February 12, 2001

Jane Dixon

f you're like many women, several days every month are downright dreadful, bringing with them cramping and nausea and general crankiness. And the week before your period may be no better. Premenstrual syndrome, with its bloating and moodiness, affects nearly three-quarters of American women. So that leaves a couple weeks of relative peace and comfort before the cycle begins again.

Imagine if you could hop off this hormonal roller coaster, once and for all.

Well, you might be able to do just that. Depending on your health history, you may be able to bid farewell to your monthly friend. While not all doctors agree on how often women who decide to dump their period should menstruate -- some say every few months, some say never -- they do know that skipping periods is a safe option for some women.

Manipulating the menses

Women, for example, who don't want to menstruate while on vacation simply skip the week of "dummy pills" in their birth control packet and continue taking active pills. Birth control, after all, contains hormones that prevent ovulation. But for a brief time, usually one week every 21 days, women take pills that contain no hormones. During that week, women menstruate.

There is no physiologic purpose, by the way, to the 28-day pill cycle, says Michael Randell, M.D., an obstetrician and gynecologist in Atlanta. Conventional thought was that women wanted the 28-day cycle to know they weren't pregnant, so birth control manufacturers developed that cycle.

Doctors have also altered periods for women who suffer from anemia, endometriosis, or heavy menstrual cramping and bleeding. But eliminating monthly menstruation may now be an option for the masses.

Sound unlikely, or even unhealthy? The experts say it's not. "This isn't crazy or unsafe," says Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology at the Yale University School of Medicine. "There's no harm in having fewer periods."

Is monthly menstruation "natural"?

If you're worried about messing with Mother Nature's sacred rhythms, you might be surprised to learn that our modern lives have already disrupted them. In fact, today's woman has far more periods than her prehistoric counterpart. Thousands of years ago, women may have had fewer than 160 periods in a lifetime, according to statistics from the Population Council. That's because they got their periods later, had more children, and breast-fed longer, Dr. Randell says.

If you're worried about messing with Mother Nature's sacred rhythms, you might be surprised to learn that our modern lives have already disrupted them. In fact, today's woman has far more periods than her prehistoric counterpart.

Today's woman, however, has less children, may not breast-feed as long, if at all, and begins menstruation younger, leaving Population Council researchers to estimate that women now have an average of 450 periods in a lifetime. That's nearly three times as many as our foremothers.

So intentionally having fewer periods really isn't "contrary to nature" at all. "There's nothing natural about having a monthly period," says Anita Nelson, M.D., professor of gynecology and obstetrics at the University of California, Los Angeles. What's more, says Dr. Nelson, "Intentionally not having a period is a healthy, safe option."

The ups and downs of menstruating less

Women may get an added boost from being on birth control, which inhibits ovulation. "Decreasing the number of times a woman ovulates in her life may decrease the risk of developing ovarian cancer," Dr. Randell says.

Women on the pill decrease their risk for ovarian cancer by 80 percent and endometrial cancer by 50 percent. And there are no known increased risks from staying on birth control for an extended period of time. Of course, Dr. Randell adds, women who have contraindications like a smoking habit, a history of liver or gallbladder disease, unexplained vaginal bleeding, or blood clots shouldn't be on the pill anyway.

There might be drawbacks to eliminating your monthly cycle, however. By menstruating less, you may run into emotional barriers. You may not feel as "womanly" or as normal as you think you should. "Some women find their periods reassuring, especially if want to know you're not pregnant," Dr. Minkin says.

And in some instances, going on birth control may mean trading in one form of moodiness -- PMS -- for another. If you experience mood swings associated with birth control, however, your doctor can probably prescribe a different type of pill.

By no means, though, does this legitimate women who naturally don't have periods. Amenorrhea, or lack of menstruation, may be caused by conditions like an eating disorder or polycystic ovary syndrome. "If you're naturally not having a period," Dr. Randell says, "get evaluated because this isn't safe."

Changing your cycle

So if you decide to oust your monthly period, how often should you menstruate? That question's still being debated. Some doctors believe women should menstruate every three months. "Theoretically, by bleeding every few months you should prevent the lining (of the uterus) from building up too much - so that erratic, unscheduled bleeding does not occur," Dr. Nardone says.

But Dr. Nelson disagrees, explaining that birth control prevents that build-up. In fact, she says, women can skip menstruation for years if they desire. Spotting may occur at first, but eventually, your body adjusts. The only reason to menstruate would be to get pregnant or make sure everything's working well, Dr. Nelson says.

Before you go on period strike, consult your doctor to determine whether you're a candidate. Then work with your doctor to find the right birth control for you. Along with birth control pills, your options include Depo-Provera, an injectionable contraception, and Norplant, an implant with time-released capsules that can suppress menstruation. Soon you may also be able to take Seasonale, an oral contraceptive that allows menstruation four times a year.

Ultimately, the decision comes down to your health history and personal preference. But at least women now have a choice. As Dr. Nelson says, "It's time to provide women with alternatives to monthly menstruation."

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