Could Effective Birth Control Also Mean You Can
Decrease or Eliminate Your Periods?
 

The new publication is co-sponsored by the Association of Reproductive Health Professionals (ARHP) and the National Association of Nurse Practitioners in Women's Health (NPWH), leading clinical education associations that focus on the latest research and technologies in reproductive health.

Three recent surveys found that many women -- regardless of age -- would prefer to eliminate menses completely or reduce the frequency to less than once a month if they had a choice. The percentage of women desiring to stop having their periods increased with age, with more than half of menstruating women over the age of 45 preferring no periods at all.(1)

"Fewer monthly bleeds and improved quality of life may soon be a reality for many women since a new extended cycle oral contraceptive is currently under review for approval by the FDA," says Andrew Kaunitz, MD, professor and assistant chair, Department of Obstetrics and Gynecology, University of Florida Health Science Center at Jacksonville. "The research also demonstrates that both clinicians and women have doubts about the safety of reducing the frequency of their menstrual cycles. We need to dispel these doubts by educating people that having fewer periods is perfectly safe so they can make informed decisions about their health."
 

The Three Biggest Menstruation Myths

Contrary to popular belief, there is no menstruation while taking a traditional hormonal contraceptive because contraceptives prevent ovulation. "One of the first surprises many women have when asking about extended contraception, is that they won't have their periods every month if they keep taking the Pill," says Wayne C. Shields, president and CEO of ARHP.

Another myth is that the 28-day cycle, including the hormone free week (the placebo week), is "natural." Believing it would prompt greater consumer acceptance, the first oral contraceptive regimen incorporated a hormone-free week to mimic a natural menstrual cycle. "There is no medical reason for this withdrawal bleed," says Susan Wysocki, RN-C, NP, president and CEO of NPWH. "I call it the BOWGSAR theory, or 'a bunch of old white guys sitting around a room,' because that is how the original pill cycle was determined in the 1950s."

Another misperception is that menstrual suppression could affect fertility. Recently, a major study of more than 8,000 women found that oral contraceptive use actually increased a woman's ability to become pregnant versus her counterparts who had not used oral contraceptives, and her chances of conceiving within the first six months were enhanced the longer she had taken oral contraceptives.(2) "Reducing the number of withdrawal bleeds does not affect women's fertility," says Shields. "Women taking oral contraceptives, whether in a traditional or extended regimen, can return to their baseline state of fertility very quickly."

Benefits of an extended contraceptive regimen

Since the introduction of birth control pills in the 1960s, some patients, under guidance from their healthcare providers, have eliminated the hormone-free week to control the frequency of their period for lifestyle reasons such as an upcoming honeymoon, vacation, military service, or athletic event. Physicians often prescribe an extended oral contraceptive regimen to treat menstruation related conditions such as iron-deficiency anemia, migraines, menorrhagia (heavy bleeding), endometriosis, and other menstruation-related conditions.
 

Survey results

In 1996, researchers conducted telephone interviews with 325 Dutch women to determine their preferred changes in bleeding patterns when using oral contraceptives as well as the extent to which women use oral contraceptives to change their menstrual bleeding pattern. The survey results indicated that 71.5 percent of menstruating women would prefer changes in bleeding patterns, such as less painful periods, shorter periods and less heavy periods. The percentage of women desiring to stop menstruation completely increased with age with more than half of menstruating women ages 45-49 reporting they prefer amenorrhea. Most women preferred to menstruate less than once a month or never.(3)

In 2002, ARHP commissioned Harris Interactive Inc. to interview 491 women by telephone about their preferences on the frequency and characteristics of menstrual bleeding. The survey data showed that nearly two-thirds of women do not rely on their monthly periods to let them know if they are pregnant, able to have children or are healthy. The results indicated that overall, 44 percent would prefer to menstruate, increasing to 59 percent for women ages 45-49; 29 percent preferred to menstruate once a month. More than one in four women surveyed reported they have missed professional, social, athletic or family-oriented events because of their period, menstrual cramps or other menstrual effects.(4)

A third survey conducted by MGH Institute of Health Professions explored the attitudes and beliefs about menstruation and menstrual suppression in 221 women. A correlation was found between negative feelings about menstruation and interest in suppressing menstruation. More than two-thirds of women surveyed were interested in reducing menstrual pain and the amount of bleeding, particularly if they were not already taking oral contraceptives.(5)

About Clinical Proceedings

The April issue Clinical Proceedings, "Choosing When to Menstruate: The Role of Extended Contraception," reviews studies on the attitudes and practice of healthcare providers and women about the extended use of oral contraceptives, as well as research on extended use of various other contraceptive methods. It also provides educational tools for health care providers to use in counseling their patients, which has been found to be a key element in women's acceptance and proper use of extended regimens.
 

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 Source: Association of Reproductive Health Professionals;