New birth control pills give more control over menstruation

Formulations allow women to have four periods a year or none at all, or shorten them to just a few days.

By Victoria Stagg Elliott — Posted July 10, 2006

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A handful of new birth control pills either approved within the past couple of years or due soon to reach the marketplace is challenging the notion that women need to have a monthly cycle.

"There's nothing that says a woman has to have a period once a month or have it for six days," said LeRoy Sprang, MD, clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine in Chicago.

The Food and Drug Administration is currently considering whether Lybrel, a hormonal birth control pill that would be taken every day without a breakthrough bleed, should be approved. Seasonale, which allows for only four periods a year, was approved in September 2003. Seasonique, with a second-generation version that replaces the placebo pills taken every three months with those that provide a low-dose estrogen, was approved in May. Yaz and Loestrin 24 FE were both approved earlier this year and provide 24 days of hormones rather than the traditional 21. The result is a shorter period than what occurs with the standard formulations.

Not a new function

Experts attribute the shift away from the pill's traditional 21/7 regimen -- long viewed as the gold standard -- on several converging factors. The pill has been around for decades, meaning that women are more likely to trust it to work without the need for the monthly reassurance that breakthrough bleeding provides.

"It was made to appear natural and be reassuring that you're not pregnant," said Leslie Miller, MD, associate professor of obstetrics and gynecology at the University of Washington in Seattle. "Forty-five years later, we don't need that."

Medications not just to cure disease but also to improve people's quality of life and, if possible, provide other benefits such as convenience, are an increasing focus.

"Women are more active and more involved in the world," said Nancy Church, MD, an ob-gyn at the Wellness Connection in Chicago. "There's no reason not to assist them."

Physicians also say the trend is an official acknowledgement that many women have been manipulating menstruation all along. Some have chosen to alter their pill doses to eliminate or shorten their period for convenience. Others were recommended by their physicians to take the pill continuously to deal with migraines or painful menstruation.

A 2003 survey by the Assn. of Reproductive Health Professionals found that nearly three-quarters of physicians who participated have prescribed menstrual suppression. Another 2003 poll, this one by the American College of Obstetricians and Gynecologists, found that about half of their female members have used the pill to avoid their periods.

"It's not a totally new idea," Dr. Miller said. "Doctors' friends and families always knew that they could skip their periods."

But despite the fact that using the birth control pill to alter menstruation has been common on an off-label basis, many physicians welcome the new approved options because they might make women more at ease with altering their cycle.

"This makes it much more acceptable to the general community," Dr. Sprang said. "Women knew they could do it, but they were not always comfortable doing it."

Many physicians also say that the additional options lead to more interesting discussions with their patients.

"It does take a little bit more time, because there are more options to discuss, but it gives me a little bit more opportunity to find out about my patients as people," said Stephen A. Wilson, MD, MPH, assistant director of the family medicine residency program at the University of Pittsburgh Medical Center's St. Margaret Hospital. "We have some different types of conversations that we may not have had otherwise."

Not for everyone

Doctors note, though, that menstrual suppression is not for everyone. Even the most ardent supporters say that if a woman is doing well with her current birth control formulation, there's no need to bring up the newer options.

"I don't think that everyone should have no periods," Dr. Miller said. "If she's happy, I'm not going to waste my breath."

Physicians also say that some women still need to experience monthly reassurance that they are not pregnant. Others may view something abnormal in giving up their periods completely. They may prefer to stick with traditional regimens or switch to the versions of the pill that allow for shorter periods.

"Patients know no pill is 100%. Each person has that fear factor," said Tyrone Malloy, MD, a obstetrician-gynecologist in Decatur, Ga. He was one of the investigators for the trials of Loestrin 24 FE. "People also feel that its natural to see something every month."

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More choices

Hormonal birth control was designed to mimic a woman's usual cycle, but a growing number of formulations -- either already available or moving toward the marketplace -- are challenging this approach:

Seasonale/Seasonique: Women take 84 days of active hormones followed by seven days of a placebo or a pill with a low dose of ethinyl estradiol, leading to four breakthrough bleeds a year.

Lybrel: Women would take active hormones every day to suppress menstruation. (Not yet approved.)

Yaz and Loestrin 24 FE: Provides 24 days of hormones and four days of placebo pills or iron supplements to have a shorter breakthrough bleed.

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External links

Contraception Online, Baylor College of Medicine, Houston (link)

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