For many women, periods are too heavy, too often, too painful. In short, too
bleedin’ awful. So a new contraceptive pill that also promises to stop
periods for a year at a time seems to offer a miraculous solution. The pill,
called Lybrel, went on sale in the United States in July. Pending approval
from European drug regulators, Wyeth, the pill’s manufacturer, plans to
launch Lybrel in the UK next year. But this will raise interesting
questions: is it safe to stop periods? Do we actually need the monthly
“curse”?
Certainly the evidence suggests that women would happily wave goodbye to their
periods. Menstrual problems are the single most common reason for women to
consult their GPs. According to a recent survey from Edinburgh University,
overall about one in five women thought that she had problem periods. About
one in 20 experienced severe pain, one in three heavy periods and one in 20
had periods so excessive that there was a risk of anaemia through blood
loss. One study has indicated that, in Britain, 60 per cent of women would
happily kiss goodbye to their periods tomorrow.
But having as many periods as we do – about 400 to 450 in a lifetime – is a
modern phenomenon. Among women of the Dogon people, an extensively studied
tribe from Mali, whose lifestyle resembles that of ancient human beings and
who have, on average, eight babies each, only 110 periods are experienced in
a lifetime. This is because all those things that keep periods at bay for
the Dogon, such as pregnancy and breast-feeding, are less frequent and take
up less time in our lives. We also start periods earlier and have babies
later than they do.
To lots of women, periods are a mystery. They assume that they need to bleed
and many think that not to have periods is to somehow sequester “bad blood”
somewhere in the body or to build up a womb lining so thick that it poses a
risk to health. This is, in fact, a myth.
So a modern woman’s body goes through a never-ending cycle of ovulation and
the subsequent menstruation that occurs when we do not get pregnant. It is
normal for women not to ovulate in some cycles; generally speaking, if you
are menstruating regularly, you are also likely to be ovulating regularly.
Aside from the problems caused by periods, such as anaemia or PMS
(premenstrual syndrome), ovulating so often increases the risk of a range of
diseases: endometriosis, ovarian cancer and endometrial cancer, for example.
What’s clear from the natural example of the long periods of time when women
do not menstruate during pregnancy or breast-feeding, or indeed post
menopause, is that to stop periods in itself is not harmful.
The Pill mimics our natural rhythm
You might wonder, if we don’t need to bleed, why the Pill dosage regimen is
engineered to make its users bleed. The answer is a surprise. One of the
inventors of the Pill, John Rock, a Boston gynaecologist, was a Roman
Catholic and thought that the Pill would be more acceptable if it seemed to
mimic the natural rhythm. We have him to thank for 28 days and bleeds. In
doing this, he also created the myth that 28-day cycles were normal. In
fact, they are naturally experienced by just 12 per cent of women. Far more
have 31-day cycles.
By avoiding the Pill-free interval and simply taking packets back to back,
women have always been able to avoid bleeding altogether if they wished,
either because of pain or heavy bleeding, or because they didn’t want their
weekend lovemaking, honeymoon or exams to be interrupted. It is perfectly
safe to do this.
This works well only with so-called monophasic pills (the ones where the same
amount of hormone is taken every day for three weeks). If it is done with
the triphasic sort, when the amount of oestrogen is increased gradually,
spotting (more properly known as breakthrough bleeding) is likely to occur.
But, strictly speaking, women aren’t meant to take the Pill without a monthly
break and this use is not licensed. This situation has been “regularised”
recently with the introduction of Pills such as Seasonale and Seasonique.
With these, active hormone pills are taken every day for three months,
followed by one week of placebo pills (in the case of Seasonale) or a week
of low-oestrogen ones (for Seasonique). Because these are licensed for
extended use, it means that such regimens had to be tested extensively
before getting their licence. The new kid on the block is Lybrel, which is
licensed to be taken continuously for a year.
However, one of the concerns with Lybrel is that there may be breakthrough
bleeding. In a clinical trial more than half the 2,134 women who took part
dropped out for this reason.
Also, according to Dr Margaret Rees, a gynaecologist at John Radcliffe
Hospital, Oxford, Lybrel is unlikely to be offered to women over 40 because
of an increased risk of thrombosis. However, this is the age group that may
be most interested in taking the Pill, and stopping periods, as they have
already had their children. So, nice idea but I suspect that this one won’t
fly.
Fertility cycle
Periods are the visible sign of a complex hormonal fertility dance
orchestrated from puberty by the brain. The purpose of each cycle is to gear
a woman up for pregnancy.
DAY 1-10 An egg – not any old one, but the pick of the bunch – is
selected for release. Oestrogen turns the womb lining from the equivalent of
parquet flooring to luxuriant shag pile.
DAY 11-14 The egg is released from its enclosing follicle.
DAY 14-26 The follicle turns into what is known as a corpus luteum
(literally yellow body) and produces another hormone, progesterone, which
helps to beef up the structure of the lining.
DAY 26 If no fertilised egg appears, the corpus luteum gives up. It is
the sudden drop in progesterone that triggers the sloughing of the
newly-grown shag pile and this, and the temporary bleeding from the little
blood vessels that supplied it, is all expelled and experienced as a period.
The Pill: key dates
1956 The American biologist Gregory Pincus conducts the first large
trial of the Pill on 6,000 Puerto Rican and Haitian women
1961 The Pill is introduced in the UK, but it is only available for
married women
1967 Single women in the UK are allowed to take it
1995 A health scare in the UK over blood clots thought to be linked to
the third-generation Pill leads to a drop in usage. Pregnancies and
abortions rise accordingly
2007 Lybrel, the first year-long pill, is licensed for use in the
United States
