Rethinking "The Pill"

Long-Term Results

Now we're beginning to see that the avoidance of pregnancy, which prehistorically would have been unnatural, has its own trade-offs. Increased tendency to ovarian, uterine, and breast cancers haunt those who have never been pregnant or who were first pregnant later in life. It's as if evolution is saying of the uterus, "You'd better use that thing."

What is it about pregnancy that seems to protect a woman from certain cancers?

Investigators are focusing in on how estrogen affects these tissues. It seems that pregnancy is good for you. But by the same token, so is "pseudo-pregnancy," which is what the birth control pill brings on. And it may be that the non-cycling nature of pregnancy is what is protective, not just the estrogen.

New Approaches

So now we're rethinking this 21 days on/7 days off with a period regimen. How about 84 days on, 4 days off, with a period about every three months? This may be a whole lot safer, it turns out. Now that the birth control pill has a successful track record for two generations (is that an oxymoronic statement?), women are more likely to trust the method even without the monthly period.

The popular press has already begun presenting articles about suppressing periods. But it's leaving a slightly anti-feminist flavor in the mouths of those who mistakenly think that periods with the pill are the "real thing." Once that prejudice fades away, women will wonder how life might be with only a rare period every now and then. Most will like it very much.

If you ask any young lady who has just begun her periods, you'll surely get an intense opinion on the unfairness of it all. Besides the merciful suppression of periods for PMS and pain, it might be appropriate to do it out of "convenience" now that we're seeing how monthly periods year in and year out may be doing women more harm than good, no matter how "natural" it seems.

If the mainstream women's magazines are starting to espouse the wisdom of non-cyclic hormones, it won't be long before this option is available from your gynecologist just for convenience. (Actually, besides PMS, we've been "cheating" with the pills like this for honeymoons, vacations, and final exams that would otherwise be spoiled by a menstrual period.) And there are currently birth control pills being developed that will limit periods to once a season.

In my practice, I've offered non-cyclic birth control pills for a couple of years now. Each individual woman's body has its own tolerance as to how many packs she can take before experiencing a little break-through bleeding, but most tolerate three or four packs well. Revisiting the four categories for women in the past, the second group can be amended to read, "Pregnant ... or continuous (non-cyclic) pseudo-pregnancy." And maybe this revision will keep women out of the fourth group longer by lowering the risk of certain cancers.