The New Pills

Once it receives final approval by the U.S. Food and Drug Administration (FDA), the new birth control pill Lybrel will be the first extended-cycle oral contraceptive designed to supply an active dose of hormones every day, stopping a woman's period altogether — for a full year, year after year. Yaz and Loestrin 24 Fe, both approved earlier this year, shorten periods by about three days. And women taking Seasonale and its newer sibling Seasonique will have only four periods a year. With so many new formulations, "the pill" now refers to an ever-expanding number of hormone-based, oral contraceptives that allow women to manipulate their menstruation.

Natural or Not?

To some, it might seem unnatural to halt menstruation completely. But women on the pill are already manipulating their menstrual cycles. Until recently, pills came strictly in 21- or 28-day packs. (Both progestin-only and combined hormone pill packets contain 21 days of "active" hormone pills; the 28-day packs also include seven "inactive," placebo, or reminder pills.) Few women naturally have a regular 28-day menstrual cycle; with the pill, all women do.

Some women appreciate monthly periods as reassurance about their continued fertility, femininity, or that they are not pregnant, but many others have been avoiding menstruation by starting a new pill pack during the fourth week, when menstruation usually occurs. Indeed, health care providers have been advising their patients how to do so for decades — particularly women with upcoming vacations or special events, severe period-related symptoms, or physically demanding jobs.

Today's Pills

Newer formulations of the pill offer pre-packaged alternatives for manipulating the menstrual cycle. Seasonale, available since 2003, was the first major breakthrough. With Seasonale, women take 84 days of active pills followed by seven days of placebo pills, allowing only four periods per year. The newly available Seasonique follows the same timing but features seven days of low-dose estrogen pills instead of placebo pills. Women still have a period during the last seven days, but the extra helping of estrogen helps to reduce hormonal fluctuations, breakthrough bleeding, and other period-related symptoms.

Seasonale's increasing popularity — sales increased 62 percent in 2005, to $110 million — signaled to pharmaceutical companies that many women were comfortable with altered periods. The industry responded with products like Loestrin 24 Fe, which became available earlier this year. A monthly pack contains 24 days of active hormones rather than the traditional 21, along with four days' worth of iron supplements. The pill's marketing materials tout clinical studies that show women taking Loestrin 24 Fe have shorter, lighter periods. Another newly available pill, Yaz, contains a slightly different form of the hormone progestin. (Yaz is a lower-dose version of Yasmin, an already low-dose pill that's been available since 2001). Packs of Yaz also contain 24 active pills and four placebos. Yaz also reduces hormone fluctuations and is currently under review by the FDA for the treatment of premenstrual dysphoric disorder, a more severe form of PMS.

The Next Generation

Surveys sponsored by pill manufacturers further encouraged drug makers to take the next step in menstruation management. In fact, one such national poll found that 60 percent of women would be interested in not having a period every month and one-third would choose never to have one.

The advantages of a pill like Lybrel are clear. Many studies have shown that bloating, cramping, headaches, and tender breasts, among other aches and pains, occur most frequently during the week when women on the pill are not taking hormones. Eliminating that week stabilizes hormonal levels and reduces or eradicates those symptoms. One study reported that after seven to 13 pill packs, women on Lybrel reported less nausea and breast pain than those on a 21-day pill. In another study, researchers found that three months of taking Lybrel reduced PMS and associated complaints in 114 women.

Some Things Never Change

Like any other medication, Lybrel has risks. In light of recent research on hormone therapy for postmenopausal women, some women worry about the continuous exposure to hormones associated with Lybrel. However, many health care providers point out that seven additional days of low-dose hormone exposure per month are unlikely to significantly increase any risks beyond those faced by women taking other formulations of the pill. Lybrel and other hormonal birth control methods slightly increase a woman's chance of developing blood clots and stroke, and so should not be used by women who smoke — especially those 35 and older — or who have other risk factors for these conditions.

Every method of birth control has its risks and benefits, and the best birth control methods are those that meet women's needs safely and effectively. Whether a woman wants a monthly period or to throw her sanitary pads or tampons away for good, if she wants to prevent pregnancy, it's important for her to talk with her health care provider about the birth control method that's right for her.

© 2006 Planned Parenthood Federation of America, Inc. All rights reserved.