Skipping Periods on the Pill

B O S T O N, Oct. 31, 2001 -- Skipping a menstrual period is unusual for many women. But experts say women taking birth control pills may not need a monthly period.

A study appearing today in the journal Obstetrics and Gynecology examines what happens when women extend their menstrual cycles using oral contraceptives.

The study compared annual expenditure on feminine hygiene products and episodes of spotting or breakthrough bleeding in 24 women who followed a typical 28-day cycle with 21 active pills and seven placebos, vs. 29 women on an extended 49-day cycle.

Subjects following the extended cycle skipped over the seven days of placebo pills included in every birth-control pill pack that normally allow for menstruation-like "withdrawal bleeding." Instead, these women took 42 active pills continuously, only then taking the placebos for seven days. The women, all in Seattle, were followed for 336 days, which allowed for study of numerous menstrual cycles in both groups.

Women who followed the 49-day regimen spent significantly less money every year on hygiene products and showed no increase in breakthrough bleeding compared to those following the 28-day regimen.

In fact, cycle lengthening was so well-received by subjects that after the study was concluded, more than half of the women on the extended cycle wished to continue with that regimen, and more than 16 percent of those on the 28-day cycle wanted to switch to the extended schedule.

According to Dr. David Grimes, clinical professor in the department of obstetrics and gynecology at the University of North Carolina School of Medicine, and a leading expert on birth control, there has until now been little scientific evidence collected on the subject of lengthening menstrual periods.

While a growing number of experts accept the idea of menstrual suppression in pill-using women, some would like to see further scientific evidence before signing on, says Grimes.

Periods on the Pill

"Withdrawal bleeding" occurs when a woman's hormone levels drop because she starts taking the seven days worth of placebo pills.

"There is nothing normal about it," says Grimes, who believes women on the pill don't need menstrual cycles, but who was not associated with today's study.

Dr. Leslie Miller, assistant professor of obstetrics and gynecology at the University of Washington and lead author of today's study, says the developers of the pill felt that women would be more accepting of it as a birth-control method if they still had their periods every month.

But, she says, "The bleeding you get on the pill is not your period."

Skipping over the pill-free week is often prescribed to women who experience extreme bleeding or menstrual migraines, and some women already alter their periods through pill use, a process known as menstrual "manipulation."

For example, women who are traveling or going on honeymoons sometimes forgo their periods in this manner.

Moreover, a survey of Dutch and Australian women found that up to 50 percent of these women had manipulated their cycles with pills. European pill package inserts even include instructions about how to do this, yet they do not say how it can be done repeatedly.

Not for Everyone

Some women who are taking birth control pills may be uncomfortable with not menstruating because they think of it a sign of health and fertility. Indeed, for women who are not on the pill, a missed period can be a sign of serious health problems. Women who are on the pill, but take it improperly or miss some days, could also become pregnant.

"What is needed is some historical revisionism," says Grimes, who assets that for women on the pill, monthly bleeding is not required for good health.

Currently, there are no extended regimen pills available in the United States, and further research is needed to explore proper dosage and safety.

Pill-using women who are interested in suppressing or manipulating their menstrual cycles should speak with their physicians.

Miller would like to make menstrual manipulation for women who are already making the commitment to take the pill a more readily available option. "What I would want to do is change what the pill user buys," she says.