story by

Melissa McDonald

“The Curse.”

The regular visit from “Aunt Flow.”

“The monthly bill” that’s due—or worse, late.

Every generation has its own code language for menstruation. Being in one’s “period” is today’s roundly accepted term for “that time of the month” (forgot that one) when a woman sheds her endometrial lining.

Over the years, researchers and drug manufacturers have continued to look for ways to help women shorten or lighten their periods. Lybrel, due this July, is a newly approved birth control pill that eliminates the monthly cycle altogether. But, is it safe to do so?

The Food and Drug Administration says yes.  In fact, the new low-dose pill is specifically designed to stop a woman’s period until she is ready to resume it, if ever.

“The idea that a woman needs to have a period is just not true,” says Pamela Berens, M.D., associate professor in obstetrics and gynecology at The University of Texas Medical School at Houston. “There are no studies right now that indicate it could be harmful not to have a period when using this type of product.”

You just think
you have periods

In fact, women who are taking any type of birth control pill do not menstruate. The pill simply simulates menstruation, akin to a fake period, called “withdrawal bleeding.” During actual menstruation, a woman’s body naturally produces hormones that prompt her ovaries to release an egg and thicken the lining of the uterus. If the egg isn’t fertilized, the uterus sheds that month’s unnecessary nest. This shedding is the bleeding experienced as a period.

The synthetic hormones in birth control pills interfere with that natural cycle.  A woman takes three weeks of active pills and a fourth week of placebo or “sugar pills.”  The drop in hormones during the placebo week is what causes the uterine lining to shed. This withdrawal bleeding is usually lighter and briefer.

Breakthrough bleeding:
a comma, not a period

While the idea of no periods might be wonderful news to some women, it could be too good to be true. In clinical studies submitted to the FDA by the drug manufacturer, Wyeth Pharmaceuticals, many women experienced breakthrough bleeding.

“Healthcare professionals and patients are advised that when considering the use of Lybrel, the convenience of having no scheduled menstruation should be weighed against the inconvenience of having unscheduled bleeding or spotting,” said the FDA. That side effect may deter some women from checking out this new product. 

Alicia Larsen wants a family some day, but not now.  She just finished medical school and is about to begin her residency in ob-gyn. She says breakthrough bleeding is one of the reasons why she won’t try Lybrel.  “You don’t know when spotting might happen. It could happen during a really embarrassing situation,” she says.

Larsen also echoes what many women feel about their periods: “How would you know if you’re pregnant? I would spend 10 to 20 dollars every month on pregnancy tests. Having a period helps eliminate that worry,” Larsen says.

Berens also points out that there is really no long-term data on products like Lybrel, or Seasonique, which promise women a period only every three months. “There’s always a small chance that side effects could pop up once more women try this product,” Berens says.

After all, remember hormone replacement therapy?  Millions of menopausal women took HRT for decades before the risks surfaced through the results of the Women’s Health Initiative studies in 2003.

But consider this: some women have been trying out their own version of Lybrel for years. All you have to do is buy three extra packets of pills a year, and substitute your active pills for the placebos each month. So is Lybrel just a packaging concept?

“Lybrel is certainly packaged for convenience,” observes Berens. “There are other oral contraceptives with only 20 micrograms of estrogen. Theoretically, those pills would produce similar results to Lybrel, but this drug’s been FDA approved.”

Women can also turn to the Depo Provera hormone injection every three months.  Most women will not have a period for up to one year after one year of use. That could be a problem if a couple changes their minds and wishes to conceive sooner than the expected wear-off year. With Lybrel, preliminary studies say that conception can occur within days—not months--after stopping the drug.

So are women choosing these products?

“Patients do frequently ask about minimizing their days of bleeding, especially college kids and athletes. I also get requests from women who want to avoid their cycles when they are on vacation or their honeymoon,” says Berens. Women with crippling dysmenorrhea (cramping), strong premenstrual symptoms and heavy periods will likely investigate this pill for reasons other than pure convenience or birth control.

The bottom line: Lybrel and other birth control methods give women more options.  Before 1960, the year the pill first hit the market, women had only two effective methods: the diaphragm and abstinence. Period.

Last Updated: 6-18-2007

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