Dr. Henry Klapholz has been stopping women's periods for years.
They may be patients with endometriosis, heavy bleeding or frequent menstrual migraines. Some are women who would just prefer to do without the monthly mess entirely.
Klapholz, along with doctors around the country, would simply prescribe a low-dose birth control pill and advise patients to start the next package instead of taking placebo pills in the fourth week. It is an off-label use that this week won federal approval when the Food and Drug Administration OK'd Lybrel, the first birth control pill marketed as a method to stop menstruation.
"Medically, this is a good thing," said Klapholz, chief of obstetrics and gynecology at MetroWest Medical Center in Framingham. "We can help people who will otherwise end up with a hysterectomy or an ablation ... we can reduce surgeries and still eliminate their periods."
Methods to shorten periods are already on the market. The Mirena, an IUD that contains low doses of hormones, and the Depo-Provera shot can lighten or stop periods entirely. The birth control pills Yaz and Loestrin 24 shorten monthly periods to three days or less and Seasonale and Seasonique reduces them to four times a year.
The original birth control pill was developed in Massachusetts in the 1950s by researcher Gregory Pincus and Dr. John Rock, a Marlborough native. Rock, a devout Catholic, campaigned to have the method approved by the Vatican, basing his arguments, in part, on the fact that the pill mimicked a woman's natural cycle and allowed a period each month.
When the birth control pill first hit the market in the 1960s, the off week was considered necessary not only because of the higher dosage of hormones but also because women took comfort in having the menstrual proof that they were not pregnant.
"Some ladies, they like having a period or at least the reassurance that they have a period once a month," said Dr. Kerri Osterhaus-Houle, a gynecologist with Women's Health of Central Massachusetts in Marlborough.
Osterhaus-Houle expects the market for Lybrel to be equally divided between women seeking to combat a medical problem and women simply seeking the convenience of a menstruation-free life.
"I have some women who are very active - they just don't want the messy side effects of a period," she said. "At some point, it may be the wave of the future. Women will say, 'I don't want to have my period. There's no need to have it.'
"The biggest question from patients is, 'If I want to have kids someday, will my fertility be hurt by this?' And it doesn't appear to be the case," Osterhaus-Houle added. She noted studies have shown women on the nonstop pills, like women on the regular birth control pill, have their fertility fully restored three months after stopping it.
Klapholz has been prescribing continuous birth control pills for over 30 years while treating endometriosis patients. The treatment was referred to as a "pseudo pregnancy."
"The big difference has to do with the dosage of the pill," Klapholz said. "Years ago, we didn't have the ultra-low dose pills we have today. We had to continuously up the dosage to prevent breakthrough bleeding."
Breakthrough bleeding - spotting outside of a period - is also a side effect of Seasonale for the first few months, Klapholz said. The uterine lining thins out over time, however, which halts the problem. Breakthrough bleeding is also a reported side effect with Lybrel, which is expected to be on the market in July.
"Everyone is different," Klapholz said. "Some women like to have their periods every month for the reassurance ... it's really a very individual thing. Others think that it's an unnecessary pain - they get mood swings, they get PMS, they have heavy bleeding and cramping. Some women have days when they don't even want to leave the house because they're bleeding so heavily."