Liberation at its best

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

An old idea has emerged as a new concept. It is called menstrual suppression. For all those poor women who suffer the numerous ill-effects and who dread the onset of the monthly cycle it seems mainstream medicine seems to be examining and finding little problem with getting rid of that menstrual cycle all together.

The idea is to promptly reinstate the cycle and hence regular ovulation at will once fertility becomes a goal. It is not really a new concept, since we doctors have been using an “off-label” method of controlling periods during undesirable times such as trips and exams for years. Birth control pills go way beyond contraception. They help women control moods, anemia, cramping, acne and libido to name a few.

Since they came into use, debate began about how to use them. At first, it was easier to accept a new concept if it “appeared” to not really influence anything. Maintaining monthly cycles gave it just that appearance. Debates began to surround this cycling. Why not have a cycle every second or third month? The answer seems to be that there is a regular rhythm to most of our existence linked to the revolution of the sun or moon, and it bothers people to disrupt the cycle. However, if you suffer pain, bloating, cramps and headaches, and relief comes with bucking the trend, then why not?

So now we have “Anya”, the birth control pill made to be taken non-stop year around, obliterating menstruation, sending napkin stocks plunging and ripple waves through the dry-cleaning industry. We are entering the age of customized cycles.

First reports suggest that the side-effect profiles are not that different from any of the two dozen existing birth control pills. Smokers carry a higher risk for developing blood clots, migraines might get worse, and women with clotting disorders and those over 35 should weigh the risks. Theoretically, you can achieve the same end with any of the traditional products already on the market. My prediction is that it will be the younger generation that will more likely accept the lack of a cycle through uninterrupted medication use and are less likely to notice any changes in libido

There are other advances in contraception as well. Traditional birth control pills are combinations of estrogen and progesterone, substances regularly produced by the body. By manipulating the levels ovulation is surpressed. There are also progesterone-only formulations, which work well, and are even preferred in special situations such as breast-feeding. Yasmin is a new type of progesterone that resembles a diuretic hormone and helps with the bloating and fluid retention of pre-menstrual syndrome. Since it inhibits androgens, the cost of relief may be a reduced libido.

There are also new methods of delivering medications as well, especially for the 70 percent of women who admit to missing an occasional pill. For example, four injections of Depoprovera are enough to suppress ovulation for a year. Evra is a weekly birth control patch, which slowly releases medication across the skin barrier. Nuvaring is a monthly vaginal device that releases birth control hormones. Even traditional Inter Uterine Devices are being re-engineered to deliver steady long-term trickles of medication. Technology and form will change, but the ethical, moral and religious arguments will remain.