Who Needs a Menstrual Period?

Anne Jorgensen, 22, a law student at Washington and Lee University in Lexington, Va., who uses birth-control pills, has a secret she doesn't want her doctor to know. To make it easier to attend her winter formal, a wedding and a few other special events, she tricked her body into skipping its monthly menstrual cycle several times in the past year. How? Instead of taking the last seven pills in her contraceptive case, which contain the placebos, or dummy pills, that allow her uterine lining to slough off each month, she immediately started her next month's batch of active medication. Result: instead of the usual 13 periods a year, she had nine.

Jorgensen is not alone. Practically since the Pill was introduced in 1960, women have used it to manipulate the timing of their periods--something the contraceptive was not designed to do. But what has been an off-label practice may soon become mainstream. Researchers at Eastern Virginia Medical School in Norfolk are testing a new contraceptive formula, called Seasonale, which can reduce the number of periods a woman experiences to as few as four a year.

"Not every woman will be able to do this initially," says Dr. Freedolph Anderson, who is leading the study. Some women, for instance, may at first experience breakthrough bleeding, something that often happens when women skip periods using standard birth-control pills. But with some fine tuning, women can learn to turn their cycles off and on to suit their busy schedules. And if all goes well--and if the Food and Drug Administration approves--Seasonale, the first pill produced for that purpose, could reach the shelves of U.S. pharmacies by 2003.

Like ordinary contraceptive pills, Seasonale contains two different hormones: progestin, which inhibits the release of eggs from the ovaries; and estrogen, which holds the uterine lining together. The idea is to take Seasonale every day for 12 weeks. Taking daily placebo pills for the following week creates a short interruption in hormone levels that allows an immature egg to be discarded with only a little bleeding.

Having just four menstrual cycles a year may not be as unnatural as it sounds. Studies of ancestral societies in Africa and Australia suggest that historically women have spent most of their fertile years either pregnant or nursing. As a result, they averaged about 150 periods between puberty and menopause, compared with 400 in developed countries today. Indeed, the risk of such modern medical ills as endometriosis is believed to increase with the number of menstrual cycles a woman goes through.

But there are risks in using the Pill to fool with Mother Nature. Seasonale would necessarily expose a woman to nine extra weeks of estrogen a year, and doctors have long known that taking estrogen increases a woman's risk of suffering a blood clot or stroke--particularly if she smokes or has high blood pressure. Estrogen may also boost a woman's risk of developing breast cancer, although the evidence for that is less clear.