Only four periods a year. That's
what Seasonale, the newly approved extended-use oral
contraceptive (OC), promises your patients.
The prospect of fewer periods will
have many of your patients eager to make the switch.
Since OC efficacy has more or less been perfected, new
developments are all about options. "I like to have
more arrows in my quiver," says gynecologist Melissa
Mirosh, a co-author of the Canadian Consensus Guideline
on Continuous and Extended Hormonal Contraception. "With
new products available, you can tailor the OC regimen
to your patients' needs." But unlike regular OCs, Seasonale's
long-term health effects are still a mystery.
Here's a list of FAQs your patients
will likely throw at you about the new extended use
pill.
How does it work? Seasonale
comes in a 91-day pack, with 84 hormone pills and 7
placebo, instead of the 21/7 in cyclical OCs. Your patients
will get their period once every three months, during
those placebo days.
Who's it for? Women opt
for an extended use pill like Seasonale for a range
of reasons -- from medical conditions to lifestyle benefits,
says Dr Mirosh. "People in the military, for instance,
or athletes will be able to have fewer periods and have
control over their occurrence," she explains. "And people
who have very bad menstrual headaches will now have
four bouts instead of 12 a year."
Who shouldn't take it? Seasonale
is contraindicated for smokers over 35.
Does it work? "Seasonale
has the same hormones as other OCs, so it works the
same way," says Dr Mirosh. In terms of preventing pregnancy,
your patients should know it's as effective as other
OCs. In fact, it's a tiny bit better. The longer cycle
makes it harder for the uterus lining to form, so there's
nothing for the fertilized egg to latch on to. However,
warn your patients that if they accidentally become
pregnant, it'll be more difficult to tell with Seasonale.
Is it safe to stop periods?
Ever since extended and continuous use pills appeared
on the market, people have been debating whether it's
safe (or natural) to stop a woman's cycle.
Women have been skipping the placebos
and using cyclic pills back to back for many years,
argues Dr Mirosh, "and we haven't seen any increase
in significant side effects." She's confident Seasonale
won't be any different.
But doctors at the UBC-based Society
for Menstrual Cycle Research are worried about potential
risks to breast, bone and cardiovascular health. The
Society says we just don't know enough about the menstrual
cycle's complex hormonal interactions to tamper with
it.
Are there benefits to stopping
menstruation? Having fewer periods can lower the
risk of endometriosis and pelvic inflammatory disease.
Both conditions are usually caused by menstruation and
blood fragments that aren't cleared properly, leading
to infection.
How about risks? The usual
risks of OCs -- such as blood clots and stroke -- are
still present with this pill.
Will I experience spotting?
Tell your patients to expect some bleeding or spotting
in the first few months. It should decrease over time.
The same problem happens with Anya, the continuous-use
OC that eliminates periods completely (not yet approved
in Canada).
"The breakthrough bleeding rate
with Anya is really high," says Dr Mirosh. "By having
a period 'break' every three months with Seasonale,
the bleeding is reduced."
Will stopping my periods make
me infertile? Assure your patients their future
fertility will not be affected. "They should start back
to normal cycles within four to six weeks of being off
the drug," says Dr Mirosh.
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