Will Quarterly Periods Become the Norm?
New birth control pill offers that option

By Kathleen Doheny
HealthDay Reporter

FRIDAY, Oct. 3 (HealthDayNews) -- Bari Rubin was tired of heavy monthly bleeding and painful menstrual cramps.

So when she heard about the concept of extended contraception -- taking birth control pills for 84 days instead of 21, resulting in only four periods a year -- she thought it was a terrific idea and tried it.

"I love not having to deal with a [monthly] period," says Rubin, a 39-year-old Los Angeles makeup artist.

Rubin began taking continuous contraception in 2000, long before the U.S. Food and Drug Administration's (FDA) approval last month of the birth control pill Seasonale, which produces four periods a year instead of 13.

She simply took standard birth control pills in a continuous fashion, a regimen prescribed by doctors for years but not well known to many women.

Doctors predict that some women using standard birth control pills will switch to Seasonale because of the convenience. Others will stay on the traditional Pill that has worked for them for many years.

"It's nothing new, other than the packaging," says Dr. David Plourd, an assistant professor of obstetrics and gynecology at the Naval Medical Center in San Diego.

While many traditional birth control pills include 21 active pills and seven inactive ones, Seasonale is packaged with 84 active and seven inactive tablets.

During the week of taking the Seasonale inactive tablets, a woman will bleed, just as she would when taking a week of other inactive tablets. Seasonale includes estrogen and progestin, just as many traditional birth control pills do.

Seasonale is expected to be in U.S. pharmacies by the end of October, according to Barr Laboratories Inc., the manufacturer. It will cost about the same as traditional birth control pills -- approximately $1 each.

"Over time, I would expect it to become the norm," Dr. Anita Nelson, a professor of obstetrics and gynecology at Harbor-UCLA Medical Center in Torrance, Calif., says of the extended regimen. The majority of oral contraceptive users will switch to extended regimens, Nelson predicts.

But before that happens, women will first need to get over certain fears and misconceptions, experts say.

Soon after Seasonale received FDA approval, online message boards were deluged with comments and questions from women concerned about safety, says Dr. William Parker, a gynecologist on staff at Santa Monica-UCLA Medical Center. Chief among the concerns, he says, was whether not having a monthly period is "natural."

Parker tells women that monthly periods have been the norm only in modern times -- that generations ago, women had many more children and spent years breast-feeding and pregnant, so they had far fewer periods than women today.

There's no reason to think there would be ill effects from the Seasonale regimen, Parker says, although that has not been studied long-term.

Some women fear that toxins could build up in the uterine lining, which is sloughed off during a period. Parker says the progestin in the birth control pill thins out the lining, so the toxin fears are unfounded.

There's also no reason to believe that taking the pill in a continuous manner will affect fertility, says Dr. David Grimes, vice president of biomedical affairs for Family Health International, a research and education organization in Research Triangle Park, N.C.

"We know birth control pills don't have an adverse effect on fertility," he says, and there's no reason to think Seasonale would.

Extended contraception has been prescribed for years to women with endometriosis, a condition in which uterine tissue grows outside the womb, Parker says. The regimen reduces their periods, which are often painful, to once or twice a year.

Grimes notes that other birth control pills have been associated with a lower risk of endometrial cancer, and the new extended pill will probably do the same.

For some women, fewer periods pose a psychological hurdle, Nelson says. "Many women define their femininity by their periods," she says.

Women are advised to talk to their health-care provider about whether Seasonale is right for them. Women with very painful cramps, menstrual migraines or heavy periods are probably the best candidates, Parker says.

Women with a history of blood clots and certain cancers are not good candidates, says the manufacturer.

One downside is the possibility of bleeding between periods, called break-through bleeding.

Rubin, the makeup artist, plans to stay on extended contraception. For her, it means fewer migraine headaches and fewer cramps.

"The birth control aspect for me is just a pleasant side effect," she says.