before doctors start prescribing to interested patients.
Christine Hitchcock, a research associate at the University of British Columbia, is one of many opponents who worry about the effects on female hormones prolonged exposure of Seasonale on will have.
Estrogen stimulates cell growth and division in the breast and uterine lining. Hitchcock and others say they are worried that without the placebo week that normalizes cell growth, Seasonale users may be at an increased risk for types of cancer, including breast cancer.
Taking more active pills, like Seasonale, does not give women the week-long ‘break’ from high levels of hormones, Hitchcock said.
It takes about two months longer to conceive after being on oral contraceptives such as Ortho Tri-Cyclen, one popular and conventional birth control pill. Hitchcock questioned whether the extended regimen of Seasonale would lengthen this lag, since the menstrual cycle is experiencing stronger suppression.
In light of these concerns, Hitchcock claimed more data is needed to show that menstrual suppression is safe and reversible. She offered examples of other therapies once recommended for women – such as hormone replacement therapy – were later proved to provide dangers to womens’ health.
Studies that examine drug safety methods conclude there is a ‘a history’ of physicians recommending women’s medications without adequate safety testing, Hitchcock said.
Some supporters claim periods are simply unnecessary. Sulak recommends menstrual suppression to any woman who expresses interest, from women with unhealthy menstrual disorder to those with uncomfortable menstrual-related symptoms to those merely inconvenienced by a monthly bleed.
On average, the modern woman experiences 450 periods over her lifetime, three times the number of periods experienced by women in non-industrialized societies. This proves it is not necessary for modern woman to have so many periods, supporters say.
‘It is natural to have one to two periods a year and be breastfeeding or pregnant [the remainder of the time],’ said Mitchell Creinin, director of family planning at the University of Pittsburgh and Magee-Women’s Hospital. It is arbitrary for women taking oral birth control to have one period per month, he added.
John Rock and Gregory Pincus, developers of the first birth control pill, chose to mimic a woman’s natural cycle not because of health benefits but to reassure a woman of her health and make the pill seem more natural in an effort to garner acceptance from the Catholic Church, he said.
YOUNG WOMEN ARE HESITANT
Boston University Student Health Services has scheduled an informational meeting about Seasonale for staff members with a representative from the drug’s manufacturer, after which they will be able to inform students about the new pill.
Many BU women think it would be convenient to have fewer periods, but they wonder about associated health risks.
‘I don’t know how healthy it is to only get your period four times a year,’ said College of Arts and Sciences sophomore Melissa Hagadorn. ‘It would be very convenient, but I’d want to know more about the long-term effects.’
College of Communication second-year graduate student Katherine Forbes, agreed.
‘To have your period only four times a year would be great,’ she said. ‘I wouldn’t mind that part of it, but I don’t know about the side effects.’
Other students say they feel reassured by having a period every month.
‘I’d almost be weirded out,’ said Prachi Patel, a College of Communication senior. ‘I’d wonder what it’s doing to my body.’
Rossie Merrill, a College of Arts and Sciences junior, expressed a similar opinion. ‘I feel like we’re meant to have our period every month,’ she said. ‘Getting it four times a year would be a psychological curveball.’