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Taking the pill throughout the month can mean no menstruation, no PMS

graphic

May 10, 2000
Web posted at: 11:25 a.m. EDT (1525 GMT)

ATLANTA (CNN) -- Discovering "one of medicine's best-kept secrets," more and more women are learning they can avoid monthly periods and the agonies of PMS by taking active birth-control pills everyday.

"It is simplicity itself to eliminate menstruation with safe, inexpensive and widely available oral contraceptive tablets," two researchers recently wrote for The Lancet, a British medical journal.

Under a doctor's supervision, a woman can take active pills all the way through her monthly cycle, instead of the traditional 21 active pills and seven placebos. The result is no monthly bleeding.

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"Health professionals and women ought to view menstruation as they would any other naturally occurring but frequently undesirable condition," wrote Sarah L. Thomas and Charlotte Ellertson.

Monthly menstruation year after year is not the historical norm, they said. While a woman in a modern, industrial society can expect to have about 450 periods during her life, women in earlier times had fewer ovulations, historic differences in life expectancy notwithstanding.

"Women who use oral contraceptives and feel that they are maintaining a 'normal' or 'natural' cycle are being duped," contended Thomas, a public-affairs graduate student at Princeton University, and Ellertson, who holds a Ph.D. in demography from Princeton.

For most women, "the fact that they can suppress their periods on an ongoing basis remains one of medicine's best-kept secrets," they wrote.

Because there have been no long term studies of women who suppress their periods, there are those who believe more research is needed on possible health hazards.

"This notion that we should just eliminate periods altogether is just crazy," said Dr. Susan Love, a surgeon at University of California Los Angeles.

British Columbia endocrinologist Jerilynn Prior agrees. "Why are we trying to fix something that doesn't need fixing? In other words, menstruation isn't that bad for most women."

The Thomas-Ellertson team contend women and health professionals are "conditioned to think of monthly menstruation as the holy grail of womanhood. Birth-control pills themselves, for contraceptive purposes, have now been accepted for many years, but there was a sensitivity among their earliest marketing executives to the psychological importance to women of the monthly bleed."

Part of that importance was the monthly assurance that the women were not pregnant, noted Dr. Charles Wootten, a gynecologist at the Emory Clinic and a faculty member at Emory University, Atlanta. Pregnancy test kits, sold at drug stores and elsewhere, can provide the assurance women formerly got from menstruating, he said.

As many as 10 percent of his patients on the pill continue taking the contraceptive during the whole monthly cycle, Dr. Wootten estimated. Also doing it are several women gynecologists he knows "who feel it is safe enough and don't want to be troubled by having the period."

He recommended women discuss the matter with their physicians. Often, his patients will take the pill continuously for three months, then have a break.

"That cuts the periods from 12 down to four a year," Dr. Wootten said. For women who suffer from menstrual migraine headaches, fewer periods are very welcomed.

Some women taking the pill daily for weeks and weeks may still experience irregular "spotting" or even heavier bleeding, he said.

Ellertson, who lives in Mexico City and is director of reproductive health for Latin America in a nonprofit organization called the Population Council, said she has received comments from around the world since publication of her essay on March 11.

While she considers herself "an ardent feminist," she said some feminists have taken an unexpected view of what she advocates. Since menses is so closely associated with women, some other feminists have argued the flow of blood and cellular debris from the uterus should be, in effect, celebrated each month.

But Ellertson and Thomas wrote, "Menstrual control with oral contraceptives could substantially improve women's health and concurrently constitute a gain for society."

Included is a commercial reason: "Menstrual disorders cost U.S. industry about 8 percent of its total wage bill," they said. The productivity of some women workers declines during the few days before and during menstruation.

"If a woman is not menstruating, she is probably also avoiding the sharp changes in hormone levels that regulate this bleeding," they wrote. "Measures to eliminate these fluctuations may help some women avoid those mood and personality changes of premenstrual syndrome (PMS)."

Taking note of growing awareness of optional menstruation and the lower risk of ovarian and uterine cancer among many women on the pill, one American manufacturer plans to market a birth-control pill for continuous use over three months.

Most doctors agree it is up to the patient to decide what will work best for her.

"Why don't we just leave it in the hands of women, give them the data that we have and the date we don't have and let them make their own decision," Love said.

CNN Correspondent Anne McDermott contributed to this report.

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RELATED SITES:
Birth control information from the U.S. Department of Health and Human Services
The Population Council


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