Maybe you're one of those women who has always called it "the curse." Your menstrual periods cause severe cramping, heavy bleeding, outbreaks of herpes, migraines. Or they make you so bitchy, even you can barely stand to be around yourself. Or maybe they're not so bad, but with white-pants season arriving, you can't help thinking that life would be simpler without them.
In either case, the Food and Drug Administration's announcement last week that it had approved Lybrel, a new low-dose birth-control pill specifically designed to eliminate monthly bleeds, probably got your attention and made you wonder: is this for me?
The short answer is maybe. While the brand name suggests "liberty" from periods, clinical studies submitted to the FDA indicate that it's not a perfect solution. "The downside is that some women will go from scheduled bleeding to unscheduled bleeding or spotting," said Dr. David F. Archer, professor of obstetrics and gynecology at the Eastern Virginia Medical School. In fact, about half of the 2,400 women enrolled in the clinical trials conducted by the manufacturer, Wyeth Pharmaceuticals, quit before the study was done because of this side effect. Of those who stuck it out, the "accidents" occurred less frequently over time. After a year on the pill, about 60 percent of those women stopped having so-called breakthrough bleeding; that's the equivalent of about one third of those who started the study. It continued to be a problem for the rest.
For women with really rough menstrual cycles, having an occasional unscheduled surprise may be a fair swap for scheduled misery. But for others, it may be a deal breaker. While Lybrel is convenient to prescribe and take, Dr. Leslie Miller, professor of obstetrics and gynecology at the University of Washington, says doctors can tailor other slightly higher-dose contraceptives to achieve the same goal with less breakthrough bleeding. For example, adding a little more progestogen in your contraceptive cocktail often does the trick. A good place to go for details on various options is Miller's Web site.
What else do you need to consider? As with all oral contraceptives, your libido may be negatively affected. And without a period, you'll lose the most obvious warning that you may be pregnant. Doctors say that means that women taking Lybrel or other contraceptives to eliminate monthly bleeds need to be extra vigilant about the possibility of pregnancy, and get tested whenever they are in doubt. (While it's always a good idea to detect a pregnancy as early as possible, doctors say that today's low-dose pills will not cause birth defects in a developing fetus.) It's interesting to note that one of the reasons the original birth-control pills were designed to give you a monthly bleed was because pregnancy tests used to be significantly more expensive and time consuming.
Some women have expressed some unease about trying Lybrel or other continuous contraceptives because it seems unnatural to never have a period. But the truth is that no one using oral contraception is actually "menstruating." Instead, birth-control pills simply simulate menstruation with "withdrawal bleeding." What's the difference? During a natural menstrual cycle, natural hormones produced by your body prompt an egg to ripen and the lining of the uterus to thicken in preparation of a possible pregnancy. If the egg isn't fertilized within a few days, the uterus sheds the lining, a process called menstruation.
The synthetic hormones in birth-control pills interfere with this natural cycle, and as a result, the lining of the uterus never gets built up. Most cyclic oral-contraceptive regimes call for 21 days of pills containing synthetic hormones, followed by seven placebo pills. The resulting drop in hormone levels prompts the withdrawal bleeding, which is generally shorter in duration and volume than menstruation. But it's not necessary or "normal" bleeding. In fact, says Archer, withdrawal bleeding "serves no biological purpose."
Miller argues that you can even make the case that many modern women have an abnormally high number of monthly bleeds. After all, women today live healthier, longer lives and have the benefit of birth control. That means they get their first period at a younger age, have fewer children and spend less time breastfeeding than previous generations. As a result, they average 400 monthly bleeds in their lifetimes, compared to the historic average of less than 50, when women died younger and spent most of their adult lives pregnant. It's worth considering, she says, whether finding a way to have fewer periods over a lifetime is the more "natural" response.
But right now, we don't have all the answers. Women's health advocates, like Phyllis Mansfield, a professor of women's studies at Penn State University, say they see "the lack of long-term data as a very serious issue" that women should consider before deciding to try the drug. While this type of research isn't required for FDA approval, there's always the possibility that previously unknown side effects will surface once a larger population starts using a new drug. Miller says she'd also like to see more data on whether women lose bone faster or teens fail to build enough bone while on continuous oral contraceptives. She said women who have a family history of osteoporosis may want to raise this issue with their doctors. Balanced against those concerns is the fact that the ingredients in Lybrel have been used for a long time, and "there is no evidence that they cause harm," said Archer. "I would say, overall, that the safety margin is very good."
Mansfield also worries that if menstrual suppression becomes widespread, women will lose an appreciation for the wonder of their reproductive system. "I am totally sympathetic with the women who can barely get out of bed because their symptoms are so bad," she said. "But it's also true that those women are few and far between. My fear is that we live in such a culture of convenience, we're so busy and overwhelmed, that a lot of women may buy into the idea that this will be one less thing they have to worry about, instead of appreciating menstruation for the magical thing it is."
The good news here is that drugs like Lybrel give women more options, as well as more control over their bodies. For some, getting rid of the "curse" may feel like a little bit of magic, too.