New drug puts periods on hold
Menstruating 4 times a year has drawbacks

Posted on September 22, 2003

BY PATRICIA ANSTETT
FREE PRESS MEDICAL WRITER

Hate having a menstrual period or the yucky side effects that may come with it? A new drug arriving in stores in late October will allow women to avoid all but four periods a year.

Seasonale -- conventional oral contraceptives repackaged in a purple-and-pink plastic box -- has pushed into public view a lesser known way of stopping periods known in medicine as menstrual suppression.

By throwing out the seven inactive pills that come with standard oral contraceptives, women increasingly have been opting for the convenience during the past decade.

It's a choice better known to female troops, physicians-in-training, honeymooning brides and women with heavy periods from endometriosis and other problems.

The promise: No muss or fuss and fewer cramps, migraines, chocolate cravings and mood swings.

"It will change your life," says Alicia Sokol, senior news and information officer for the Cleveland Clinic who has suppressed her period for more than a year. "I no longer am ravenous before my period. Before, I felt like I needed to eat everything that wasn't nailed down."

But drugs, like almost everything else in medicine, come with drawbacks and possible unknown risks.

"This is homogenizing women, chemicalizing them into uniformity," says Dr. Susan Rako, a Boston-based, Harvard University trained psychiatrist and author of "No More Periods: The Risks of Menstrual Suppression and Other Cutting-Edge Issues About Hormones and Women's Health" (Harmony Books; $21).

The known methods of menstrual suppression put women at increased risk of osteoporosis, infertility, heart attacks, strokes and cancer, Rako says. Menstruation actually lowers blood-pressure levels by half each month, decreasing a woman's risk of heart-related problems, she says.

She calls menstrual suppression "irresponsible and hazardous," and cites 225 scientific references in her book to bolster her argument.

Though oral contraceptives may protect some women against ovarian cancer, Rako particularly abhors the menstrual suppression trend among teens.

"Girls need to get to know themselves," she says.

How Seasonale works

The drug Seasonale contains synthetic forms of two hormones -- .03 milligrams of a type of estrogen called estradiol and 0.15 milligrams of a progestin, levonorgestrel, also contained in modern birth-control pill doses.

But instead of taking three weeks of real pills and a week of inactive or placebo drugs -- a regimen known as 21-7 -- women take one Seasonale tablet daily for 84 days and then take the seven inactive pills, producing a period every four months.

Seasonale's cost has yet to be determined. It will be comparable to conventional regimens of about $30 a month and some insurance plans may pay for it, a company spokeswoman says.

Birth-control products such as Depo-Provera, an injection that lasts 3 months, also stop periods.

All of the choices, Seasonale included, may cause break-through bleeding, so women still may get caught unaware with the sudden arrival of a period.

Birth-control pills of any kind are not advised for women who smoke because they carry an increased risk of blood clots, heart-related problems such as strokes, and certain cancers and liver diseases. They also do not protect against sexually transmitted diseases, including HIV, the virus that leads to AIDS.

And oral contraceptives aren't a good choice for girls and women who forget to take their pills -- the reason many doctors give Depo-Provera or tell women to put pills next to some item, like a toothbrush or an alarm clock, that they use daily.

A regimen on the rise

Dr. Patricia Sulak, who has prescribed menstrual suppression regimens for a decade, calls the trend to suppress periods huge.

"When the Food and Drug Administration approved this, it was like telling women, 'It's OK not to have a monthly period.' All of this will take off and skyrocket," she says. "The redesign of birth-control pills is happening."

Sulak, professor of obstetrics and gynecology at Texas A & M University's College of Medicine in Temple, Texas, and a consultant to Barr Laboratories, the Woodcliff Lake, N.J., manufacturer of the drug, says: "21-7 will be out the door. This is long overdue."

The trend of suppressing menstruation is particularly popular among young, female obstetricians and gynecologists. Dr. Renee Page, clinical instructor in the obstetrics and gynecology department at the Wayne State University School of Medicine in Detroit, has used conventional pills to suppress her period for more than a year.

"It's not convenient to have a period every month when you work 80 hours a week and might have to be scrubbed for surgery," she says. "It's a big thing among the female OB-GYNs."

She says she's observed some additional breast tenderness but has experienced no other big drawbacks. She and others say they don't think menstrual suppression regimens carry any higher risk of breast cancer and other cancers.

"I think it's a great option," she says. But she adds, "Every woman who considers it should talk to her doctor about her individual case."

Dr. Kristina Sole, a Cleveland Clinic obstetrician-gynecologist, recommends menstrual suppression to counteract moodiness, crying, irritability and other menstruation-related problems. Asked whether the pills cause weight gain, she laughs and says, "If women can blame it on their pill, they do. Some women think they burned dinner because of the pill."

Long-term use of any estrogen product raises the risk of breast cancer, she and others acknowledge. But given the low hormone doses in the pill, she doubts there is a significant cancer risk.

"No medication should be taken over time without weighing the risks involved against the benefits," she says. "If their quality of life is impaired, and they are willing to assume the risks, then go ahead and take it."