A New Form of Birth Control Pills: Seasonale

by Jennifer Russo

The thought of menstrual periods often conjures up images of PMS, cramps, and a mountain of feminine hygiene products. Are there days that you wish you could reduce the frequency of your periods? Does having your period only four times a year seem like an impossible fantasy? The realization of your dream may be closer than you think.

Seasonale is a new type of birth control pill that will be manufactured by Barr Laboratories in Pomona, New York. (It is currently under review by the FDA but may be available as early as the fall of 2003.) In addition to the contraceptive benefit of the pills
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currently on the market, Seasonale will reduce the number of yearly menstrual periods from 13 to four, so women menstruate only once each season.

Seasonale contains a combination of two hormones commonly used in other oral contraceptives, but in significantly lower doses -- an estrogen (ethinyl estradiol) and a progestin (levonorgestrel) -- according to information released by Eastern Virginia Medical School (EVMS), where the clinical trials were conducted. Dr. Freedolph Anderson, the lead researcher in the trials, said that the cumulative amount of hormones in Seasonale is less than other pills, even though the pills are taken for 84 days rather than the normal 21 days before a woman takes seven days off in order to menstruate.

Seasonale works similarly to the conventional pill by suppressing ovulation, causing the cervical mucus to thicken and become hostile to sperm, and preventing the lining of the uterus (endometrium) from growing thick enough for a fertilized egg to imbed itself. The hormones in Seasonale vary slightly by suppressing the growth of the endometrium entirely, according to Patrice C. Malena, MS, FNP, who coordinated the Seasonale studies at EVMS. This further reduces pregnancy risks and causes periods to be lighter than ever. Many of the women involved in the clinical trials had either very light periods, usually lasting two days during their week of placebo pills, or no periods at all, according to Malena.

Prescribing an Old Secret

In actuality, Seasonale is merely a new take on a common off-label use of the birth control pills. For years, some gynecologists have assured their patients that it's safe to take birth control pills continuously through two months in order to avoid a period that some patients might consider inconvenient. By skipping the seven placebo pills, some women have been skipping out on menstruation for many years.

The lower dose of hormones in Seasonale probably means a lower potential for side effects. According to Malena, it would even be safe to skip your seasonal period if it were going to occur at an inconvenient time. In fact, the researchers of the Seasonale study believe that women could easily go longer than three months between periods.

Health Benefits

Avoiding periods has benefits beyond convenience. Skipping or decreasing the frequency of periods can help to prevent anemia and endometriosis -- a common cause of pelvic pain and infertility -- and may also reduce the risk of ovarian and cervical cancer. According to Dr. Anderson, the risk of ovarian cancer can be reduced by 80 percent for women who take any type of birth control pills for 10 consecutive years. Taking the pill for eight consecutive years may also reduce the risk of endometrial cancer by up to 80 percent, according to data from Planned Parenthood.

Some scientists believe that having fewer periods is actually more natural for women. Women of the past had far fewer periods than they do today, probably because of the amount of time that they spent either pregnant or breast-feeding. In addition, the age at which most women began menstruating was later than it is now.

Health Drawbacks

But not everyone thinks skipping periods is such a great idea. Some doctors believe that since menstruation is a natural part of a woman's monthly hormonal cycle, it should not be eliminated, even if the cycle is artificially controlled through birth control pills.

There may also be disadvantages associated with the use of any type of birth control pill. The hormones in the pills may increase the risk of stroke and blood clots. Women who smoke, are over age 35, or already have risk factors for cardiovascular disease, for example those that have high blood pressure, high cholesterol, a sedentary lifestyle, or are obese, may be at an increased risk for these conditions due to birth control pill use.

Until recently, it was suspected that the Pill increased a woman's risk for breast cancer, but a June 2002 study in The New England Journal of Medicine examining 9,267 women ages 35 to 64 found that current or former use of the Pill did not increase the risk of breast cancer later in a woman's life, the time when the risk for the disease is highest. Researchers are unclear, however, whether OC use in the teenage years, or during perimenopause, a stage before menopause, increases a woman's chance of developing the disease.

Sources:
Dr. Freedolph Anderson, interviewed by Maggie Gallagher, On the Line, National Public Radio, December 26, 2000.

Patrice C. Malena, MS, FNP, phone interview.

Planned Parenthood, Federation of America, Inc.

EVMS Press Releases

National Cancer Institute Fact Sheet: Oral Contraceptives and Cancer Risk.