Continuous Contraception

By Stacy Tressler

The development and FDA approval of the first birth control pill in 1960 completely changed the face of women’s reproductive health. For the first time in history women had control over family planning and their own sexuality. Over the past decades the “pill” has undergone relatively few changes and new lower dose pills make taking the pill safer than ever. Approximately 12 million women rely on the pill for birth control as well as a way to control the unpleasant side effects associated with their monthly period. Recently a new type of pill that allows a woman to go months or even a year without a period has come on the market. Many women are wondering if it is safe or natural to take such a pill. To understand how continuous contraception work, it is helpful to first have some basic knowledge about how traditional birth control pills work.

Each month a reproductive age woman goes through a 28-day cycle during which the body’s natural hormones fluctuate in preparation for pregnancy. During the first half of the cycle the body prepares for ovulation (release of an egg) and the implantation of a fertilized egg. The lining of the uterus becomes thick and nutrient rich so that it can support an egg if it is fertilized. Once an egg is released there is about a three day window of opportunity for it to become fertilized resulting in pregnancy. If the egg is not fertilized it is shed along with the lining of the uterus during a woman’s monthly period.

Traditional birth control pills come in 21 or 28 day packs and contain the synthetic hormones estrogen and progestin, which are similar to the natural hormones produced by a woman’s body. A woman who is not on birth control will have great fluctuations in her hormone levels throughout her 28-day cycle. Birth control pills suppress this fluctuation and keep hormone levels relatively low. Instead of hormone variation the pill delivers a set amount of synthetic estrogen and progestin every day and this prevents a woman’s body from releasing an egg thus ovulation does not occur.

At the end of the 21 or 28 day pack there is seven days of placebo or spacer pills that allow a woman to have her period. However this is not a true period and is in reality an “artificial period”. A woman taking the pill does not ovulate therefore she does not have an egg or a uterine lining to shed. A woman on the pill experiences “withdrawal bleeding” while taking her spacer pills which is meant to mimic a real period. This artificial period serves no health purpose and has more to do with marketing than with science. The inventors of the pill decided to include seven days of spacer pills so that the pill would appear more natural and be more acceptable to women. Also, the pill was invented before the days of drugstore pregnancy tests and the “artificial period” gave women the assurance that they were not pregnant.

Fast forward, to 2008, and the three new types of continuous birth control pills: Lybrel, Seasonique and Seasonale. These pills allow a woman to go months or even an entire year without a period. They work the same as the traditional pill by delivering a low dose of synthetic hormones to prevent ovulation but the new continuous pills do not contain monthly placebo pills. Because the new continuous pills are taken for an extended amount of time, they contain lower doses of hormones than the 28-day pill, which may result in break through bleeding for the first couple months. The new continuous birth control pill is not much different than the traditional pill and it is just as safe and as effective. The only downside of continuous contraception is that it may take a woman longer to realize that she is pregnant. Also women who take any type of hormonal birth control have an increased risk for blood clots, strokes and heart attacks. This risk increases if you are over the age of 35, smoke or have high blood pressure.

There has been a lot of debate about the safety of taking hormonal birth control for extended amounts of time. Women today have an average of 450 periods in their lifetime, which may increase the risk for ovarian, endometrial and breast cancer. Throughout history women had fewer periods because they were either pregnant or breast-feeding and it is believed that fewer periods may have positive health benefits. Women who are thinking about taking continuous contraception should talk to their health care provider. There is really no medical difference between continuous contraception and the traditional pill so it really comes down to a personal choice. There are both risks and benefits to taking hormonal birth control and each woman must decide what is best for her own body.

References:
http://www.noperiod.com/handout.html
http://www.npr.org/templates/story/story.php?storyId=5458926
http://www.enotalone.com/article/7832.html
http://contraception.about.com/od/prescriptionoptions/p/MissingPeriods.htm