Do we really need to have monthly periods?

The flexibility of the Pill

Doctors and very savvy patients have known for years that the Pill's 28-day cycle is an arbitrary one that only mimics a woman's natural rhythm. For women with debilitating cramps, heavy flow, anemia, endometriosis or menstruation-related migraines, some doctors prescribe the Pill to be taken every day, with perhaps the "week-off" of placebos taken every three months or so.

But healthy women, too, are using the Pill this way. Soldiers and astronauts have the option of staying on birth control pills to avoid having periods while on duty or in space. And women often turn to their doctors—and the Pill—to ensure a period-free honeymoon.

"I had a patient who was going on a scuba-diving trip to photograph sharks," says Andrew M. Kaunitz, MD, professor and assistant chair at the University of Florida's Department of Obstetrics and Gynecology and a researcher of contraception. "It was very obvious why she wanted to postpone her cycle."

More research needed

Dr. Kaunitz cautions that taking the Pill continuously to stretch out the length of cycles should always be done in consultation with a physician. And, he says, there need to be more studies on this use of the Pill. But he does believe that using the Pill this way for health reasons or even "health style" reasons is reasonable and probably healthy, and therefore will likely become routine some day soon.

Health benefits

"If men were faced with having to bleed each month, we would have done something about it a long time ago," says Dr. Kaunitz. "And that's not all a joke, because there are positive implications from a health perspective. Not just the obvious ones, like menstrual cramps and anemia, but we know there are non-contraceptive health benefits to using the Pill, and they may be enhanced by continuous use."

Dr. Kaunitz is referring to purported benefits of the Pill, including protection from some cancers and heart disease, though he cautions that studies have yet to be done that might show any enhanced benefit or uncover any potential risks. Large studies, like the ongoing "Pill-A-Day" study at the University of Washington, are fairly new and have yet to be completed.

Some researchers believe that interrupting the recurrence of menstruation could protect some women against ovarian, endometrial and breast cancers, as well as other serious diseases like anemia. Going long cycles without menstruating might also inhibit fibroids, migraine and endometriosis. And of course it would address lesser complaints like mood swings, pelvic pain, breast pain and swelling.

The history of menstruation

Those who argue that menstruating every month is unnatural cite faraway tribes and pre-industrial times. In such places and times women start menstruating at about age 16, begin having several children shortly after, and breast-feed each child for years (which can prevent menstruation). American women today typically menstruate 400 times before menopause; by contrast, in the lifetimes of our ancestors as recently as colonial times or of such tribes as the Dogon in Mali today, women might menstruate 100 times before menopause.

The argument is that evolution didn't make the leap when we advanced our nutrition to the point where we began menstruating around the age of 10 and the control of our fertility to the point where we have only two children, often well after the age of 30.

"Recurrent menstruation is unnecessary and can be harmful to the health of women. It is a needless loss of blood," argue Elsimar M. Coutinho, MD, PhD, and Sheldon J. Segal, PhD, MD, in their book Is Menstruation Obsolete?

Their book looks at attitudes and misconceptions about menstruation from around the world. "Many women still view menstruation as a purifying mechanism that rids them of contaminated or bad blood," they explain. "Similarly, many women also associate menstruation with femininity, fertility and youth..."

The history of the Pill

When the Pill was first being introduced, its makers decided that maintaining a woman's monthly cycle would engender its acceptance. But they also knew that the Pill's cycles weren't the same as normal menstruating cycles, and that a three-month-long cycle on the Pill would be just as "natural" (or unnatural).

"Experienced OB/GYNs are familiar with creating long cycles occasionally," says Kaunitz. "What's going to be new is a more widespread, continued use. There need to be studies on that. But ultimately I think younger women are more willing to recognize this as an option."

Maybe our menstrual cycles are natural

Susan Fekety, a certified nurse midwife with the Yarmouth, Maine, practice Women to Women, dismisses the supposed health risks of menstruation. "Women were meant to have cycles. That's like saying we were supposed to be dead before we reach menopause, which I've also heard. I don't think there are that big of accidents in the natural world."

What about "health style" reasons to create long cycles? And the nuisance factor?

Fekety agrees that birth control pills are disruptive to a woman's natural hormone production anyway, and for those on the Pill, that the "bleed week" is arbitrary. "When some women take birth control hormones like Depo-Provera they stop having periods," she says. "For some, that's fantastic and they're happy to skip it. But to me, someone who is too busy to menstruate has got a problem."

Still, Fekety would prescribe the Pill for someone who wanted it and even for someone who wanted to control and lengthen her cycles. "I really try to listen to what women tell me are their priorities," she says. "Everyone is different and every woman needs different things at different times in her life."

Another example of the right to choose?

There are many holistic-minded practitioners like Fekety who are leery of the Pill as a contraceptive, even after all these years, and they are loathe to consider continuous use of the Pill. However, for the 10 million American women on the Pill, the idea may be intriguing. Indeed, should studies show that continued use of the Pill is good for you, or at least as healthy as the 28-day Pill cycle, Kaunitz believes many women will welcome some more control over their cycles..