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Is it safe to use the pill for period prevention?

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March 6, 2000 (San Francisco) -- Laura DeMarco (not her real name) knew she'd get her period during her honeymoon, so she decided to skip it that month. She's not alone: Many women are deliberately avoiding menstruation by not taking the seven dummy pills at the end of their birth control packs and starting a new pack right away.

Although preventing a period is not widely discussed, some gynecologists have routinely recommended this method to their patients for everything from treating anemia to avoiding menstruation while on vacation. But doctors remain divided over whether to recommend skipping one's period for more than an isolated occasion.

Disagreement Among Doctors

There is a common belief among women that getting their period every month is "natural," according to Kirtly Jones, M.D., spokesperson for the Association of Reproductive Health Professionals and a proponent of the pill-skipping method. A monthly period lets women know they're not pregnant, and it "provided reassurance [when] women weren't convinced the pill would work," she explains. "You don't need a week off. When you take that time off, it's not required medically."

But not all doctors agree that women using oral contraception should stop menstruating. "It's a controversial topic that goes back to when the pill was introduced," says Fred Hawwa, MD, assistant clinical professor of obstetrics and gynecology at the Brown University School of Medicine in Providence, R.I. He says that skipping the dummy pills in a birth control pack can be a good idea if your period happens to be on your honeymoon or if you're going on vacation, but he wouldn't recommend practicing it permanently.

First, Hawwa says, this method can provoke anxiety because a woman has no way of knowing whether she's pregnant. (He acknowledged, however, that the risk of pregnancy while taking the pill continuously is less than 1%.) Second, skipping your period may mask other health problems, such as an underactive thyroid and cancer of the uterus, that manifest themselves through changes in the amount of menstrual bleeding. However, Jones focuses on the positive side of skipping a monthly period: It can help decrease the symptoms of endometriosis, anemia, cramps, migraines, or seizures during menstruation.

Problems Still Continue

The downside of using this method is that it doesn't always let women avoid breakthrough bleeding, also known as spotting, and PMS symptoms. "I still had the cramping, and the bloatedness, and the emotional craziness," DeMarco says.

Spotting occurs, according to Shelley Breene, M.D., an OB/GYN at Santa Monica Bay Physicians in California, because the endometrial lining normally builds in response to female hormones. When the pill suppresses those hormones, the lining is never built -- so it stays thin. Sometimes it's not thin enough, or it becomes irritated due to bacteria, inflammation, or hormonal imbalance, all of which can cause spotting. Breakthrough bleeding can also be a symptom of other conditions, such as uterine fibroids.

To deal with spotting while taking the pill continuously, a woman has two choices, Jones says. She can either continue to take the pill and just ignore the spotting, or stop taking the pill after she finishes her three-week cycle of pills -- which, of course, will lead to a period again. She recommends that women who try the latter method keep a calendar of when they get their period in case they need to see their physician.

Which Pill Works Best?

If a woman chooses to take the pill continuously, monophasic birth control pills, vs. triphasics, are the best types because the levels of estrogen and progesterone remain the same throughout the month, Hawwa says. The hormone levels in the triphasics, conversely, change every week. Breene also prescribes the monophasics due to the fact that there is less research on triphasics. "The studies that showed all the good preventive measures associated with pill use -- including decreased incidence of anemia, decreased incidence of fibrocystic breasts, and decreased incidence of endometrial and ovarian cancer -- were done with the monophasics," she explains.

Once all the pros and cons are weighed, a woman may decide that missing a period each month isn't for her. DeMarco, however, has gone from not getting her period once to wanting to skip it long term. "I've skipped periods for various occasions, but now I think I'm going to do it on a regular basis," she says.

Amy Durgan is a writer based in San Francisco.

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