BOSTON (Boston Globe) — The ancient Persians didn't have much patience for a woman's period. If she continued to bleed after four days, she could be whipped, then placed in isolation for five more days. And woe to the woman whose bleeding continued after her release.

Brutal as it was, the Persian disdain for menstruation had a certain evolutionary logic. In the centuries before Christ, death rates were high and the community had a collective interest in producing more children. And a woman having her period was neither pregnant nor breast-feeding a baby.

Today, a new movement against monthly periods is building, this time led by researchers who say menstruation is neither necessary nor even healthy. Because of longer lives and fewer children, women today have almost three times as many periods as they did just 200 years ago, bringing them far more discomfort than women of the past as well as an elevated risk of ovarian cancer and other diseases.

"There's really no good medical reason for menstruation," said Dr. Freedolph Anderson, director of clinical research at the Eastern Virginia Medical School's Institute for Reproductive Medicine, and one of the leaders of the anti-period movement.

Anderson is overseeing a nationwide test of a form of birth-control pill that would reduce the number of periods a woman has each year from 13 to four. And Anderson believes there is no reason to stop at four: Within a few years, he said, women might view menstruation - with all its attendant cramps, mood swings and other discomforts - as entirely optional.

But, for many women, Anderson's campaign presents an uncomfortable choice that cuts against years of social training that a woman's period is both natural and cleansing, not to mention a declaration that they are not pregnant. The idea that they would take a pill to stop their period unsettles them.

"To regulate a lot of these health problems through a pill is an absurdity and is really cutting women's options . . . to deal with the problem," said Dr. Susan Lark, a women's health specialist in California. "I don't think it's necessarily more desirable to be going toward more medication."

In truth, Anderson - along with Dr. Elsimar Coutinho, a Brazilian gynecologist who wrote the book, "Is Menstruation Obsolete?" - is simply making public what a lot of women with uncomfortable periods have known for a long time: Birth control pills in the right dosage can make periods stop altogether.

The pill delivers a combination of two hormones, estrogen and progestin, that prevents a woman's body from going through its monthly preparation for pregnancy. Normally, seven out of the 28 pills in a monthly pack contain no hormones, allowing the woman to menstruate at the end of the cycle, which is the body's way of clearing a path for the next ovulation.

But, if women skip the seven placebo pills and take full-strength birth control every day, their periods stop. Bonnie, who is 49, began doing just that more than 25 years ago after her doctor suggested a hysterectomy to cope with painful periods.

"I did it for years, and it was fine," said Bonnie, who asked that her full name not be used. "I just didn't want to have (my period) any more and deal with it. I'm surprised more people don't do this. As far as I'm concerned, it was a godsend."

Indeed, the cramps, mood swings, cravings, and headaches commonly associated with monthly menstrual cycles can be enough to make any woman want to follow Bonnie's lead.

Each year, an estimated 2.5 million women are affected by serious menstrual disorders, causing them to miss work and seek gynecological care, according to a study published in the February 1996 issue of the American Journal of Public Health. Menstrual-cycle-related complaints account for 50 percent of all gynecological visits.

"If women would stay on the pill, I would be out of a job," said Dr. Patricia Sulak, an obstetrician-gynecologist at Scott and White Hospital in Temple, Texas, and author of the 1996 study. "Why are they coming to me? Because they have irregular periods, heavy bleeding, PMS, cysts on their ovaries. For the majority of women, (continual use of the pill) takes care of all their menstrual problems."

Even women on conventional birth-control pills experience symptoms associated with menstruation. During the time they are taking inactive pills, the number of women experiencing pelvic pain, bloating and swelling more than triples, breast tenderness more than doubles, and headaches increase by almost 50 percent, according to an article in the February 2000 issue of the Journal of Obstetrics and Gynecology.

As a result, doctors increasingly recommend continuous use of hormones, both for women with difficult periods and those who want to skip periods for honeymoons or other special events.

"Sixty-seven percent of gynecologists are recommending this to (some of) their patients already, mostly just to delay menstrual periods at certain events, but also to cut down on the number of periods per year," said Anderson of Eastern Virginia Medical School.

Doctors say there is no harm for women on birth-control pills to skip the menstrual period. Since a woman's uterus doesn't thicken in preparation for carrying a fetus, there is little material to flush in preparation for a new cycle.

"There's really nothing magic about taking the placebo pills every fourth week," said Dr. Karen Freund, director of the Boston Medical Center for Excellence in Women's Health. "There's a lot of sense that (menstruation) cleanses the body. Some women are also assured that they're not pregnant if they in fact have bleeding every month."

And, contrary to popular belief, continuous use of the pill does not affect a woman's fertility. Bonnie had no trouble conceiving once she stopped taking the pill. She became pregnant within two months.

The major "new" argument that leaders of the anti-period movement are raising focuses on the reduced disease risk that is derived from birth-control pills. Women on the pill for five years cut in half their risk of ovarian cancer, which kills 14,000 US women annually, and they reduce the risk of endometrial cancer. Studies also show that benign cysts of the ovaries and breasts as well as pelvic inflammatory disease decrease with pill use.

In addition, Anderson said periods can intensify existing conditions, such as epilepsy, asthma, rheumatoid arthritis, and migraines. Anemia, an iron-deficiency disorder that afflicts millions of menstruating women worldwide, is linked to menstrual periods.

Some cancer risks, however, may be increased by the pill. There is still uncertainty as to whether continued use of estrogen causes an increased risk of breast cancer, the leading cause of cancer among women. A recent study by the World Health Organization found slightly higher breast-cancer risk among women on the pill, but another major study found no increase among women who had taken the pill for 10 years.

The anti-disease arguments don't persuade Dr. Susan Love, director of the Santa Barbara Breast Cancer Institute in California. She has argued that women can reduce their ovarian and endometrial cancer risks by taking conventional birth-control pills rather than the constant hormone variety.

"It's not whether you bleed or not that's the key thing" in reducing cancer risk, Love said on NBC's "Today" show recently. "It has to do with the levels of hormones."

Moreover, conventional birth-control pills have drawbacks, such as daily "breakthrough" bleeding in some women and the fact that it raises long-term estrogen levels by 25 percent.

"Some women who are very sensitive to the hormone effects of the pill will have more symptoms when they use the pill this way," said Dr. Robert Barbieri, chief of obstetrics-gynecology at Brigham and Women's Hospital in Boston.

Lark, the California physician who has specialized in women's health for 26 years, said that women would be better off managing premenstrual syndrome and other discomforts without taking hormones at all. Lark said that lifestyle modification, such as changes in diet, stress-reduction efforts, and regular exercise combined with over-the-counter drugs like Midol and Pamprin, "don't suppress a woman and promote better health."

Beyond the pros and cons of menstruation lies a difficult philosophical argument: Are women's periods a natural event to be celebrated or an unnatural problem to be eliminated?

In "Is Menstruation Obsolete?" Coutinho stated that women were never meant to have periods each month. In primitive societies, most women would get pregnant very early, have more children, and experience menopause at an early age. A woman in ancient Persia may have experienced 100 periods in her lifetime. Women today get their period earlier, have fewer children, experience menopause later, so that a childless woman might have 480 periods in her lifetime.

"I have never understood why women bleed when they don't have to," said Dr. Florence Haseltine, an obstetrician-gynecologist with the Society of Women's Health in Maryland. "If you're having regular ovulation, it is normal to have a period. If you're suppressing ovulation, using drugs, then there's no reason to have a withdrawal bleed," the term for having a period while on the pill.

The clinical studies of the new pill being carried out in Norfolk, Va., and 49 other US locations won't resolve the philosophical dispute. But they could present women everywhere with a chance to settle the question for themselves. The trial involves two forms of low-hormone birth-control pills that women would take for 84 consecutive days, before taking seven days off. Women taking Seasonale, as the new pill is called, would have just one period every three months.

If the trials are successful, Seasonale could be available by 2003.

And a survey by the International Health Foundation suggests many women are eager for the choice. The survey of 1,500 women who currently use oral contraceptives found that 62 percent were interested in having their period just four times a year. Almost half favored complete suppression of menstruation.

But Lark said women are the subjects of a giant experiment and should be well aware that the continuous use of the pill regimen might have some dangers attached.

"(A woman) has no way of knowing 20 years later what (continuous use of the pill) will do to her body," Lark said.

Finally, a top federal health official urges women to be cautious, even if a world with no PMS, no more pads, and no cramps sounds like heaven.

"My concern is giving women the idea that a period is wrong and unnatural," said Dr. Sara Mark, senior medical adviser with the Office on Women's Health at the US Department of Health and Human Services. "We start medicalizing our bodies, our natural systems. I think that is not a good thing because it causes fear and it causes unnecessary concern for women."

Copyright 2000 The Boston Globe. All rights reserved.