Q: Some of my friends are excited about the new oral contraceptive that eliminates periods. But it worries me. Does anyone know what happens when you stop menstruating for a long time? It just seems unnatural.
A: In May, the FDA approved Lybrel, the first oral contraceptive (OC) designed to be taken 365 days a year. Developed by Wyeth Pharmaceuticals, Lybrel comes in a 28-
day pack of tablets containing 20 micrograms of ethinyl estradiol (an estrogen) and 90 mcg of levonorgestrel (a progestin). This is about equal to the lowest level of hormones in combination OCs today. Women who use Lybrel don’t have regular periods, although they can have light bleeding.
The idea of suppressing menstruation isn’t completely new. Conventional OCs will also stop periods if they are taken continuously and without the placebo pills. For many years, doctors have suggested this approach if a woman wanted to skip her period at a particularly inconvenient time, such as her honeymoon, an athletic event or a long vacation.
The notion of suppressing menstruation over a longer term has become increasingly attractive, partly because this strategy has been successful in the treatment of endometriosis and the management of the hormonal swings associated with perimenopause. In 2003, the FDA approved Seasonale, an OC that’s taken for 84 days, followed by seven days of placebo pills. Women who take Seasonale have four periods a year instead of the 13 that occur with standard OCs.
There’s some theoretical justification for reducing the number of periods a woman has – or eliminating them altogether. For one thing, menses brings considerable discomfort to some women, including severe cramps, mood swings, headaches and heavy bleeding, which may result in anemia. On the other hand, many women are uncomfortable with the notion of not having periods.
There are no long-term safety data on Lybrel, but its risks are thought to be similar to those of conventional OCs: an increased incidence of blood clots, heart attacks and stroke.
Martha K. Richardson, M.D., Advisory board, Gynecology, Harvard Women’s Health Watch
