Each month--from menarche, or the beginning of a woman's first menstrual cycle, until menopause, her last menstrual cycle--the body is getting ready to bear a child.

The average menstrual cycle is 28 days. Women have always had an ambivalent relationship with their cycles, or periods. It is welcome as a sign that they are healthy or not pregnant, while at the same time it is seen as a nuisance.

The pill works by putting the ovaries and normal hormone system to sleep. Because of this, the ovaries do not release an egg, and a woman cannot get pregnant.  It also alters mucous secretion from the cervix. The Pill, patterned after a woman's menstrual cycle, is designed to produce a "natural" monthly cycle -- only without the worry of becoming pregnant. When the Pill is used correctly, it is about 99% effective.  Most birth-control pills contain two female hormones, estrogen and progesterone. A few have progesterone only, which makes them slightly less effective.

When birth control pills were formulated decades ago, they were patterned after the 28-day cycle. They consist of 21 active pills and then non-active, or placebo pills for the next seven days. Three days after stopping the active pill, the lining of the uterus starts to slough off, because of low levels of hormones. Usually these periods are lighter and last fewer days.

What women want

The talk these days revolves around the "active woman" being able to control her menstrual period, delay it, or even postpone it as wanted. A Dutch survey of about 1,300 women (age 15 to 57) explored women's attitudes toward menstrual bleeding and changes caused by the pill and HRT. Among the menstruating respondents, the most common preference of girls aged 15 to 19 was for less painful (55%) and shorter (50%) menses; 36% preferred no menses. Among women aged 15 to 49, 30 to 35% preferred menses each month, while 10% of older women shared this preference.

The same study found that menstruating women using the pill were less likely to desire a change in their bleeding patterns. When asked how they would design a pill or HRT formulation to regulate menses, the most common preference among adolescents was for menses every 3 months (35%). Among all women, 65 to 70% preferred a bleeding frequency of less than once a month or never

The talk these days is for the active woman to be able to control her menstrual period, delay it or even postpone it as wanted. Can it be done? Yes, with birth control pills.

But can controlling your menstrual period be done? Yes, with birth control pills.

Short Term Control

Over the years, I have helped many patients to delay their menses for a few days, for a variety of reasons; because they did not want to have a period during their vacation; because they were going camping with less than adequate sanitary conditions; or because they wanted to avoid menses during their honeymoon, to name a few. The way to do it is to continue to take the active pill, skipping the placebo pill, and starting with a new pack.

The talk these days is for the active woman to be able to control her menstrual period, delay it or even postpone it as wanted. Can it be done? Yes, with birth control pills.

Also, I have received many calls over the years from patients wanting to know if there was a pill that they could take to delay their menses. There is no such interim pill. It can only work while using the pill.

Long-Term Control

Can a woman take the pill continuously for weeks or even months? For women with severe PMS, or endometriosis, delaying periods as long as possible can be beneficial.

But what about a healthy woman who just wants to do it for convenience?

There are many drawbacks. First of all, in my experience, most women will eventually start to spot after being on the pill for four to five weeks. The spotting can be so bothersome, with PMS, cramping and all, that some women find that it is better to just stop all together, have a period and start all over again. However, the longer a woman continually takes the pill to delay menses, the longer it will take for her to bleed.

 Second, most women do not know that it could be done, and health care providers do not often discuss the subject. Third, using the pill this way would be considered an "off-label" use, not officially approved by the Food and Drug Administration.

Is it Safe?

There is a general belief that if a woman does not have a menstrual cycle, something "unclean" will be left behind, stored somewhere in her body. But when women were given a choice to participate in a study in 1977 to see the safety of prolonged used of the Pill, the majority welcomed the reduction of their periods to once every three months. There have been other studies since, showing that the longer a woman stays on the pill, the less likely she will be to have breakthrough bleeding, with minimal side effects. (These side effects include spotting, breast tenderness, bloating, and headaches.)

The feeling among scientists is that a woman should be able to manage her periods if she wants to and that it is safe. There is some caution in the medical community stemming from the fact that not enough studies are available to know exactly the physical or psychological effects of long-term use of the Pill.

What should you do as a patient?

If you're interested in controlling your cycle, simply do as the soon-to-be newlyweds; ask your doctor 'what can I do so I cannot have my periods when I am on my honeymoon next October?'  Do not, however, try to control periods yourself. Playing around with the pill without proper knowledge may increase the risk of pregnancy. Also, for practical reasons, since you are only allowed one pack of pills per month, you may not be able to justify the need for more to your insurance company. Your best bet is to make your choice and find an ally in an understanding health care provider who will be willing to work with you.

About the Author:
Dr. Carolle is a board certified obstetrician and gynecologist, and a fellow of the American College of Obstetrics and Gynecology. She is a clinical instructor at the University of California at San Diego Medical School's Department of Reproductive Endocrinology, and is a clinical mentor for underprivileged students at San Diego State University. Recently, her private practice has been primarily devoted to advising women on the peri-menopausal, menopausal, and post-menopausal periods.