Scientists Study Suppression of Menstruation

      We call it "the curse." Our "monthly visitor." "Old Faithful."

      Elsimar Coutinho, a professor of obstetrics and gynecology, has another term for menstruation: "Obsolete."

      Breaking from the medical ranks, which long have perceived a woman''s menses as beautiful and natural, the Brazilian physician has shaken the scientific community with his assertions that monthly periods are more than just a nuisance.

      He - and a growing number of reproductive health experts - insist they''re also unnecessary, going so far as to label the regular blood loss unhealthy for women.

      "Nature never expected women to menstruate. Nature expected women to get pregnant when they ovulate," says Dr. Coutinho, co-author of the revolutionary treatise Is Menstruation Obsolete? (Oxford Press, 1999).

      The idea is actually decades old and has been discussed ever since the advancement of oral contraceptives in the late 1950s and early ''60s. In fact, the late Robert Greenblatt of the Medical College of Georgia, pioneer of the sequential oral contraceptive pill, advocated that female Olympic athletes ought to be able to manipulate their periods so that menstruation wouldn''t interfere with their performance, Augusta gynecologist Murray A. Freedman said.

      "Can you imagine training four years, and you''re going to be on the balance beam that day and you start your period?" Dr. Freedman asked. "(But) the Olympic Committee thought this was meddlesome and didn''t do it."

      Dr. Freedman said he began helping patients reduce their periods about three or four years ago after talking with national experts, including Dr. Raquel Arias at the University of South California.

      "Some women felt for years that they had to have this monthly period, and I think it''s pretty well recognized today that it''s not unhealthy to go two and three cycles and then have a period," Dr. Freedman said. "It''s perfectly safe to do that, and it''s obviously more convenient. It just adds one more of the noncontraceptive benefits to the oral contraceptive."

      Other benefits include a 50 percent reduction in the risk of uterine cancer and reduced risk of endometrial cancer, said Lawrence C. Layman, chief of the section of reproductive endocrinology, infertility and genetics at MCG. The new, low-dose pills have a number of benefits and are much safer than the initial, higher-dose pills, Dr. Layman said. But these benefits, like the reduction in periods, just don''t seem to be widely known.

      "This is the best-kept secret in medicine," said Dr. Freedolph Anderson, a Virginia researcher who is studying the long-term benefits and risks of halting menstruation.

      No cramping, no tampons, no bloating, no backaches: For many women, the concept has been nothing more than an impossible dream. But in some doctors'' offices across the country, female patients have been given standard birth-control pills and told how they can take them so their "monthly visitor" will get the heck out of town for more than a few months.

      "Not a lot of women know about it," agreed Dorothy Furgerson, medical director of Planned Parenthood Mar Monte, which serves Santa Clara, Santa Cruz and Monterey counties in California.

      But word that the "curse" indeed can be broken is being spread, woman to woman, and clinics are seeing more patients who come in and ask how to reduce or eliminate monthly bleeding, Dr. Furgerson said.

      "It''s they''re getting married; it''s for their honeymoon or backpacking or scuba diving - times they definitely wouldn''t be wanting to have their period," she said.

      And all indications are that such occasional attempts to curb bleeding are completely safe and, for the most part, effective. Scientific studies suggest that, except for causing occasional spotting, the practice has few short-term side effects and is indicated for any woman who can tolerate birth-control pills.

      "I don''t understand why there''s opposition to this. Women, they don''t have to be miserable every month," said Dr. Coutinho, who recommends that any woman suffering from anemia, excessive cramps, severe pre-menstrual syndrome or period-related migraines talk with a physician about menstruation suppression.

      The benefits are manifold. Besides allowing women to forgo costly feminine hygiene products, menses manipulation can drastically reduce menstrual pain and PMS symptoms, which include mood swings, food cravings and breast tenderness.

      Anemia, which plagues a significant number of menstruating women, could be prevented, as could some reproductive cancers and quite possibly heart disease, which have been linked to frequent ovulation and menses.

      In this regard, regular periods are anything but healthy, insist researchers Sarah Thomas and Charlotte Ellertson, who blasted monthly menstruation in an article that appeared in the British scientific journal the Lancet in March.

      "Monthly menstruation for decades on end is not the historical norm," they explained.

      Women in prehistoric times probably had just 160 ovulations during their lifetime, a result of the fact that they experienced the beginning of menstruation at a later age, underwent menopause earlier, gave birth to many more children and nursed them much longer - all which cut down on ovulation and bleeding.

      Modern women, however, get about three times as many periods in their lifetime - an alarming figure given that studies have shown each time a woman has a child, her lifetime risk of ovarian cancer drops by 10 percent. That''s because women stop ovulating for an average of 12 months with every pregnancy, during which time the ovarian walls undergo no cell division.

      "By re-examining the credo that frequent and prolonged menstruation is the `natural'' state, it is easier to see menstrual management using oral contraceptives as just another medical therapy, akin to daily and continuous pharmaceutical management of hypertension," Ms. Thomas and Ms. Ellertson wrote.

      Suppression of menstruation "not only gives relief from menstrual- related disorders to individual women, but it also confers additional health benefits and gains to society."

      Indeed, an estimated 2.5 million women are thought to suffer from menstrual disorders, and many more - a whopping 80 percent of women - experience pain during their monthly cycle.

     

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