- SUNDAY, Aug. 24 (HealthDay News) — With new “extended cycle” and
“continuous” oral contraceptives on the market, women today can choose to
have monthly withdrawal bleeding just four times a year — or not at all.

To many American women of childbearing age, these options have
tremendous appeal. In fact, more than two-thirds of women said they are
interested in suppressing monthly bleeding, according to national survey
results presented at an Association of Reproductive Health Professionals
(ARHP) reproductive health conference.

“In the last 10 years, there really has been almost a revolutionary
change in the opinions and the views of women regarding menstruation,”
observed Dr. Lee P. Shulman, professor and chief of reproductive genetics
in the Department of Obstetrics and Gynecology at Northwestern
University's Feinberg School of Medicine in Chicago.

“It's not just the more mature reproductive women desiring fewer
withdrawal bleeds,” said Shulman, immediate past chair of the ARHP. “Now
that's becoming a more common desire among even younger women seeking
hormonal contraception.”

Oral contraceptives were initially designed to mimic the natural
experience of menstruation. Women took 21 days of “active” pills,
containing hormones, and seven days of placebo pills. During the
hormone-free week, women experienced withdrawal bleeding, much like a true
period.

Today's generation of oral contraceptives includes Seasonale and
Seasonique, extended cycle products that reduce bleeding to four times a
year, and Lybrel, a continuous-use product that stops monthly bleeding
altogether. With Loestrin 24 Fe and Yaz, women still have a monthly bleed,
but those “periods” are shorter.

Extended cycling, though, is not a new phenomenon. For years, doctors
have being tailoring birth-control regimens to women's needs by having
them skip the placebo week of traditional oral contraceptives and go on to
a new pack. A woman going on her honeymoon, for example, or being deployed
by the military, might seek to avoid bleeding and the need for sanitary
protection. Extended regimens have also been used to treat women with
endometriosis.

“The only difference recently is that we have these dedicated
products,” said Patricia Aikens Murphy, associate professor and the
Annette Poulson Cumming Presidential Endowed Chair in Women's and
Reproductive Health at the University of Utah College of Nursing in Salt
Lake City.

Despite mounting interest, women in the survey also expressed some
reluctance about the safety of suppressing monthly bleeding. By contrast,
97 percent of physicians who were surveyed said it's medically safe and
acceptable.

Shulman attributes women's concerns about whether it's safe and natural
to tamper with menstruation to conventional wisdom passed down by mothers
and grandmothers. They'll hear about it and say, ” 'You're not pregnant;
you're supposed to have a period,' or 'Dammit, I had a period for 35
years; you're going to have a period for 35 years,' ” he said.

Some women who try extended cycling really like it, because it reduces
symptoms such as headache and bloating that occur during the placebo week,
Murphy said. And there's some theoretical speculation that overall birth
control effectiveness might be improved when women continue to use
hormone-containing pills, she added.

“Many failures with birth control pills occur when that seven-day
hormone-free interval gets extended longer and women actually run the risk
of ovulating — if you forget to start your pack right when you're
supposed to,” she explained.

One note of caution, though. These products are associated with a
greater frequency of breakthrough bleeding and spotting, Shulman pointed
out.

And there are other considerations. It takes most women a few months or
more to stop having bleeding, said Susan Wysocki, president and CEO of the
National Association of Nurse Practitioners in Women's Health in
Washington, D.C.

“I liken it to buying a new pair of shoes,” she said. “New shoes take
breaking in. But once they are broken in, they are the shoes you like to
wear. It takes time to break in a non-cycling contraceptive pill as well.”

More information

The Association of Reproductive Health Professionals can tell you more
about menstrual suppression.