The End of the Period?

What you need to know before you stop the flow.
By Lisa Marshall

Some see menstruation as a curse that dashes vacation plans, cramps our bellies (and our styles), and wreaks havoc on our emotions. Others embrace it as a welcome sign of health and an integral part of womanhood. But in an age when a pill exists for everything, a growing number of women look toward one that can render their menstrual cycle something else entirely: optional.

Since the ’60s, the birth-control pill has allowed women to suppress ovulation (the release of an egg). If taken a certain way, it also allows women to suppress menstruation (the shedding of the uterine lining, aka your period). Today, “skipping your period is also an option, and I think a lot more women are going to start doing it,” says gynecologist Leslie Miller, MD, who founded the website noperiod.com in 2000 to promote the idea of using contraception to keep menses at bay.

A number of drug companies have made it easier than ever. In July 2007, Lybrel came onto the market as the first oral contraceptive designed not only to prevent pregnancy, but also to eliminate periods for a year or more. Before that came Seasonale and Seasonique, “extended-cycle” birth-control pills expressly marketed to reduce menses to four times a year—transforming “that time of the month” into “that time of the season.” Two other products, Yaz and Loestrin 24, reduce bleeding time to three days or fewer, while Depo Provera, a quarterly injection, and to a lesser degree the Merina intrauterine device (IUD), can actually halt periods completely.

For the cycle-stopping pills, the hormonal ingredients are virtually identical to those in the conventional birth-control pill introduced nearly 50 years ago. The big difference? They lack the seven placebo pills that prompt withdrawal bleeding (a sort-of “fake” or anovulatory period). “When you take the placebo pills, your estrogen and progesterone levels fall, and you shed your endometrium,” explains Susan Ernst, MD, chief of gynecology services for the University Health Service at the University of Michigan.

Unlike the conventional Pill, these new versions are marketed to all women (not just sexually active ones) by a slew of ads, industry-sponsored blogs, and websites touting “freedom” from that pesky bleeding. “Fewer periods. More possibilities!” cheers one Seasonale ad.

Not everyone brims with enthusiasm, however. Amid the media blitz has come a fury of outrage, from both physicians who fear we may be in store for another “women’s health experiment gone awry,” and feminists who wonder what message we are sending our daughters.

“It’s a horrifying prospect,” says Susan Rako, MD, a Boston psychiatrist and author of The Blessings of the Curse: No More Periods? (www.Backinprint.com, 2006). “Encouraging healthy young girls and women to do away with their periods for the sake of convenience, without educating them about the health benefits of a normal menstrual cycle—as well as the risks of menstrual suppression—is irresponsible and unethical.”

Old pills, new packaging
The notion of using oral contraception to prevent menstruation is nothing new. For decades, physicians have quietly advised women with a looming honeymoon, camping trip, or any other upcoming event during which a period would be highly inconvenient to simply toss out the week of sugar pills and start their next packet, if they wanted to skip their period.

In the past five years, though, this once-hushed notion has become a booming industry. Health practitioners say they’ve received a surge in inquiries from women of all ages—some of them sexually active, some not. “We used to recommend menstrual suppression for particular reasons: for women who had endometriosis, horrible pain with periods, or cognitive problems that made menstruation hard to manage,” says Ernst. “Now the average young woman who may not have any medical problems has heard about menstrual suppression on TV.”

That worries Christine Hitchcock, PhD, a researcher with the Centre for Menstrual Cycle and Ovulation Research in British Columbia, Canada: “We just don’t know what the longterm risks are.”

Is it worth it?
Certain known risks already exist with both the new Pills and the conventional kind. Estrogen levels in contraceptive pills can be as much as four times higher than those present during a natural menstrual cycle. Partly because of this, research shows that women taking the Pill have double the risk for strokes and heart attacks. They also may be more susceptible to estrogen-fueled cancers such as breast cancer.

Additionally, the Pill can bind testosterone in the body, possibly dulling libido and causing depression. Most recently, studies have linked oral contraceptives to atherosclerosis and cervical cancer. On the flip side, the Pill decreases the risk of ovarian cancer by 40 percent and, of course, prevents pregnancy.

Now, in the age of “no periods,” doctors wonder if continuous-use contraceptives will exacerbate the risks of the Pill. Specifically, several questions loom large:

Will taking seven more pills each month (rather than the sugar pills) increase the cardiovascular risks? Since 1981, numerous researchers have hypothesized that men and postmenopausal women have more strokes and heart attacks than naturally cycling women because they store excess iron. Women who menstruate monthly purge the iron they don’t need. As Rako points out in her book, nature has provided reproductive- age women with a natural form of protection against cardiovascular disease that few of them know anything about.

Does taking a week of placebos allow the breast tissue a much-needed break from all that estrogen?

Does bleeding cleanse a woman’s body of harmful elements, such as potentially precancerous cells in the uterine lining?

Will the new Pills cause more bone loss? Already, people on the normal Pills lose 1 percent to 2 percent more bone density in their hips and spines every year than those not on the Pill (setting them up for osteoporosis later in life). A study from Purdue University on 135 healthy women found that eating more calcium-rich dairy foods offsets this bone loss. But with the new Pills, the loss of calcium may increase. Many doctors, in fact, fear that in women age 15 to 25, continuous-use oral contraceptives could stunt bone growth at a critical stage. One study of adolescents taking low-dose Pills for one year found “significantly lower” rates of bone growth than in those not on the Pill.

Most experts agree that the answers to all these health questions have not been decided. “Most of the research on extended-cycle contraception has been short-term,” Hitchcock says. “There is not much research into the broader context of the menstrual cycle.”

A cultural shift
Medical issues aside, stopping menstruation carries significant cultural implications. Miller believes it liberates women. Research has shown that because we have fewer children and don’t nurse as long as we used to, we have nearly four times as many periods as those in primitive agricultural societies. Those roughly 400 weeks of bleeding, cramping, and mood swings, says Miller, are neither fun nor necessary. “Ovulation and menstruation are about getting pregnant. If you aren’t going to get pregnant, you shouldn’t have to bleed.”

Still, many people consider the increasing popularity of menstrual suppression as nothing less than a threat to womanhood. As much as we dread it, “the curse” bonds women together—from adolescence when we whisper about who got hers first to adulthood when we wordlessly lend a tampon to a stranger.

“I think as a culture, we have come a long way in trying to prepare young girls for menarche and telling them this is an exciting time in their lives,” says Ingrid Johnston-Robledo, an associate professor of psychology and women’s studies at State University of New York, Fredonia. “Now, we are sending a message that menstruation is extremely bothersome and debilitating. It is really pathologizing a natural bodily function.”

What’s more, by keeping our hormone levels more constant via the Pill, we may rob ourselves of the ebbs and flows that make women women. “In my life, I can remember the rhythms of my sexual interest, the times of the month I had a nesting instinct, the times of the month I felt the most creative,” says Rako. “This takes away that entire cycle.” In a way, it divorces women from their bodies.

So although menstruation is joining the list of everyday, prosaic decisions—should I dye my hair? shave my legs? have a period?—keep in mind that the long-term physical and mental health effects are essentially unknown. The period remains a question mark.

Lisa Marshall, a freelance writer based in Estes Park, Colorado, is a frequent contributor to Natural Solutions.