Farewell To 'Aunt Flo'

Ask a bunch of women if they enjoy getting monthly periods and a significant majority (at least according to our own water-cooler survey) will answer "No!" Still, a woman's cycle has long been seen as a healthy and inevitable part of reproductive life. That could soon change with a new version of the birth-control pill that dramatically reduces the number of periods a woman has every year, from 13 to 4. Now even menstruation turns out to be a lifestyle choice.

Doctors have been prescribing "menstrual suppression" off-label for years to treat endometriosis (an overgrowth of uterine tissue), menstrual migraines and PMS. And plenty of women have altered the pill's regimen to enjoy period-free vacations. Now, in addition to the new version of the pill, which manufacturer Barr Laboratories has submitted for FDA approval, makers of the birth-control patch and vaginal ring are also testing their products for continuous use. If the pill, called Seasonale, passes muster, women could reprogram their monthly cycles by the end of the year with government approval.

Seasonale contains the same ingredients as conventional birth-control pills, but will be packaged and prescribed differently: 84 active pills taken in a row, followed by seven placebos, as opposed to the traditional 21/7 regimen. Women do seem to want it. In a Dutch survey, two thirds of women between 15 and 49 said they'd prefer fewer periods. And when 318 women with painful periods were counseled on continuous oral contraception in a study led by Dr. Patricia Sulak at Texas A&M Medical School, 91 percent jumped at the chance to try it.

Many doctors believe cutting back on menstruation could be healthy. Researchers estimate that women now have three times as many periods (450 over a lifetime) as our hunter-gatherer ancestors, who started menstruating later and spent many more years pregnant or nursing. Menstruation can promote fibroids and endometriosis. And taking oral contraceptives cuts the risk of uterine and ovarian cancer. As it is, the pill shuts down ovulation, so bleeding is a reaction to the shift in hormones, not true menstruation. Why, then, have monthly periods? asks Dr. Leslie Miller of the University of Washington: "There's really no benefit."

The pill has some negative side effects like breast tenderness, and, in very rare cases, blood clots. A recent study found no increased risk of breast cancer, but it's not known whether that's true for continuous use. So far, the biggest problem has been breakthrough bleeding. In the Seasonale trial, 7.5 percent of the women dropped out because of it, compared with 1.8 percent taking the pill conventionally. The problem tends to dissipate after the first few months and may be less of an issue among women already on the pill, says Dr. Alison Edelman, who is studying breakthrough bleeding at Oregon Health & Science University. Still, other problems could show up later. "One of the things that the HRT debacle showed us is we just can't assume safety," says Dr. Susan Love of the Susan Love MD Breast Cancer Research Foundation. As a result, Miller, who is studying menstrual suppression, believes the lowest-dose birth control available (20mcg) should be used.

So far, there's no official stance. The American College of Obstetricians and Gynecologists may issue an opinion this spring, says ACOG's Dr. Jimmy Moore. Until then, it's up to women and their doctors to decide. Many women depend on their periods as proof that they're not pregnant and think fiddling with nature's rhythms is "freakish." But for others, cutting back on periods (and cramps and chocolate cravings) would be a fantasy come true. "We're giving women a choice," says Dr. William Gibbons of Eastern Virginia Medical School, a test site for Seasonale: to go with the flow or to control their bodies in a whole new way.

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