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"  My biggest problem with menstruation is probably the words used to describe it. First: menstruation. It&amp;#039;s just a horrible word. (If you&amp;#039;re interested, my other hated words: panties, slacks, moist. The worst sentence in the world: &amp;quot;Her menstrual flow moistened her panties and slacks.&amp;quot;) Period is no good either. And most of the euphemisms are even worse\u2014&amp;quot;Aunt Flo,&amp;quot; &amp;quot;on the rag,&amp;quot; &amp;quot;riding the crimson wave,&amp;quot; &amp;quot;the curse.&amp;quot; It&amp;#039;s like a cabal of sexless nuns and sex-crazed 12-year-old boys got together and came up with every word or phrase to describe a woman&amp;#039;s cycle. There&amp;#039;s a damp reek of mothballs and Cheez-Its hanging over them all.  On the other hand, I&amp;#039;ve always viewed the thing itself, the, er...time of the month, as inevitable and nothing $10 and a trip to the drugstore can&amp;#039;t resolve. But when it stopped for a year or so while I gestated and lactated, I found that I did enjoy the absence of mood swings, of cramps, of blood. I lapsed into denial that I&amp;#039;d ever had a period, that it would ever come back.  Then one day I found myself screeching obscenities at a parking garage attendant before storming out, in tears, yelling, &amp;quot;I&amp;#039;m never using this garage again!&amp;quot; (I&amp;#039;m sure he was heart-broken.) While the situation was frustrating\u2212he wouldn&amp;#039;t give me my car\u2212I was rattled that I was so rattled. And the feeling persisted for days. I felt nauseated and filled with neck-throttling rage. I wasn&amp;#039;t sleeping, my skin broke out, I was bloated...and then, of course, I got my period. Ah, you again.  Distance had not made me any fonder of menstruation (the word or the bodily function). Suddenly it seemed ridiculous that for more than 20 years I had accepted the fact that I&amp;#039;d feel lousy once a month. By my calculations, I&amp;#039;d already spent nearly five years of my life bleeding. So I was intrigued when Lybrel, the first continuous oral contraceptive (OC), was approved by the Food and Drug Administration this spring. Unlike most birth control pills, where you take &amp;quot;blanks&amp;quot; for a week to induce a period, on Lybrel you take a low dose of estrogen and progestin 365 days a year so that, in theory, you never bleed. (In practice, after a year, 59 percent of women experienced complete amenorrhea\u2014i.e., no period; 20 percent had light spotting; and 21 percent experienced breakthrough bleeding heavy enough to require protection.)  This isn&amp;#039;t a new idea\u2014doctors have been advising women with very painful or heavy menses to skip the placebos in their pill packs for decades. Still, Lybrel will make this protocol more accessible. And though Lybrel is not FDA-approved to treat premenstrual syndrome or premenstrual dysphoric disorder (PMS&amp;#039;s angrier, uglier cousin), scientists say it could reduce or even eliminate the pre-period blues for many women. And like all OCs, it&amp;#039;s 98 percent effective in preventing pregnancy, will reduce your risk of ovarian and endometrial cancer by 30 to 50 percent if you take it for three years or more, and is completely reversible (women who went off Lybrel usually began ovulating and menstruating again within a month and showed no decrease in fertility).  To me, this sounded like a great new option for the 80 percent of U.S. women who take the Pill at some point in their life. I was surprised, then, to see that much of the attention Lybrel was receiving in the media and blogosphere was negative. Some of it was rational\u2014women said it seemed unnatural and worried that not taking a break from the Pill would increase the risks associated with OCs, such as stroke and blood clots (for the record, current studies have not shown a greater risk with Lybrel). But some of the complaints were frankly insane\u2014women waxed poetic about the joys of PMS (Chocolate! Yelling at strangers! Yelling at people you know!) and hinted darkly that Lybrel was a form of mind-control meant to enslave women. ABC News even described the Pill as &amp;quot;yet another step toward the blurring of the genders.&amp;quot; (Really? Maxipads are the only thing standing between us and manhood?)  &amp;quot;It does make you stop and think about all that,&amp;quot; says -Hadine Joffe, MD, MSc, director of endocrine studies at Massachusetts General Hospital and assistant professor of psychiatry at Harvard Medical School. &amp;quot;[Menstruation] is such an instinctive part of what it means to be a woman.&amp;quot;  However, as she points out, the standard Pill &amp;quot;is already messing with Mother Nature.&amp;quot; A normal period is the end point of a cycle in which you ovulated but didn&amp;#039;t get pregnant. When you&amp;#039;re on OCs, you don&amp;#039;t ovulate and your uterine lining remains light; the bleeding during the placebo week is withdrawal from the synthetic progesterone you were taking.  Those blank pills weren&amp;#039;t inserted into the regimen for scientific reasons, but for religious ones: The creator of the Pill was a devout Catholic and hoped the Pope would approve of OCs if they mimicked a woman&amp;#039;s cycle. In the end, the Church ruled against OCs\u2212but the &amp;quot;fake&amp;quot; period has persisted, in part because women find it reassuring. &amp;quot;The Pill has been prescribed to simulate [nature] so people don&amp;#039;t have to ask these questions,&amp;quot; Joffe says. &amp;quot;The way they&amp;#039;ve controlled the menstrual pattern has made people forget that it isn&amp;#039;t natural.&amp;quot; So, far from being a new and manipulative plot, Lybrel is actually a more honest form of the Pill we&amp;#039;ve taken for more than 40 years.  Furthermore, we didn&amp;#039;t evolve to menstruate as much as we do these days. In studies of cultures that don&amp;#039;t practice birth control, most women get around 100 periods in their whole lifetime, between pregnancy, breast-feeding, and wet-nursing. Modern Western women may menstruate 400 times or more. While not getting your period because you&amp;#039;re too thin or have a hormonal abnormality may be a sign of trouble, incessant menstruation isn&amp;#039;t medically necessary, says Anne Davis, MD, assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center and a lead researcher on Lybrel. &amp;quot;It&amp;#039;s not that the body keeps building up blood and it backs up in there. The lining of the uterus only grows in response to the cycle. If you&amp;#039;re on birth control pills, the lining stays the same,&amp;quot; she says. &amp;quot;And your uterus is not a kidney. It doesn&amp;#039;t need to clear things out. I think people get a little mixed up.&amp;quot; But what about the psychological effects of taking such a pill? While it made sense to me that erasing your period might reduce PMS (for starters, when would you get PMS if you don&amp;#039;t menstruate?), it also struck me that taking more hormones could only lead to feeling more hormonal. But it turns out I had some misconceptions about the causes of PMS and PMDD.  According to the latest research, PMS is not caused by having too much (or too little) of any of the reproductive hormones. It&amp;#039;s triggered by the brain reacting to hormonal fluctuations, says Lee S. Cohen, MD, director of perinatal and reproductive psychiatry clinical research at Massachusetts General Hospital and associate professor of psychiatry at Harvard Medical School. And women who have PMDD are simply more sensitive. &amp;quot;So where some women might have a little reactivity of mood and some mild physical symptoms, others have much more dramatic symptoms that really get in the way of their life,&amp;quot; Cohen says, noting that the same mechanism is likely at work in postpartum depression. Most women feel emotional as their hormones shift after giving birth, some become clinically depressed, and a few become psychotic\u2212not because their hormones radically differ, but owing to differences in their brains&amp;#039; response to hormone changes.  In most studies, the Pill has not been shown to increase risk for depression in the majority of women, says Bernard Harlow, PhD, the head of the Division of Epidemiology and Community Health at the University of Minnesota. Pills that minimize hormonal fluctuations, such as monophasic OCs (which contain the same amount of hormone every day) and those with a reduced number of placebo pills (such as Yaz, which was FDA-approved last fall to treat PMDD), have even been shown to stabilize moods and reduce PMS. So it stands to reason that a monophasic pill with zero placebo days, such as Lybrel, could erase menstrual-related tension altogether. &amp;quot;For women who still get PMS on the Pill, it typically happens as soon as you go off the active pills,&amp;quot; Harlow says. &amp;quot;So if you don&amp;#039;t have the menstrual bleed, is there any likelihood that you&amp;#039;re going to have a mood disorder? You&amp;#039;d think probably not.&amp;quot;  Though I liked what I heard about Lybrel, I generally try to avoid drugs unless I really need them. I wondered, do I truly have PMS or PMDD? In clinical studies of PMS, up to 80 percent of women will say they have premenstrual symptoms, but when researchers further examine the women, they find the percentage who have full-blown PMDD hovers around 7 percent.  To get a handle on what&amp;#039;s going on, Joffe suggests symptom charting. At the end of each day for a few cycles, she asks patients to rate their emotional state on a scale of one to four, one being the greatest mood ever and four being the depths of despair. Once you&amp;#039;ve established a pattern to your dark days, Cohen says it&amp;#039;s fairly easy to tell the difference between PMS, PMDD, and other mood disorders. &amp;quot;If a patient says, `My PMS is so bad I have it every day,&amp;#039; that patient does not have PMDD. [She] may have other difficulties,&amp;quot; he says. &amp;quot;Women who have the real McCoy, true PMDD\u2014it&amp;#039;s not subtle.&amp;quot;  Selective serotonin reuptake inhibitors (SSRIs) have been shown in over 30 studies to effectively treat PMDD. But calcium supplements also have been proven to help, and it&amp;#039;s believed that exercising and reducing caffeine, alcohol, and simple carbs can further ease symptoms. Joffe has even found that diagnostic charting can be therapeutic. &amp;quot;It&amp;#039;s a -normalizing thing,&amp;quot; she says, that allows women to see the connection between their hormones and moods as both real and temporary.  Since Old Faithful&amp;#039;s return, I&amp;#039;ve been charting my moods as Joffe recommended. The numbers suggest I have some PMS, but not PMDD. Still, my attitude toward my, uh, lady days has not improved. When Lybrel hits pharmacies this month, I plan to be first in line. In the meantime, I&amp;#039;m taking calcium and getting exercise...and I found a new parking garage. "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.elle.com/beauty/health-fitness/advice/a9382/against-the-flow-261022/>