From Daily Health News... 12-10-2007

The Importance of a Woman's Cycle0-3007

A woman's relationship with her menstrual cycle can be complicated, on the one hand connecting her to her feminine power and on the other leaving her feeling resentment at the discomfort and inconvenience it can bring. Since doctors have known for years how to manipulate hormones to prevent menstruation from occurring, it was just a matter of time until a drug company brought that option to market. Seasonale was introduced in 2003 by Barr Pharmaceuticals, and the second generation version, Seasonique, which is said to decrease the incidence of breakthrough bleeding that was a problem with Seasonale, came out in 2006. However, not everyone thinks it is such a great idea to fool Mother Nature by tampering with hormones in this way. While doctors generally see benefit for some women of taking birth control pills to reduce symptoms of PMS, in general more naturally focused practitioners question the wisdom of forcing a woman's body out of its natural cycles.

Let's take a moment to consider this. The human body is hormone-driven -- everything from growth to sleep to stress management to reproduction depends on normal hormone production and cycling. Over and over again we are learning -- too often the hard way -- that changing one body system affects every other. Hormones operate in concert, and one slight shift in one can lead to a cascade of unpredictable changes elsewhere. Many doctors and drug companies claim there are no major health risks to interrupting the female menstrual cycle -- but honestly, they also said that arsenic and mercury could cure syphilis in the late 1800s... cocaine could treat heroin addiction in the early 1900s... smoking was safe in the 1950s... and Vioxx in the 2000s. The list goes on.

To understand the whole-body impact of extended-cycle pills, I called an obstetrician-gynecologist in California, on faculty at a major academic medical center with a reputation for "expertise" on birth control pills and hormones. Interestingly, she told me that many women had already figured out how to suppress their periods themselves by skipping the placebo pills in their oral contraceptive packs, thereby limiting or avoiding menstruation completely. Since side effect issues are nearly the same with all birth control pills, whether they allow for 12 periods per year or four as these new pills do, the results -- and risks -- are believed to be the same, she said. Her view -- and that of many other mainstream medical practitioners -- is that this is perfectly safe. In fact, when I called back for clarification on a few points while writing this story and she realized that I planned to discuss some very real concerns about the wisdom of interfering with a natural process in this way, she refused to speak further on the topic. That's why she's not named here -- but for the sake of fairness in presenting both perspectives, I am including her comments.

ON THE PLUS SIDE OF HORMONE MANAGEMENT

Frighteningly, there's little long-range research available on the side effects associated with extended cycle oral contraceptives, but some findings have shown that in general oral contraceptives decrease risk of some cancers -- ovarian and endometrial cancers in particular.

On the flip side, the pill tends to decrease testosterone, the hormone that affects muscle strength and stamina, along with libido in many women -- but the doctor I spoke with says that she finds most women are so relieved to have reliable birth control it compensates for any drop they might experience in sex drive.

THE IRON DEBATE

One concern about the extended cycle pills, specifically, relates to iron. The menstrual cycle naturally depletes iron stores each month and this might be considered an advantage of the extended cycle pills. Anemia is quite common among menstruating women and being anemic can cause cardiac stress, in addition to creating fatigue and general malaise.

However, other studies have linked iron storage in post-menopausal women, like these non-menstruating women may now have, with increased risk for coronary heart disease (see Daily Health News, January 23, 2007). Some scientists speculate that women's lower rate of heart attack when pre-menopausal may in fact stem from the loss of iron each month through menstrual blood, and interfering with that would therefore increase their risk. This question is still unanswered, however, and is likely to be so for some time, though the doctor acknowledges the potential risk.

CONCERNS FROM THE NATUROPATHIC COMMUNITY

While scientists are proud of their achievements and harried women are pleased to have some power over the inconvenience of menstruation, playing with the natural ebb and flow of hormone levels can have unintended consequences. I asked Mark Stengler, ND, author of Bottom Line's Natural Healing newsletter along with several books on women's health, about the other bodily changes that might result from a dramatic reduction in menstrual periods. As expected, he has concerns:

• Reducing testosterone can cause fatigue, memory problems and loss of both lean muscle mass and bone mass. Risk for osteoporosis may be elevated.

• Synthetic progesterone, the kind used in birth control pills, is foreign to the human body, and therefore may lead to an imbalance between estrogen and progesterone and theoretically increase the risk of chronic disease. Since hormones operate in concert, altering the balance anywhere can affect everything else, says Dr. Stengler.

• Further imbalances involving adrenal function may distort blood sugar balance, vulnerability to disease and infection, and fluid retention or electrolyte levels.

• Hypothyroid disorders may be created.

PRACTICAL MATTERS

On the purely practical level, another drawback is that the extended cycle pills do not exactly eliminate bleeding, at least not for the first six or so months, a fact confirmed by the gynecologist I interviewed. Breakthrough bleeding is common while the body adjusts, and it is unpredictable and can be quite pronounced. This leads some women to choose to remain on the conventional pills so they at least can plan in advance for their periods.

According to my mainstream gynecology expert, one particular group of women -- those with endometriosis -- may benefit from the extended cycle pills. Endometriosis is a condition in which the tissue that normally lines the uterus, to be later sloughed off during menstruation, grows outside of the uterus in places like the fallopian tubes or ovaries. Women with endometriosis suffer terrible pain with their periods, so they are grateful to be able to avoid it by taking extended cycle pills. The long-term results of manipulating endometrial tissue in this manner have yet to be evaluated.

The reasons why a woman might consider staving off many of her periods with an extended cycle birth control pill vary, of course, and some may be valid. It's a less radical intervention than surgery for women who are debilitated by problems related to their menstrual cycle, for sure. But it is not a decision to make lightly or for convenience. Our bodies have their own wisdom and changing things around for convenience may seem a good idea in the short term -- but over the long term the consequences may prove such decisions regrettable.

Source(s):

Mark A. Stengler, ND, a naturopathic physician and leading authority on the practice of alternative and integrated medicine. He is director of the La Jolla Whole Health Clinic, La Jolla, California, and associate clinical professor at the National College of Naturopathic Medicine, Portland, Oregon. He is author of the newsletter Bottom Line Natural Healing, www.DrStengler.com.