STORY BY

Liz Bennett

Can a pill a day take “The Curse” away?

If initial reaction to a new birth control pill called Seasonale is any indication, the dreaded monthly menstrual cycle may eventually become a thing of the past.

Approved last month by the Food and Drug Administration, Seasonale makes it possible to have only four periods a year instead of every month. It contains the same ingredients as other birth control pills, but the difference lies in how a woman takes them.

Traditional pills are taken 21 days, followed by seven days of placebo pills, followed by a monthly period. Seasonale is taken for 84 days straight, followed by seven days of placebos, followed by a quarterly period.

A number of physicians in Houston and across the country have spoken out in favor of Seasonale, calling it a safe, convenient way to prevent pregnancy.

“For women who have heavy periods, irregular periods, or who simply do not enjoy having periods, this is a good option,” says Dr. Michele Curtis, associate professor of obstetrics/gynecology at The University of Texas Medical School at Houston. “Unless you feel more comfortable actually seeing blood to confirm each month that you are not pregnant, there is no proven medical necessity for having periods.”

Commas or Periods?

Dr. Carolyn Westhoff, an obstetrician-gynecologist at Columbia Presbyterian Medical Center in New York, told CNN she would prescribe Seasonale for her patients. “It’s really terrific not to have the bleeding, not to have the cramps, not to have some of those symptoms that lead up to a period,” says Westhoff, who has herself been using regular packs of birth control pills back-to-back to skip her period for about 10 years.

Houston’s Dr. Pamela Berens says she would also prescribe Seasonale for her patients, even though “some physicians feel it’s very important for women to have monthly cycles. I remember during training someone saying, ‘Well, that’s what women want! Women want to have monthly cycles!’” adds Berens, associate professor of obstetrics/gynecology at UT Medical School at Houston.

While there’s been a lot of talk in the medical press about Seasonale, the idea of menstrual suppression is nothing new. For years doctors have told patients how to skip a period by continually taking the active birth control pills in each month’s supply and ignoring the week of dummy pills in the packet.

“The only thing that’s new to me is that now (with Seasonale) everything’s in a nice little packet,” says Berens. “It’s a lot easier, and you don’t have to throw out (placebo) pills for two out of three months.”

Berens doesn’t buy the theory that women need monthly periods. She points out that before “The Pill” was introduced in the 1960s, making contraception easier for women, they spent much more time either pregnant or breast-feeding, both of which block menstruation. And she has been helping patients block their periods for years, including those with endometriosis, menstrual migraines and women going on their honeymoons.

“When you have the menstrual cycle with endometriosis, you’re more likely to have pain as well,” Berens explains. “If women menstruate less often and less heavily, the symptoms are also less severe, so we cycle them every third month.”

She applies the same logic to the pain some women have with menstrual migraine (not premenstrual) headaches. “Why make that happen every month?” she asks. “Let’s do it less often.”

And for patients planning honeymoons? “We’ve traditionally told women: ‘When is your period supposed to fall? You don’t want to be bleeding then, so throw out those fake (placebo) pills, start the next pack and move your cycle.’”

Risks and Benefits

Not all medical authorities agree that period suppression is a good idea, however. One of the most outspoken opponents is Dr. Susan Rako, a Boston-based psychiatrist and author of the recently published No More Periods? Rako argues in her book that there are good reasons women have periods, and the risks of suppression include heart attacks, strokes and cancer.

“Tampering with the hormonal climate of healthy menstruating women, including teenage girls whose lives stretch ahead for decades, for the purpose of doing away with their periods is, in a word, reckless,” she writes in her book. “Manipulating women’s hormonal chemistry for the purpose of menstrual suppression threatens to be the largest uncontrolled experiment in the history of medical science. Hands down.”

But Berens, among others, believes the health benefits of oral contraceptives, including Seasonale, outweigh the risks.

“We know that birth control users have less ovarian cancer, we know that they have less cancer of the uterus,” she says. “So these are positive effects of the pill. And there are some really interesting studies indicating that the more periods you have in life, the higher the risk of breast cancer.”

The manufacturer, Barr Laboratories, plans to have prescription-only Seasonale in pharmacies by November. Studies indicate that it’s as effective at preventing pregnancy as traditional birth control pills, which work for 98-99 percent of women who use them correctly, according to the FDA.

The price is expected to be comparable to other oral contraceptives – about $1 a pill – with generic versions running about half that amount.

UPDATED: 10-16-2003

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