November 2008
Birth-control pills:
Is it OK to fool Mother Nature?
Reduced PMS. Fewer periods. No periods. These are the respective marketing promises of the makers of Yaz, Seasonique, and Lybrel, a trio of oral contraceptives currently starring in TV, Web, and print ads. They’re called "extended-cycle" contraceptives
because they either shorten or reduce the number of hormone-free (placebo) intervals that produce withdrawal bleeds, or periods.
Lybrel, the newest of the three, is the first pill approved to eliminate placebo days—and thus periods—completely.
Is it safe to use pills to suppress menstruation? Yes, according to most of the 375 primary-care doctors and obstetricians/gynecologists surveyed by the Consumer Reports National Research Center. We surveyed only doctors who prescribed birth-control pills, and 85 percent of them had prescribed an extended-cycle drug in the past year. But the majority of those had also had patients use conventional birth-control pills in longer cycles to achieve the same effect.
Almost 90 percent of the specialists who prescribed extended-cycle drugs said they were highly confident of the long-term safety of short or eliminated periods. That’s encouraging, although there is no long-term data on the safety of such regimens.
Patient convenience was a common reason for choosing the pills, but doctors also frequently prescribed them for medical problems affected by hormonal fluctuations. These included acne, endometriosis, irregular or very painful periods, ovarian cysts, abnormal uterine bleeding, and migraine headaches.
Extended-cycle regimens have some drawbacks, our survey suggests. For one thing, they can make it more difficult for women to tell if they’ve accidentally become pregnant. Indeed, about 10 percent of doctors who prescribed one of these drugs had a patient fail to detect a pregnancy because there were no missed periods to alert her.
Among the doctors who prescribed one of the three drugs, roughly half had at least one patient in the past year who had stopped taking them. Adverse effects, such as breakthrough bleeding and breast tenderness, were the top reasons cited for stopping. Cost and problems with insurance coverage for the drugs were also frequently cited. Extended-use contraceptives cost about $680 annually, compared with $500 on average for conventional oral contraceptives.
Also troubling: Only about half of the doctors surveyed said they routinely asked patients whether they were taking dietary supplements before prescribing an oral contraceptive. That’s bad news because some supplements, particularly St. John’s wort (available to subscribers), can reduce oral contraceptives’ effectiveness. Women considering any oral contraceptive should tell their doctor if they take supplements.
Bottom line
Extended-cycle oral contraception can be useful to some women, especially those with a medical need. Ask your doctor about which brand or generic would be best for you.
Is it safe to use pills to suppress menstruation? Yes, according to most of the 375 primary-care doctors and obstetricians/gynecologists surveyed by the Consumer Reports National Research Center. We surveyed only doctors who prescribed birth-control pills, and 85 percent of them had prescribed an extended-cycle drug in the past year. But the majority of those had also had patients use conventional birth-control pills in longer cycles to achieve the same effect.
Almost 90 percent of the specialists who prescribed extended-cycle drugs said they were highly confident of the long-term safety of short or eliminated periods. That’s encouraging, although there is no long-term data on the safety of such regimens.
Patient convenience was a common reason for choosing the pills, but doctors also frequently prescribed them for medical problems affected by hormonal fluctuations. These included acne, endometriosis, irregular or very painful periods, ovarian cysts, abnormal uterine bleeding, and migraine headaches.
Extended-cycle regimens have some drawbacks, our survey suggests. For one thing, they can make it more difficult for women to tell if they’ve accidentally become pregnant. Indeed, about 10 percent of doctors who prescribed one of these drugs had a patient fail to detect a pregnancy because there were no missed periods to alert her.
Among the doctors who prescribed one of the three drugs, roughly half had at least one patient in the past year who had stopped taking them. Adverse effects, such as breakthrough bleeding and breast tenderness, were the top reasons cited for stopping. Cost and problems with insurance coverage for the drugs were also frequently cited. Extended-use contraceptives cost about $680 annually, compared with $500 on average for conventional oral contraceptives.
Also troubling: Only about half of the doctors surveyed said they routinely asked patients whether they were taking dietary supplements before prescribing an oral contraceptive. That’s bad news because some supplements, particularly St. John’s wort (available to subscribers), can reduce oral contraceptives’ effectiveness. Women considering any oral contraceptive should tell their doctor if they take supplements.
Bottom line
Extended-cycle oral contraception can be useful to some women, especially those with a medical need. Ask your doctor about which brand or generic would be best for you.
