In 2003, the FDA approved Seasonale, an extended-cycle birth control pill. This pill, a combination of estrogen and progestin, is taken daily for 84 days followed by one week of inactive (placebo) pills, allowing a woman to have her period once every three months — four times per year.

Since that time, several other extended-cycle birth control pills have been marketed, including Lybrel, released in 2007, which offers women continuous contraception coverage with only one period per year.

Using birth control to skip periods doesn’t result in side effects quite this exaggerated.

Prior to Seasonale’s debut, certain types of birth control pills could be taken back to back, allowing users to have period-free weddings and honeymoons, or to treat certain conditions, such as endometriosis. But there was no consensus about how to use birth control pills this way, and no actual product marketed specifically for this type of use. Early studies on extended-cycle pills reported that users were highly satisfied using pills to have fewer periods — and wanted to continue using these pills to reduce periods after the study was completed.

Can skipping periods be beneficial or harmful? Is this a lifestyle choice that’s not “natural”? How many “normal” periods do you need in a lifetime?

First, we should discuss how birth control pills were developed and the way they work to prevent pregnancy. When the “Pill” was first developed and decisions were made about its marketing and public acceptance, it was decided that women should have a period regularly to feel comfortable and also to be able to know if they were pregnant or not by noticing missed periods. When a woman menstruates, her period is due to shedding of the lining of the uterus. This lining develops to ready itself for a possible pregnancy with a fertilized egg. If you do not become pregnant, the uterine lining sheds and that is your period. Birth control pills contain hormones to prevent ovulation (release of an egg for possible fertilization), so the uterine lining doesn’t really develop. The period you have while on the Pill is actually just a withdrawal bleeding due to decreased levels of hormones in your body during that placebo pill week.

So what are the pros and cons of using birth control pills to reduce the number of periods you have in a year? There are different opinions among doctors. Some say that in primitive societies women had fewer periods in a lifetime due to more and earlier pregnancies and more time spent breastfeeding babies — having more periods over our lifetime is not the historical norm. Other doctors state that the menstrual cycle is very complex and we don’t know what the long-term effects will be on women’s health. They cite unknown effects on bone densities, cancers, and cardiovascular health. They worry that for a lot of women this is just a lifestyle choice — not a health choice.

Let’s lay out the pros and cons of using continuous contraception to reduce periods:

PROS:

• fewer periods, which reduces the cost of lost work, pain medications, and feminine products
• very good contraceptive, almost 100 percent effective in preventing pregnancy if taken properly
• decreases PMS symptoms and treats painful conditions such as endometriosis, migraines, and anemia
• decreased risk of uterine and ovarian cancers
• fertility resumes easily when stopped

CONS:

• we don’t know what effects the increased amounts of hormones over time might have on breast cancer risk or bone density
• spotting and breakthrough bleeding common, especially during first year
• can’t tell if you’re pregnant, so need to test for pregnancy more often
• may mask some menstrual conditions, such as ovarian failure (“premature menopause”)
• no long-term research data available on continuous contraception’s effect on risk of heart attack, stroke, or blood clots
• no data on teenagers — when should they start, do they need a few normal periods first?

Millions of women in America use birth control pills, and the option of controlling when or if they have a period is an appealing idea. There will surely be more products on the market for these choices, and a lot more research conducted to evaluate what the long-term effects will be as women have fewer regular periods. Right now, there are no guidelines regarding age, when to start reducing periods, or how many normal periods you should have first, and there is little research on the effects continuous contraception has on adolescents and bone density. Of course, any woman with a history of contraindications to birth control pills in general, such as blood clots, stroke, or smoking should not take this type of contraception. And you still need yearly checkups.

If this type of birth control is attractive to you, talk to a health care provider, such as one of the reproductive health professionals at Planned Parenthood. Don’t try to skip periods without talking to a doctor first, because some birth control pills may not lend themselves to continuous usage. Health care providers at your local Planned Parenthood health center can talk to you about the pros and cons of using birth control to skip periods. Make an appointment today!

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