February 12, 2001
Why you might consider dumping your monthly friend
By Karen Asp
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
While skipping periods has recently received considerable media attention,
doctors say it's nothing new. "For years, we've manipulated the periods
for women on birth control," says Adelaide Nardone, M.D., a New York-based
gynecologist and medical advisor for the Vagisil Women's Health Center.
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
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
The ups and downs of menstruating less
Skipping the monthly cycle offers several advantages, the most obvious
being relief from menstrual side effects. For many women, menstruation
is a pain, causing problems like PMS, migraine headaches, and severe
bleeding and cramping -- which often force them to miss work. Even
women who take birth control pills may experience PMS symptoms during
the dummy pill interval. Eliminating this interval and subsequent
menstruation could improve their quality of life, Dr. Randell says.
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
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
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