A trend toward women using oral contraceptives more frequently to reduce their number of menstrual cycles dramatically is gaining momentum, say health professionals here and nationally.


By staying on birth control pills continuously, rather than taking placebos one week a month, most women can go without menstrual bleeding for extended durations of time and remain healthy, the health professionals say.


In October 2003, the U.S. Food and Drug Administration approved the birth control pill Seasonale as an alternative to the 21-day active hormone, seven-day placebo pill packets that have been on the market since the first oral contraceptive, Enovid, was approved by the FDA in 1960.


Seasonale provides for a 91-day cycle84 days with pills and seven days with placebosallowing for four menstrual periods in a year instead of the standard 13.


The benefits to women who dont want to get pregnant go beyond the relative assurance of birth control. Menstrual cycles, in addition to the loss of blood, often bring with them such side effects as breast tenderness, bloating, headaches, cramps, and mood swings that dont have to be experienced on a monthly basis.


Menstruation brings with it quite a burden of suffering for many women, says Dr. Andrew Kaunitz, a researcher involved in the 1999 to 2001 study that determined Seasonale was a safe, extended-cycle alternative. He is a professor at the University of Florida, in Jacksonville.


Most birth control pills supply the hormones progestin and estrogen to a womans body, changing the hormonal levels and preventing conception by tricking the body to think it is pregnant, says Brenda Covert, coordinator of Sacred Heart Womens Health Center, which is part of Sacred Heart Medical Center here.


Dr. Shawn Barrong, of Northwest Ob-Gyn, of Spokane, says it differently, saying the added levels of progestin and estrogen send feedback to the brain causing it to instruct the ovaries not to ovulate.


The daily use of birth control pills to stop monthly bleeding was practiced well before the FDA approved Seasonale.


I know of women who have been successfully doing it for years and years, says Susan Wysocki, president and CEO of the National Association of Nurse Practitioners in Womens Health, in Washington D.C.


Wysocki, who has been a nurse practitioner since 1975, says her thinking expanded beyond the commonly adhered-to 28-day cycle about seven years ago, and adds, I couldnt believe Id not previously questioned it on my own.


The purpose of a womans menstrual cycle is to prepare her body for conception. Kaunitz, Barrong, and Wysocki all agree that there is no medically proven advantage for a woman to menstruate.


Wysocki says that about 80 percent of all women today have used some type of birth control by the time they reach menopause, and that birth control pills are clearly the most popular. Repeated studies have indicated that women would prefer to go without menstrual periods if it were safe and free to do so, she says. A 2003 survey of women by the Association of Reproductive Health Professionals found that 62 percent of respondents were interested in stopping their period under those conditions.


American women today ovulate an average of 400 times in their lifetime, compared with an estimated 100 times in the lifetime of ancient ancestors, says Wysocki. Kaunitz says the difference is that women now live longer, begin their menstrual cycles at a much earlier age, dont have offspring until a later age, and have birth control options that keep them from being continually pregnant or lactating.


The use of native plants and natural remedies for contraception purposes goes back as far as Biblical times, says Covert.


Barrong says he prescribed extended use of oral contraceptives long before Seasonale was approved by the FDA. A common method he prescribes is for a patient to take a 21-day pack of pills, throw away the placebos, then immediately begin a new pack. He says 50 percent of his birth control pill referrals are for purposes other than birth control, such as to control abnormal bleeding and painful periods. He says the continual use of birth control pills over a five-year period also reduces the risk of ovarian cancer by 50 percent.


Medical professionals interviewed for this story agree that oral contraceptives arent advantageous for all women, an argument for keeping the prescription of birth control pills under the supervision of a doctor, nurse midwife, or nurse practitioner, and not making pills available over-the-counter.


Women who are routinely denied access to birth control pills are those with a history of blood clotting and those over 35 years of age who smoke.


Oral contraceptives arent without side effects. A major concern is the risk of an increase in blood clots, especially venous thrombosis in the legs, says Kaunitz. He says women who take birth control pills are three times more likely to suffer blood clotting than women who dont take the pill. He adds that the risk of blood clotting increases tenfold when a woman becomes pregnant.


Blood clots, strokes, and heart attacks also can be side effects of birth control pills, but are rarer than the risks associated with pregnancy, says Wysocki.


Fertility comes back rapidly once the pill is discontinued, says Kaunitz.


The monthly cost of a pack of birth control pills, depending on what is prescribed, can vary from $15 for generic brands to $45. A 91-day pack of Seasonale sells for about $135.


Barrong says a huge percentage of drugs used in the field of obstetrics is not approved by the FDA because most pharmaceutical companies dont want to get involved with the huge liability issues involved with pregnant women.


Although definitely the most popular of obstetric-type drugs, oral contraceptives are only one of many birth control products on the market. There also are patches that release hormones into the body, injections that can last up to three months, and barrier devices such as condoms and diaphragms. Other newer products include an intrauterine system that slowly releases hormones into a womans body and a vaginal ring that accomplishes basically the same thing when its inserted into the vagina once every three weeks.


It is important that women not be pressured into the extended use of oral contraceptives, say both Kaunitz and Barrong. They emphasize that doing away with menstrual cycles is merely a modern option that can only be decided on a personal level.