Soon after Donna Shea turned 40, her periods became so heavy and frequent that she couldn't leave the house for two days each month.

On the advice of Cheri Gard, her nurse practitioner who is also a midwife, Shea started using birth control pills to stop menstruating as frequently.

She takes three weeks of pills that have the same level of estrogen and progestin in them each week. Then, instead of taking placebos the fourth week and allowing menstruation to occur, she simply starts on the next pack of birth control pills.

Consequently, she has no periods until she decides to have one. When she does have one, they are not as heavy or as debilitating, and she doesn't miss the mood swings that came with premenstrual syndrome.

Shea, of Mountville, is one of many women who are enticed by the possibility of limiting or eliminating their periods, according to various surveys compiled on the Association of Reproductive Health Professionals Web site.

The question women need answered is whether menstrual suppression is a safe practice or one grand experiment with women's health?

In the absence of long-term studies —conducted over a decade or more — on the safety of birth control pills or menstrual suppression, physicians are relying on existing research, their experience and intuition to advise their patients.

Dr. Madonna Talbert is one gynecologist at Ephrata OB/GYN who doesn't hesitate to advise menstrual suppression for women who have endometriosis, premenstrual dysphoric disorder or excessive bleeding or cramping with their periods.

Suppressing periods is not a new idea, said Talbert, who has been a gynecologist and obstetrician in Lancaster for 23 years. Not only has she used it as a treatment, Talbert said, she knows that women, for years, have manipulated their birth control pills to avoid having a period on vacations and honeymoons.

Eliminating menstruation is receiving more attention since Duramed Pharmaceuticals has increased its advertising of Seasonale, said Steve Wiley, owner of Wiley's Pharmacy in Quarryville, Centerville, Millersville and Strasburg.

Seasonale birth control is packaged so that a woman taking it only has a period four times a year. Wiley estimates that 10 percent of customers using birth control use Seasonale and another 3 percent are using regular birth control pills to skip periods.

Talbert sees no more health risks to using the pill to suppress menstruation than using the pill that gives women a period once a month.

"If they've done well on the pill in general, they don't have hypertension; they don't have cholesterol issues; they're young — I really don't have pause (concern) for that.

"If they have no risk factors and they want to be on that for years and years and years continuously, I might make the recommendation that they might want to have a period a few times a year just to clear things out … ."

Dr. Richard Legro, an associate professor of obstetrics and gynecology at Milton S. Hershey Medical Center's College of Medicine, just completed a study of women who suppressed their menstruation for six months.

Although he can't talk about the study in detail because it hasn't been published yet, he said nothing in his study or in other research he's read makes him doubt the safety of suppression.

"I could hypothesize to you that it may be more dangerous to be on and off birth control than it is to have continuous suppression," Legro said.

 Stopping the pill causes the clotting proteins to increase and decrease, which could be more detrimental than keeping them at a steady level, he said.

In addition, he said, staying on the pill is likely to bring the same benefits that the pill brings when used cyclically — decreased endometrial cancer, uterine cancer, pelvic inflammatory disease, decreased menstrual symptoms and mood changes.

Some physicians insist that having a period is a natural phenomenon that shouldn't be tampered with.

Dr. Jerilynn C. Prior, scientific director and founder of the Centre for Menstrual Cycle and Ovulation Research in Canada, said menstruation suppression is nothing more than a marketing ploy by pharmaceutical companies to boost flagging products.

"Menstruation, this amazingly intricate, carefully crafted cycle, is a vital sign of our health," she told Macleans online magazine and reiterated in an e-mail to the Intelligencer Journal. "To wantonly disrupt it is a horrifying thought."

Legro doesn't think this mind-set is logical.

"The bottom line is that if you want to start talking about what's natural for a woman: What's natural for a woman is to never have a period. It's to constantly either be pregnant or lactating — that's what she was designed for," Legro said. "This idea of a constant interrupted period is an anomaly of the modern world."

Plus, he contended, the "natural" argument doesn't hold up when comparing it to other medical procedures.

"God made us to deliver vaginally, but 20 percent of the time we deliver by C-section, and in many cases it saves babies and mother's lives — so take your pick."

Legro admits, however, that he is troubled by the possible connection between birth control pills and breast cancer.

"Does continuous progestin every day increase your chances of getting breast cancer?" Legro asks. "There's certainly information out there to suggest it might. Or is it the cycling effect that contributes to the increased risk, or is there no increased risk at all?"

Prior also points to a recent cross-sectional study she helped conduct that showed women who used birth control pills had bone-density values lower than women who had never used them.

She is currently testing her hypothesis that teenage use of birth control pills disrupts the development of regular ovulation.

"Regulatory bodies are saying, 'We approved the original pill, so it must be OK,' " Prior said in the Macleans article " 'It's just taking the pill more frequently.' But even the original pill might contain negatives we don't know about."

Certainly long-term studies must be done regarding the safety of birth control pills, Legro said. Until now, it's been difficult to study them long term because the amount of estrogen kept declining and the kinds of progestin kept changing.

He believes the pills have reached the lowest possible effective estrogen level, making now the optimal time to start studying their effect.

Meanwhile, using the information he has now, Legro is not concerned about the safety of suppression for women, other than the health risks that are inherent with the pill.

"We live in a world where we want everything to be absolutely safe, but this is something where there is no easy choice."

E-mail Linda Espenshade at lespenshade@lnpnews.com.