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"The best-kept secret in medicine.' Period.

A Brazilian doctor and others break with the ranks and call menstruation unnecessary and unhealthy, and recommend menstrual management and suppression.

We call it "the curse." Our "monthly visitor." "Old Faithful."

Dr. Elsimar Coutinho has another term for menstruation: "Obsolete."

Breaking from the medical ranks, which have long perceived a woman's menses as beautiful and natural, the Brazilian physician has shaken the scientific community with his assertions that monthly periods are more than just a nuisance.

He _ and a growing number of reproductive health experts _ insist they're also unnecessary, going so far as to label the regular blood loss unhealthy for women.

"Nature never expected women to menstruate. Nature expected women to get pregnant when they ovulate," says Coutinho, co-author of the revolutionary treatise Is Menstruation Obsolete? (Oxford Press, 1999).

Yet Coutinho, a professor of obstetrics and gynecology and pioneer of the Depo-Provera contraceptive injection, isn't calling for modern women _ like our hunter-gatherer ancestors _ to have teams of children.

No, what he is recommending is that more doctors teach women how to suppress all but four of their periods each year _ a practice, quite remarkably, that physicians have been capable of doing for the past 40 years.

"This is the best-kept secret in medicine," says Dr. Freedolph Anderson, a Virginia researcher who is studying the long-term benefits and risks of halting menstruation.

No cramping, no tampons, no bloating, no backaches: For many women, the concept has been nothing more than an impossible dream. But in some doctors' offices across the country, female patients have been given standard birth control pills and told how they can take them so their "monthly visitor" will get the heck out of town for more than a few months.

"Not a lot of women know about it," agrees Dorothy Furgerson, medical director of Planned Parenthood Mar Monte, which serves Santa Clara, Santa Cruz and Monterey counties in California.

But word that the "curse" can indeed be broken is slowly being spread, woman to woman, and clinics are reporting seeing more patients coming in and asking how to reduce or eliminate monthly bleeding, Furgerson says.

"It's they're getting married; it's for their honeymoon or backpacking or scuba diving _ times they definitely wouldn't be wanting to have their period," she says.

And all indications are that such occasional attempts to curb bleeding are completely safe and, for the most part, effective. Scientific studies suggest that, except for causing occasional spotting, the practice has few short-term side effects and is indicated for any woman who can tolerate birth control pills.

"I don't understand why there's opposition to this. Women, they don't have to be miserable every month," says Coutinho, who recommends that any woman suffering from anemia, excessive cramps, severe pre-menstrual syndrome or period-related migraines talk with a physician about menstruation suppression.

The benefits are manifold. Besides allowing women to forgo costly feminine hygiene products, menses manipulation can drastically reduce menstrual pain and PMS symptoms, which include mood swings, food cravings and breast tenderness.

Anemia, which plagues a significant portion of menstruating women, could be prevented, as could some reproductive cancers and quite possibly heart disease, which have been linked to frequent ovulation and menses.

In this regard, regular periods are anything but healthy, insist researchers Sarah Thomas and Charlotte Ellertson, who blasted monthly menstruation in an article that appeared in the scientific journal Lancet in March.

"Monthly menstruation for decades on end is not the historical norm," they explain.

Women in prehistoric times probably had just 160 ovulations during their lifetime, a result of the fact that they experienced menarche at a later age, underwent menopause earlier, gave birth to many more children and nursed them much longer _ all which cut down on ovulation and bleeding.

Modern women, however, get about three times as many periods in their lifetime _ an alarming figure given that studies have shown each time a woman has a child, her lifetime risk of ovarian cancer drops by 10 percent. That's because women stop ovulating for an average of 12 months with every pregnancy, which saves the ovarian walls from undergoing cell division 12 times.

"By re-examining the credo that frequent and prolonged menstruation is the "natural' state, it is easier to see menstrual management using oral contraceptives as just another medical therapy, akin to daily and continuous pharmaceutical management of hypertension," they write.

Suppression of menstruation "not only gives relief from menstrual-related disorders to individual women, but it also confers additional health benefits and gains to society."

Indeed, an estimated 2.5 million women are thought to suffer from menstrual disorders, and many more _ a whopping 80 percent of all women _ experience pain during their monthly cycle.

The impact on big business alone is staggering. Menstruation and its accompanying pain and suffering are thought to cost U.S. industry about 8 percent of its total annual wage bill. One large employer _ Texas Instruments _ determined there was a 25 percent reduction in the productivity of its female workers during their monthly periods.

Prescribing hormones to women who want to skip monthly bleeding is thought to be an easy and cost-effective way to reduce on-the-job absenteeism and individual suffering. The practice involves nothing more than standard packs of birth control pills, which women take as they normally would except for one caveat: All seven placebo pills are thrown away and the next packet of standard pills is started immediately.

By always taking only active birth control pills, women are subjected to a constant influx of estrogen and progestin, which keep the body from shedding excess endometrial tissue.

After taking the hormones non-stop for three months, women are told to take one week of placebo pills to allow the body to slough off the excess tissue that has built up on the uterine walls.

"It is a new concept, but I think one that certainly deserves a look-see," says Dr. Charles Coddington, director of obstetrics and gynecology at Denver Health Medical Center. "Hopefully people will find it to be helpful to them to put a little more control in their life and on their physiology."

When the birth control pill was introduced in 1960, women could have taken this control over their own bodies and avoided monthly bleeding _ if only anyone had advertised this fact. The Pill's inventors decided it would be best if the new drug mimicked a woman's monthly menstrual cycle. Women, they believed, wanted to continue their monthly bleeding, a notion that astounds modern researchers.

An article in The New Yorker last March 13 also describes how Dr. John Rock, one of the Pill's inventors and a devout Catholic, truly believed that the Pill was a natural method of birth control because the Pill's ingredients duplicated what could be found in the body naturally. He saw in that naturalness enormous theological significance, so much so that he thought the Catholic Church eventually would approve of the birth control pill.

Birth control pills are among the most thoroughly studied medications and are generally considered to be extremely safe when taken as directed, says Dr. Felicia Stewart, co-director of the Center for Reproductive Health Research and Policy at the University of California-San Francisco. But it simply isn't known if suppressing periods nine months of the year can cause eventual health problems.

"Tell me that story about why women want to have a period every month again?" Stewart says. "For a lot of women, less is more here in the domain of periods."

Stewart, who says she wholeheartedly stands behind the occasional suppression of menstrual bleeding, believes that more research is needed on the long-term use of the Pill for this purpose.

Some critics have theorized that long-term continual pill use could increase a woman's risk of complications such as headaches, high blood pressure and blood clots. Supporters of the practice concede that women should not go six, nine or 12 months without a period because then the endometrium could potentially change in a way that could ultimately lead to endometrial cancer.

And world-renowned physician and author Dr. Susan Love has posted a statement on her Web site alleging that "while taking birth control pills continuously can stop your period, doing so won't reduce your risk of breast cancer. In fact, it may even increase your risk."

Scientists at Eastern Virginia Medical School are trying to determine whether there are any significant risks to menstruation suppression, having just launched a 12-month study of 1,350 women. The researchers are studying the efficacy of a new birth control pill called Seasonale, which women would take for 84 consecutive days before a week of respite.

The specially packaged hormones would need the approval of the Food and Drug Administration before they could be marketed specifically as a safe means of halting blood loss. It is expected the pills would not be available before 2003 _ although women can get traditional birth control pills from most ob-gyns for this purpose.

Many in the scientific field believe Seasonale has the potential to be much more popular than the anti-impotence drug Viagra.


No cramping, no tampons, no bloating, no backaches.

The end of the period?

Some doctors and researchers are recommending that physicians talk to women about suppressing all but four of their periods each year. Here's a look at the details:

How it works: Women take birth control pills, but all seven placebo pills are thrown away and the next packet of standard pills is started immediately. The constant influx of hormones keeps the body from shedding excess endometrial tissue.

Benefits: lower risk of anemia and ovarian cancer; reduction of endometriosis and PMS symptoms; big savings on feminine hygiene products.

Side effects and risks: breakthrough bleeding or spotting is common; not recommended for women who shouldn't take birth control pills, including smokers over age 35. Long-term risks unknown.