Extended-cycle birth control gains popularity
by Anna
Web Correspondent
Planned Parenthood Minnesota, North Dakota, South Dakota Action Fund
Women have been controlling the timing of their periods for years with typical 28-day pill packs, which usually include 21 days of active pills and 7 days of inactive “placebo” pills. Menstruation takes place during the week of inactive pills, but by skipping the placebos and moving directly to a new pack and therefore three more weeks of active pills, a woman can put off her period for an extra three weeks. The primary hassle associated with this manipulation is breakthrough bleeding (BTB), spotting or a light flow between periods. This is particularly common for women who use triphasic as opposed to monophasic brands (triphasic brands provide different levels of hormones each week during a cycle—Ortho Tri-Cyclen is one widely used example).
Recently, three new birth control options on the market that further extend the amount of time between periods. Seasonale was the first to be approved by the FDA in 2003, and Seasonique followed suit in 2006. Both allow women to menstruate just once every three months. The newest brand name, Lybrel, which gained approval on May 22, 2007, takes this trend a step further by prolonging the time between periods to an entire year.
The new extended-cycle brands control hormone levels and leave out the inactive pills for months at a time to prolong time between periods. Seasonale provides 84 days of active pills followed by a week of inactive pills so that a woman gets her period once every 12 weeks. Seasonique is similar but uses very low-dose hormone pills rather than inactive pills during the thirteenth week, which may make bleeding lighter. Lybrel provides just under a year’s worth of active pills followed by one period. Lybrel is very likely to cause BTB, especially early in use, although this decreases over time for the majority of women. Lybrel’s website points out that “the convenience of having no regular periods should be weighed against the inconvenience of unscheduled breakthrough bleeding and spotting.”
The primary objection to prolonged cycles maintains that not menstruating every month is "unnatural". However, let me point out that the bleeding a woman experiences during the “placebo” week while on the pill is actually called withdrawal bleeding (hormone withdrawal, that is) and is not the same as an unmediated period. Using birth control pills suppresses ovulation and keeps the uterine lining thin (so that implantation cannot take place should ovulation occur), meaning that bleeding while on the pill is not medically significant. When birth control became available in the 1960s, pharmaceutical companies included a week of withdrawal bleeding each month precisely because they wanted it to seem more “natural,” an important marketing strategy because at the time birth control was a foreign concept. That said, having monthly bleeding may be more reassuring for women who want to guarantee that they are not pregnant.
A lot of women still don’t fully understand the extended-cycle option because doctors and gynecologists tend not to publicize it as an alternative. If you think it might suit you, take the lead and ask about it at your next appointment.
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