The No-Period Birth Control Pill

The pivotal question in the consideration of birth control pills and the No-Period pill in particular is: 'Is the convenience of stopping the monthly hassle worth the long term risk?'

There are a host of hormone-related disorders that complicate women's lives. So, since few of us are endocrinologists, how does a reasonable, health-concerned woman who is raising a family and contributing to the household income make a decision? Is the convenience of stopping the monthly hassle worth the long term risk?

The Facts

The No-Period Birth Control pill, Lybrel, is simply a logical extension of the birth control industry, pharmaceutical companies claim. It's taken daily without the monthly pill-free days. By providing a constant low dose of hormones, it stops your period – cold. No ovulation – except for the frequent side-effect of significant break-through bleeding the first few months.

The risks are the same as all birth control pills: increased chance of developing blood clots, heart attacks, and strokes as indicated on the labeling. Women with PCOS and others with certain metabolic disorders should be aware that there may be increased risks of cardiovascular complications. (1) The manufacturer did a years' worth of trials and the product is approved by the FDA. However, the long term risks are not known.

The biochemistry of the No-Period pill isn't substantially different from that of the pills currently marketed. The pill "shuts down normal hormone production and replaces it with a very tiny amount, so there is no buildup of the uterine lining," says Steve Goldstein, MD, a professor at NYU Medical Center in New York City. (2) Lybrel, marketed by Wyeth Pharmaceuticals, contains 90 micrograms of levonorgestrel and 20 micrograms of ethinyl estradiol (3), two synthetically-derived hormones that mimic the estrogen/progesterone activities in the normal cycle. It seems straightforward enough except for that shutting-down-of-major-hormones part. Again, the long term risks are not known.

Long Term Research

That lack of long term research is the greatest concern. Christina Hitchcock, PhD, a researcher with the Center for Menstrual Cycle and Ovulation, while acknowledging some of the early research, still had some concerns that medical science was unclear about the long term implications of interrupting the menstrual cycle. Indicating that the endocrine system was highly sensitive and that altering their levels might have other consequences, she is quoted as saying "the same hormones that work on the menstrual cycles act in the brain, bones and the skin. You need to think about whether there are consequences we don't know about for the whole body." (4)

The long term consequences are also still unknown for estrogen-stimulated cancer. Says cancer expert, Julia Smith, MD, director of the Lynne Cohen Breast Cancer Preventative Program at the NYU Cancer Institute, "This is something that has not been carefully studied yet. We don't have any evidence that there is a problem, but we certainly have many instances in the history of medicine where problems only showed up at a much later date after long term exposure and widespread use." (5)

No Need for a Period?

But, corporate scientists (and, to be fair, others) tell us that there's really no medical reason that a woman on oral contraception needs to have a period. In reality, she doesn't have "real" periods since her estrous cycle is manipulated by the dosage of hormones in the pill she takes. The period she does have when off her pills is actually caused by unstable hormone levels.

In fact, the necessity of having monthly periods has been called "folklore" noting that until very recently, women didn't have as many periods each year – maybe two or three at the most – because they were either pregnant or nursing, implying that perhaps having a monthly period is not exactly what Mother Nature had in mind.

According to Dr. Paul Blumenthal, a professor of obstetrics and gynecology at Stanford University School of Medicine, "Women used to have very few menstrual periods. Now, with the delay of childbirth and birth spacing and a significant decrease in lactation, we have incessant ovulation and incessant menstruation. The fact that women really don't need to menstruate needs to be reintroduced." (6)

Which brings us to the last little bit of unsettling information. The Lybrel website states: "LYBREL provides women with more hormonal exposure on a yearly basis (13 additional weeks of hormone intake per year) than conventional cyclic oral contraceptives containing the same strength of synthetic estrogens and similar strength of progestins." (7)

Some researchers are concerned that a lifetime of these hormones (artificial ones, at that) could raise levels abnormally and increase the possibility of other health issues. Again, we won't really know until they start to happen.

Is it convenience or just smart marketing that suddenly makes the No-Period pill seem like a good idea? Perhaps a bit of both. The introduction several years ago of pills and shots that halt periods for longer than a month met with cool reception in the marketplace. The reason the No-Period pill was not developed sooner was because there was a concern that women felt that menstruation was a natural cycle, a perception so entrenched that marketers didn't think the product could overcome it.

Convenience is certainly the underlying marketing concept behind this product. And it's a good one. Research shows that women feel less effective during their period. Now, counting on the love-hate relationship a woman has with her body as well as the demands of an active home and professional life, marketers are confident that most women of child-bearing age will happily buy the new pills, hopefully to the tune of $250 million a year as presented by the Therapeutic Director for Women's Health to the Wyeth Board of Directors.

No Easy Answer

The decision to go on the No-Period pill is a hard one, not only because the information is murky but because women's health has an unfortunate history of being subject to opportunists. The answer is that there aren't any easy answers. A woman has to be her own health advocate.

Yes, oral contraceptives are often prescribed for PCOS and some women with PCOS have had good luck with Lybrel. However, be cautious. The convenience of no periods now may not be such a great trade-off for a stroke later. Certainly, your family health history should be taken into consideration. Your weight, your general health and whether or not you have ever smoked, are all factors. It's also important to make sure whatever menstrual problems you're having aren't related to some other hormonal issue, so make sure that you have a full evaluation before you make your decision.

– Chris Thomas