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Expert Q&A

	By Craig Sweet, M.D. Reproductive Endocrinologist

I have heard about this pill that prevents a period from happening all year long. Is that safe? It sounds like a dream come true to me, but will it mess up my chances of conceiving a child when I am ready to?

Continuous hormonal contraception (pill, patch or ring) is certainly used today and has been used in the past to both prevent pregnancy and menstruation. The original oral contraceptive pill was formulated to allow for menstruation to remind the user that she was not pregnant for fear she would think she was pregnant if she didn't bleed each month, thus stopping the pill truly resulting in a pregnancy. While difficult to remember, oral contraceptives were an amazing leap in female contraception, and they had to win the hearts, minds and uteri of the American public, so regular bleeding was built into the system.

Now that the contraception is better trusted and perhaps better tested, we are moving back to the concept of removing the menstrual cycle. I am certain that if men menstruated each month, we would have figured out how to fix it long ago!

Continuous hormonal contraception involves the use of three weeks of active pills/patches/rings before starting another three week run. One never uses placebos or is without a patch or ring. About two-thirds of the patients will not bleed (yay!), while one-third will do some bleeding and spotting. We are trying to improve on that unlikely 33 percent so stay turned for new protocols and formulations.

While easy to get confused, please understand that the hormonal contraceptive medications have both estrogens and progestins. Women who do not bleed on a regular basis who are NOT on the hormones may indeed be at risk for abnormal uterine bleeding, anemia and even pre-cancer or cancer of the lining of the uterus. These women do not release progesterone on a regular basis and are at risk for medical problems. While difficult to understand, it IS safe not to bleed when both estrogens and progestins are provided, as they are in hormonal contraceptive preparations. Confused?

Moving off the hormonal contraception will not reduce your chances for pregnancy as long as you don't wait too long. If you start them at 20 and end them at 40, you will have the reduced pregnancy rates of a 40-year-old, not because of the medicine, but because you waited too long! If you use them as most women do and discontinue them to have a child by age 30 (sooner is probably better), the success rates should be just fine. One caveat; however, many women are placed on hormones because of irregular cycles so when the medications are discontinued, these same women usually go back to the irregular cycles they had before!

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