Yes

by Pedro Miranda

Created on: August 08, 2007

There are, to my knowledge, four "no-period" birth control pills on the market in the US:

Seasonale, Seasonique, Yaz and Lybrel.

What is an "extended use pill"? It is a birth control pill designed to be used for longer than the 21 days that regular birth control pills are taken. The result is that women do not need to have a period every month while on this method, and will have "periods" only three or four times a year.

There is nothing new about this. Birth control pills have been used in this fashion for years. It is very simple, you take the active birth control pills but, when you get to the "blank" pills, you simply start a new pack, skipping the blanks. No blanks, no period.

The problem with this approach is that insurers pay for a pack of birth control pills every 28 days and, if taken in this fashion, women need a new pack every 21 days. Enter Seasonale, the pill is the same levonorgestrel and ethynil estradiol, only repackaged, each package now includes 84 active tablets and 7 blanks, this would last for 3 months, and four refills will last for a year.

After Seasonale came out, Yaz was introduced; Yaz is essentially the same pill as Yasmine by Bayer (drospirone and ethynil estradiol), only repackaged for extended use. Lybral (levonorgestrel and ethynili estradiol) by Wyeth and Seasonique (a bi-phasic Seasonale) came next.

All of them have essentially the same risks as conventional birth control pills, mostly cardiovascular (heart attack and stroke); these risks are higher in women who smoke; After age 35 women who smoke should really not be on these medications.

Are these pills safe? The answer is yes; they are just as safe as any of the modern conventional birth control pills.

So, Where does the menses go? Nowhere. Women on birth control pills do not have real periods. They have withdrawal bleeding, which happens when you stop the estrogen (ethynil estradiol) intake during the week of blank pills.

Women on birth control pills do not need to have periods. The only reason they do is because the pills were designed that way; fifty years ago, when birth control pills were originally introduced. At that time, birth control pills had much higher doses of estrogen than they do now, so there was a consideration that excessive growth of the endometrium (lining of the uterus) could happen. Periods also would ensure that an unexpected pregnancy would not be missed, and these drugs would not be taken during an unintended pregnancy, since the effects were, at the time, unknown. One more thing was that women were used to having periods, and would "miss them" if they did not.

After fifty years, we have come a long way. Our modern second and third generation pills have very little estrogen in them, so little in fact that many women will only spot for a day or so during their menses. That takes care of the concern for the endometrium. Also we now that pills, if taken correctly are 99% effective in preventing pregnancy, so the chances of an unintended pregnancy, if no pills are forgotten is minimal. Most importantly, there have been thousands of pregnancies where women kept taking the birth control pills for different periods of time, and we now know that there is no effect on the baby or the pregnancy from the pills. Finally, many women now prefer not to have any menses at all, if they can avoid it.

So, in conclusion, these pills are an excellent solution for the woman who wants contraception, in the form of oral birth control pills, has no contraindications, and does not want to have to deal with periods as often. They may also be very helpful in women with PMS or PMDD (Premenstrual dysphoric disorder)

They should not be used by women who have a history of blood clots, breast cancer or women over thirty who smoke.

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