The continuous contraceptive 'super pill'

A new contraceptive pill that is taken every day could end pre-menstrual tension, newspapers reported on September 27 2007. The so-called 'super pill', Lybrel, is taken continuously, without the monthly seven-day break that is recommended for women taking conventional contraceptive pills. It works, said the newspapers, by suppressing menstruation.

It “completely stops bleeding in more than 70% of women who take it for seven months”, they reported.

Lybrel is already available in the US and manufacturers have announced that they hope to bring it to Britain next year. However, yesterday's reports raised questions over the safety of a pill that stopped periods. "Doctors have raised concerns that suppressing menstruation could be unsafe and the long-term effects on the body are not yet known,” said the Telegraph .

Where did the story come from?

The reports are based upon an article written in the magazine New Scientist . The article says that, for many women, periods and PMT are an unwelcome occurrence, and this has caused some women to take the conventional pill continuously without a break in order to avoid having a period.

The author discusses a popular debate amongst health professionals about whether this can lead to increased health risks (such as masked infertility, risk of blood clots or reduced bone density) or whether it's actually healthier for women not to menstruate regularly, which could possibly decrease risks such as anaemia and fibroids.

The author then discusses the contraceptive pill Lybrel and other contraceptive developments.

What kind of scientific study was this?

This is a news article on the contraceptive pill, Lybrel, which is “the first oral contraceptive to be approved for continuous use”. The article did not provide in-depth information about the research that has led to this approval.

There is some information about this research on the US Food and Drug Administration (FDA) website. The FDA reports that two one-year clinical studies were carried out to test the safety and efficacy of the pill, during which it was administered to 2,400 women in the US.

What were the results of the study?

In the US, the FDA approved Lybrel for continuous use on May 22 2007. The FDA reports that in the main clinical study, 59% of women who had taken Lybrel for one year had been free of any bleeding during the last month of the study.

What interpretations did the researchers draw from these results?

The New Scientist article makes no conclusions relevant to this story.

What does the NHS Knowledge Service make of this study?

These news reports will no doubt be of interest to many women in the UK. Lybrel is not currently available in this country, but if it does become available there are several things to consider:

• Lybrel cannot guarantee a complete halt to periods or PMT for all women. To achieve a complete lack of menstruation is likely to take several months or up to a year of taking the pill, and even then many women may continue to have very irregular and troublesome periods or spotting.
• The benefits of not menstruating should be balanced against the possible risks from continuous hormone exposure, such as the potential for increased risk of deep vein thrombosis, or slight increases in risk of certain cancers, e.g. cervical cancer. It may also be more difficult for the woman to be aware if she has accidentally become pregnant while taking the continuous pill.
• There are many alternative methods of contraception available to women, some of which may also lead to a reduction or an end to periods, such as the levonorgestrel-releasing intrauterine system. However, women should realise that such methods of contraception may not be recommended or suitable for their particular situation. Women should discuss the most appropriate contraceptive options that are available with their medical practitioner.
• As always, it is worth reiterating that contraceptive pills cannot protect against STIs.

Sir Muir Gray adds...

It is difficult to weigh up the options and make a decision about the relevance of this type of article. This is not a systematic review of all the evidence about the pill. An article of this type helps our understanding, but it cannot be used as a basis for decision-making.